新内镜中心验收过程发现的问题及对策

目的 新内镜中心验收过程中模拟内镜清洗消毒流程，查找存在的问题并给予解决方案。方法 新内镜中心验收中采用人工和全自动机清洗方法模拟内镜清洗消毒流程，对终末漂洗用纯水及清洗消毒后内镜进行微生物学检测，根据检测结果分析不合格原因并针对性进行改进。结果 纯水供给管道消毒前后内镜终末漂洗用纯水检测合格率分别0、100%，染菌量中位数（四分位数）分别为200（186，213）、1.5（0，6）CFU/100 mL，差异有统计学意义（P<0.01）。酶液浓度调整前后人工清洗消毒内镜检测合格率分别为80.00%、91.67%。全自动内镜清洗消毒机（AER）自身消毒前后，自动清洗消毒机空载运行后水标本检测合格率分别为30%、100%，染菌量中位数（四分位数）分别为97.5（8，175）、4（1.75，6.00）CFU/100 mL，差异有统计学意义（P<0.01）。对管腔疑似有生物膜形成的内镜用2 000 mg/L过氧乙酸消毒后，合格率达100%。结论 新内镜中心纯水供给管道未消毒、内镜清洗环节中酶液浓度错误、AER未进行自身消毒、内镜管腔生物膜形成是此次新内镜中心验收过程中发现的问题，针对性改进后，问题得到解决。为保障医疗安全和医疗质量，医疗机构应积极重视新内镜中心启用前的验收工作，消除造成内镜消毒不合格的危险因素。

Problems and countermeasures in the acceptance process of new endoscopy center

Objective To simulate the cleaning and disinfection process of endoscopes during the acceptance of new endoscopy center, find out the existing problems and put forward solutions. Methods Manual and automatic endoscope reprocessor(AER)washing methods were used to simulate the cleaning and disinfection process of endoscope during the acceptance process of new endoscopy center. Pure water used for end-rinse and endoscopes after cleaning and disinfection were performed microbial detection, according to detected results, causes for the unqualification were analyzed, the corresponding improvement was made. Results The qualified rates of pure water used for end-rinse of endoscopes before and after disinfection of pure water supply pipeline were 0% and 100% respectively, the median (quartile) of bacterial contamination were 200 (186, 213) and 1.5 (0, 6) CFU/100 mL respectively, with significant difference (P<0.01). The qualified rates of manual cleaned and disinfected endoscopes before and after adjusting enzyme concentration were 80.00% and 91.67% respectively. Before and after AER were disinfected, the qualified rates of water specimens from AER at on-load condition were 30% and 100% respectively, the median (quartile) of bacterial contamination were 97.5(8,175) and 4(1.75,6.00)CFU/100 mL respectively,with significant difference (P<0.01). After endoscope lumen with suspected biofilm formation was disinfected with 2 000 mg/L peracetic acid, the qualified rate was 100%. Conclusion Problems existed during the acceptance of new endoscopy center are non-disinfection of pure water supply pipeline, incorrect enzyme concentration for endoscopic cleaning, non-disinfection of AER, and formation of biofilm of endoscope lumen, after targeted improvement, these problems are solved. In order to ensure medical safety and quality, medical institutions should attach great importance to the acceptance before operation of new endoscopy center, and eliminate risk factors for unqualified endoscopy disinfection.