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不同清洗与消毒灭菌方法应用于内镜器械处理的效果比较

发布时间:2022-03-30 08:22:17 | 浏览次数:

[摘要]目的 分析不同清洗與消毒灭菌方法用于内镜器械处理的效果。方法 选择2016年1~12月需清洗消毒的胃镜作为研究对象,按照内镜器械清洗消毒方式分为手工组和清洗工作站组,分别通过手工清洗和一体化清洗工作站清洗。清洗结束后,从手工组和清洗工作站组分别随机抽取80条内镜,比较两组内镜细菌培养结果合格率以及洗消规范性,同时统计两组的人工耗时、总耗时和消毒时间,比较组间差异。结果 ①清洗工作站组79条合格,1条不合格,合格率为98.8%;手工清洗组58条合格,22条不合格,合格率为72.5%。清洗工作站组的合格率高于手工清洗组,差异有统计学意义(P<0.05)。比较洗消规范性,清洗工作站组75条规范,5条不规范,规范率为93.8%;手工组70条规范,10条不规范,规范率为87.5%,清洗工作站组规范率高于手工组,差异有统计学意义(P<0.05)。②清洗工作站组内镜平均手工耗时为(3.9±0.5)h,显著短于手工组的(6.8±0.6)h,消毒时间为(24.5±2.5)min,明显短于手工组的(30.2±2.3)min,差异均有统计学意义(P<0.05);总耗时分别为(12.7±1.1)h和(12.4±1.4)h,差异无统计学意义P>0.05)。结论 一体化清洗工作站可显著提高胃镜的清洗效果和效率,值得临床推广应用。

[关键词]消毒;清洗效果;清洗效率

[中图分类号] R472 [文献标识码] A [文章编号] 1674-4721(2018)9(c)-0183-03

Comparison of different cleaning and disinfection methods applied to endoscopic instruments

SHU Yu-lan

Gastroscope Room, People′s Hospital of Wan′an County, Jiangxi Province, Wan′an 343800, China

[Abstract] Objective To analyze the effect of different cleaning and disinfection methods applied to endoscopic instruments. Methods The gastric endoscopy which should be cleaned and sanitizing from January to December 2016, was selected as the research object. According to the cleaning and disinfection methods of endoscopic instruments, the endoscopy was divided into two groups, which were cleaned by manual cleaning and integrated cleaning workstation respectively. The former was used as a manual group, and the latter was used as a cleaning workstation group. After the cleaning, 80 endoscopes were randomly selected from the manual group and cleaning workstations group. The results were compared between the two groups of endoscopy bacteria culture results and the normalization, and the manual cleaning group and the cleaning workstation group were compared with the manual time, the total time and the time of disinfection. Results ①The workstation group, 79 were qualified, 1 were unqualified and the qualified rate was 98.8%; the manual cleaning group, 58 were qualified, 22 unqualified, and the qualified rate was 72.5%. The qualified rate of cleaning workstation group was higher than that of manual cleaning group, and the difference was statistically significant (P<0.05). The results showed that the cleaning workstation group was standardized, the results showed that the cleaning workstation group was 75 were standard, 5 were non standard, and the standard rate was 93.8%; the manual group, 70 were standard, 10 were non standard, and the standard rate was 87.5%. The standard rate of the cleaning workstation group was significantly higher than that of the manual group, the difference was statistically significant (P<0.05). ②the average time of endoscopy in the cleaning workstation group of (3.9±0.5) h was shorter than that of the manual group (6.8±0.6) h, and the disinfection time of (24.5±2.5) min in the cleaning workstation group was significantly shorter than that of the manual group (30.2±2.3) min, and there were significant difference in groups (P<0.05), and the difference between the two groups of total time consuming was not statistically significant (P>0.05). Conclusion The integrated cleaning workstation can significantly improve the cleaning effect and efficiency of gastric endoscopy, and is worthy of clinical application.

[Key words] Disinfection; Cleaning effect; Cleaning efficiency

胃镜是广泛用于胃部检查或手术的消化内镜,在临床诊疗中扮演着重要角色。胃镜在使用中可能受到多种微生物感染,彻底、有效的清洗消毒是保障其安全性的关键[1-2]。清洗是消毒和灭菌中的一个重要环节,通过清洗能去除器械90%以上的病原体。一体化清洗工作站是医院引入的用于提高清洗效果和效率的清洗系统,本研究比较了手工清洗和一体化清洗工作站用于胃镜清洗消毒的效果,现报道如下。

