全自动内镜清洗消毒机消毒肠镜效果监测及风险因素分析

Effect monitoring and risk factors analysis of automated endoscope reprocessor to disinfect enteroscope

摘要:

目的 对全自动内镜清洗消毒机（AER）消毒肠镜效果进行生物学监测，同时综合分析导致消毒失败的风险因素。方法 收集2013年1月－2022年7月该院AER清洗消毒肠镜内腔面及终末漂洗用水常规采样生物学监测数据。检测结果若超标，从内镜设备维护管理、终末漂洗用水管理、人员管理和消毒剂使用等方面查找消毒失败原因，并提出有针对性的改进措施。结果 AER清洗消毒肠镜生物学监测分别在2018年8月和2022年3月出现结果异常，前者经过5轮、后者经过1轮措施改进和复查之后监测达标；AER终末漂洗用水生物学监测分别在2019年12月和2022年3月出现结果异常，前者经过1轮、后者经过2轮措施改进和复查之后监测达标。内镜和终末漂洗用水生物学监测在2022年3月出现异常，经分析，内镜污染是由终末漂洗用水超标引起的。结论 通过根因分析，发现AER清洗消毒肠镜失败的主要风险因素为仪器老化和人员操作不规范等。通过建立设备检修保养制度和标准化操作程序等进行针对性管理，同时定期对内镜内腔面和终末漂洗用水进行生物学监测，能及时发现问题，避免了因内镜污染导致的相关感染，从而保障医疗质量与患者安全。

Abstract:

Objective Biological monitoring was carried out on the disinfection effect of automated endoscope reprocessor (AER) , and the risk factors leading to disinfection failure were comprehensively analyzed.Methods From January 2013 to July 2022, routine samples of the water for cleaning and disinfecting the endoscopic inner cavity surface and terminal rinsing by the AER in a hospital were collected. Then find the reasons for excessive endoscopy and excessive end rinse water, and the causes of failure were found from the aspects of endoscopic equipment maintenance and management, terminal rinsing water management, personnel management and disinfectant use, and propose targeted improvement measures from equipment, person and management.Results AER cleaning-disinfection colonoscopy biological monitoring was abnormal in August 2018 and March 2022 respectively, the former after five rounds, the latter after one round of improvement measures and review, the test results reaches the standard; AER final rinsing water biological monitoring was abnormal in December 2019 and March 2022 respectively, the former after one round and the latter after two rounds of improvement measures and review, the test results reaches the standard. The abnormal biological monitoring of endoscopic and terminal rinsing water was crosslinked in March 2022, and the analysis showed that the endoscopic contamination was caused by the excessive terminal rinsing water.Conclusion Through the root cause analysis, the main risk factors for the failure of machine washing enteroscope were the aging of instruments and the nonstandard operation of personnel. Through the establishment of endoscopic cleaning and disinfection machine equipment maintenance system, standardized operation procedures, and regular biological monitoring of endoscopic cavity surface and terminal rinsing water, problems can be found in time to avoid related infections caused by endoscopic contamination, thus ensuring the medical quality and patients’ safety.