2016年－2020年天津市胃肠道内镜再处理评估效果的多因素分析

Multivariate analysis of the evaluation on gastrointestinal endoscopic reprocessing in Tianjin, China, 2016－2020

摘要:

目的 对2016年－2020年天津市胃肠道内镜再处理评估效果进行并多因素分析。方法 2016年采用泵辅助法与普通冲洗采样法、2017年采用普通冲洗采样法、2018年－2020年采用刷辅助采样法和普通冲洗采样法采集内镜管腔冲洗水。2017年与2020年采样覆盖全市所有内镜中心并做信息调查。结果 2020年全市16个区有57家内镜诊疗中心，共有胃镜297条、肠镜214条、170名洗消人员，33家（57.9%）医疗机构有 ≤ 2名洗消人员；5年共采集内镜再处理后管腔冲洗水349份，总体合格率为86.2%，最高细菌菌落总数为7.00×10⁵ CFU/件；除2017年，其余4年共采集终末漂洗水292份，总体合格率为72.9%，最高细菌菌落总数为9.1×10⁴ CFU/100 mL。多因素分析显示，开展ERCP、人工清洗和使用合格的终末漂洗水是保护性因素（O = 33.365，95%CI：3.255～342.010；O = 19.111，95%CI：1.904～191.779；O = 4.078，95%CI：1.750～9.501）；采用泵辅助采样和刷辅助采样法可使检测到再处理合格的概率下降26.704倍（2.555～279.102）和2.710倍（1.088～6.757）。结论 内镜再处理及终末漂洗水合格率较低，需增加清洗消毒人员数量、加强自动清洗消毒机维护保养，泵辅助法或刷辅助法灵敏度高，推荐使用泵辅助法或刷辅助法开展采样监测。

Abstract:

Objective To evaluate the reprocessing of gastrointestinal endoscopy in Tianjin from 2016 to 2020 and analyze multiple factors.Methods In 2016, the pump-assisted method and the common flushing sampling method were used, the common flushing sampling method was used in 2017, and the brush-flush-brush sampling method and the common flushing sampling method were used to collect the endoscope flushing water in 2018－2020. In 2017 and 2020, sampling were covered all endoscopy centers in Tianjin and conducted information surveys.Results In 2020, there were 57 endoscope centers in 16 districts of the city, with 297 gastroscopes, among them, 214 colonoscopies, and 170 decontamination personnel. There were 33 (57.9%) endoscope centers with ≤ 2 decontamination personnel; A total of 349 flushing water after endoscope reprocessing were collected in 5 years, the overall pass rate was 86.2%, and the highest total bacterial colony was 7.00×10⁵ CFU/Piece, a total of 292 pieces of final rinse water were collected except 2017, the overall pass rate was 72.9%, and the highest total bacterial colony was 9.1×10⁴ CFU/100 mL. The results of multi-factor analysis showed that carrying out ERCP, manual cleaning, and using qualified final rinse water were protective factors. The O values (95%CI) were 33.365 (3.255 ~ 342.010), 19.111 (1.904 ~ 191.779) and 4.078 (1.750 ~ 9.501); The use of pump-assisted sampling and brush-flush-brush sampling methods can reduce the probability of detecting qualified reprocessing by 26.704 (2.555 ~ 279.102) and 2.710 (1.088 ~ 6.757).Conclusion The pass rate of endoscope reprocessing and the quality of the final rinse water were low. It is necessary to increase the number of cleaning and disinfection personnel, strengthen the maintenance of the automatic cleaning and disinfection machine, and pump assisted method or brush assisted method has high sensitivity, it is recommended to use the pump assist method or the brush-flush-brush method for sampling monitoring.