1资料与方法

1.1一般资料

选取我院2016年1~12月需清洗消毒的胃镜作为研究对象,按照胃镜器械清洗消毒方式分为手工组和一体化清洗工作站组,分别通过手工清洗和一体化清洗工作站清洗。采用两种方式清洗后,各随机选取80条内镜,手工组中有胃镜45条,肠镜35条,清洗工作站组中胃镜43条,肠镜37条,,胃镜数量和肠镜比较,差异无统计学意义(P>0.05),具有可比性。本研究经医院医学伦理委员会审核批准。

1.2方法

手工组内镜由专员按照操作要求清洗、消毒[3-4]。清洗工作站组采用一体化内镜清洗工作站按照自动化、规范化流程进行消毒[5-8]。清洗结束后,从两组分别随机抽取80条内镜,进行清洗效果比较,采用细菌培养法对内镜活检孔样本进行菌落培养48 h,细菌菌落数≤20 cfu/件,表明监测结果为阴性,未检出致病菌,结果合格。

1.3观察指标

比较两组的细菌培养结果合格率以及洗消规范性,同时统计两组清洗内镜的人工耗时、总耗时和消毒时间,比较组间差异。

1.4统计学方法

采用SPSS 19.0统计软件进行统计学分析,技术资料用百分率(%)表示,采用χ2检验,以P<0.05为差异有统计学意义。

2结果

2.1两组合格率和洗消规范性的比较

一体化清洗工作站组79条合格,1条不合格,合格率为98.8%,手工组58条合格,22条不合格,合格率为72.5%,差异有统计学意义(P<0.05)。洗消规范性的比较,清洗工作站组75条规范,5条不规范,规范率为93.8%,手工组70条规范,10条不规范,规范率为87.5%,差异有统计学意义(表1)。

2.2两组清洗消毒时间的比较

清洗工作站组内镜平均手工耗时显著短于手工组,消毒时间明显短于手工组,差异均有统计学意义(P<0.05);两组的总耗时比较,差异无统计学意义(P>0.05)(表2)。

3讨论

胃镜在使用过程可与患者胃液、组织内壁等部分直接接触,其清洗消毒工作也越来越得到重视[9-12]。清洗工作是内镜消毒的第一步,也是最重要的部分,清洗效果不佳可导致内镜表面或管腔内开始滋生细菌,因此要想高效完成内镜清洗消毒工作,需高度重视清洗工作。随着内镜的使用量与日俱增,加之医院内部高负荷的工作,使内镜清洗消毒时间相对不足;且胃镜结构精细,若完全手工清洗并满足临床使用标准,则需耗费较多的时间[13-14]。一体化内镜清洗消毒工作站采用全自动电脑控制,清洗和消毒过程均为仪器自动进行,无需人工介入,因此手工耗时大大减少;且清洗过程采用仪器自动净化的纯化水,过滤掉部分微粒和细菌,减少了污染物残留[15],较手工清洗消毒效果更佳,另外也避免了手工清洗过程中因员工业务技术不佳或责任心不强引起的清洗消毒效果不合格现象的发生。

一体化清洗工作站的优势在于电脑自动化运行,减少了人力消耗,缩减了操作流程,降低了成本。本研究结果显示,采用一体化的清洗工作站进行清洗消毒,合格率为98.8%,明显高于手工组(P<0.05)。比较洗消规范性,清洗工作站组规范率为93.8%,高于手工组的87.5%,差异有统计学意义。提示一体化清洗工作站清洗消毒效果更好,操作更规范,手工组合格率低可能是因为员工责任心不足,且清洗工作量大引起清洗效果的降低。另外清洗工作站组内镜平均手工耗时(3.9±0.5)h,显著短于手工组(6.8±0.6)h,差异有统计学意义;但两组总耗时分别为(12.7±1.1)h和(12.4±1.4)h,差异无统计学意义(P>0.05),提示两种清洗方法手工耗时相近,但清洗工作站清洗内镜的总耗时明显更短,大大提高了清洗效率,减少内镜资源浪费。张艳等[16]研究了一体化内镜清洗中心与全自动洗消机对内镜清洗消毒效果的影响,结果显示一体化内镜清洗中心组在内镜周转、干燥合格、洗消规范性及消毒监测等方面,明显优于全自动洗消机组,一体化内镜清洗中心消毒时间短于全自动洗消机,内镜周转率(96.15%)和干燥合格率(100.0%)显著高于全自動洗消机组的41.67%和91.03%,这与本研究结果一致。采用一体化清洗工作站,简化了操作,优化了流程,解放了劳动力,提高了清洗质量,值得推广和借鉴。

综上所述,一体化清洗工作站用于医院胃镜清洗消毒较传统的手工清洗法可显著提高胃镜的清洗效果和效率,值得临床推广应用。

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(收稿日期:2018-04-28 本文编辑:崔建中)

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