两种监测方法对软式内镜清洗消毒效果的评价

Comparison of two methods for monitoring the cleaning and disinfection effects of soft endoscopes

摘要:

目的 初步探讨两种监测方法对于软式内镜清洗消毒结果的影响，并鉴定内镜消毒不彻底时，残留微生物的种类。方法 选取2019年1月－2022年1月该院的345条内镜。其中，132条内镜依据《内镜清洗消毒技术操作规范（2004年版）》进行检测，并设为对照组，剩余的213条内镜按照《软式内镜清洗消毒技术规范WS507-2016》中的监测方法进行检测，并设为实验组。比较两组的清洗消毒达标率和微生物检出率，同时用质谱分析未消毒彻底时，内镜上残留微生物的种类。结果 实验组清洗消毒达标率为88.3%，对照组清洗消毒达标率为93.2%，差异无统计学意义（P > 0.05）；对照组检出的细菌菌落数明显少于实验组，差异有统计学意义（P < 0.05）。未消毒彻底的内镜上共检出34种微生物，革兰氏阴性菌占76.5%。其中，嗜麦芽窄食单胞菌和铜绿假单胞菌检出频次最高。结论 《软式内镜清洗消毒技术规范WS507-2016》中的内镜监测方法敏感性明显高于《内镜清洗消毒技术操作规范（2004年版）》中的相应方法，软式内镜清洗消毒不彻底时，残留微生物以革兰氏阴性菌为主。

Abstract:

Objective To compare two methods for monitoring the cleaning and disinfection effects of soft endoscopes, and identify the types of microorganisms on unqualified endoscopes.Methods A retrospective analysis was conducted on the results of cleaning and disinfection of 345 endoscopes from January 2019 to January 2022. Among them, 132 endoscopes which evaluated the disinfection effect according to the “Regulation for cleaning and disinfection technique of endoscope (2004 Edition)” were the control group, and the remaining 213 endoscopes monitored by the standard of WS507-2016 “Regulation for cleaning and disinfection technique of flexible endoscope” were the experimental group. The qualified rate of endoscopes and microbial detection rate were analyzed, and the types of microorganisms were identified by mass spectrometry on unqualified endoscopes.Results The qualified rate was 88.3% in the experimental group and 93.2% in the control group (P > 0.05). The number of bacteria detected in the control group was less than that in the experimental group significantly (P < 0.05). Mass spectrometric analysis of the microorganisms on the unqualified endoscopes revealed a total of 34 species, with 76.5% gram negative bacterium. Among them, Stenotrophomonas maltophilia and Pseudomonas aeruginosa were most frequently detected.Conclusion The sensitivity and accuracy of the endoscopic monitoring method specified in the WS507-2016 “Regulation for cleaning and disinfection technique of flexible endoscope” were significantly higher than the related methods in the “Regulation for cleaning and disinfection technique of endoscope (2004 Edition)”, and the microorganisms were mainly gram negative bacterium on qualified endoscopes.