67所医疗机构内镜终末漂洗水使用调查及相关因素分析
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摘要
目的通过调查全国67家医疗机构消化内镜终末漂洗水的使用情况,了解内镜终末漂洗的使用现状,分析终末漂洗水在内镜处理中的问题,提出解决方法。方法分析2017年6月-2017年11月全国67家医疗机构消化内镜终末漂洗水使用的基本请况,应用VITEK-2全自动微生物分析系统对67家医疗机构内镜终末漂洗水进行病原菌鉴定。结果 67家医疗机构消化内镜终末漂洗水主要为纯化水、非纯化水和无菌水,其中56家医疗机构使用纯化水,占83.58%;67家医疗机构中24家终末漂洗水水样合格,合格率为35.8%,不合格样本中检测出少动鞘氨醇单胞菌、缺陷短波单胞菌及铜绿假单胞菌等条件致病菌。结论 67家医疗机构内镜终末漂洗水合格率低,医疗机构应严格遵守规范,落实终末漂洗水使用要求,需进一步加强管理与监测。
OBJECTIVE To understand the current status of use of final rinse water in endoscopes by investigating the status of use of the final rinse water in 67 medical institutions in China so as to analyze the problems in the endoscopic treatment and put forward solutions.METHODS From Jun 2017 to Nov 2017,the basic status of use of endoscopic final rinse water in 67 medical institutions was observed,and the pathogens that were isolated from the final rinse water of the 67 medical institutions were identified.RESULTS Purified water,non-purified water and sterile water were the major final rinse water in the 67 medical institutions,the purified water was used in 56(83.58%)medical institutions.The final rinse water samples were qualified in 24 of 67 medical institutions,with the qualified rate 35.8%.The opportunistic pathogens such as Sphingomonas paucimobilis,Pseudomonas syringae and Pseudomonas aeruginosa were isolated from the unqualified samples.CONCLUSIONThe qualified rate of the final rinse water is low in the 67 medical institutions,and it is necessary for the medical institutions to follow the rules,implement the requirements of use of final rinse water and further intensify the management and surveillance.
OBJECTIVE To understand the current status of use of final rinse water in endoscopes by investigating the status of use of the final rinse water in 67 medical institutions in China so as to analyze the problems in the endoscopic treatment and put forward solutions.METHODS From Jun 2017 to Nov 2017,the basic status of use of endoscopic final rinse water in 67 medical institutions was observed,and the pathogens that were isolated from the final rinse water of the 67 medical institutions were identified.RESULTS Purified water,non-purified water and sterile water were the major final rinse water in the 67 medical institutions,the purified water was used in 56(83.58%)medical institutions.The final rinse water samples were qualified in 24 of 67 medical institutions,with the qualified rate 35.8%.The opportunistic pathogens such as Sphingomonas paucimobilis,Pseudomonas syringae and Pseudomonas aeruginosa were isolated from the unqualified samples.CONCLUSIONThe qualified rate of the final rinse water is low in the 67 medical institutions,and it is necessary for the medical institutions to follow the rules,implement the requirements of use of final rinse water and further intensify the management and surveillance.
引文
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[16]陈黎霞,王恒辉,何培彦,等.医疗机构口腔科治疗用水污染现状调查[J].中国消毒学杂志,2014,31(6):601-603.
[17]Richards J,Spencer R,Fraise A,et al.Rinse water for heat labile endoscopy equipment[J].J Hosp Infect,2002,51(1):7-16.
[18]周慧芬,吴小琴,黄玉莲,等.消毒供应中心水处理系统的质量控制[J].中国消毒学杂志,2014,31(12):1374-1375.
[19]Khalsa K,Smith A,Morrison P,et al.Contamination of a purified water system by Aspergillus fumigatus in a new endoscopy reprocessing unit[J].Am J Infect Control,2014,42(12):1337-1339.
[20]Schelenz S,French G.An outbreak of multidrug-resistant Pseudomonas aeruginosainfection associated with contamination of bronchoscopes and an endoscope washer-disinfector[J].JHosp Infect,2000,46(1):23-30.
[21]Gillespie TG,Hogg L,Budge E,et al.Mycobacterium chelonae isolated from rinse water within an endoscope washer-disinfector[J].J Hosp Infect,2000,45(4):332-334.
[22]付桂枝,张晓秀.消毒供应中心纯化水管路的消毒管理与监测[J].中国消毒学杂志,2015,32(10):1036-1037.
[23]Alfa MJ,Sepehri S,Olson N,et al.Establishing a clinically relevant bioburden benchmark:aquality indicator for adequate reprocessing and storage of flexible gastrointestinal endoscopes[J].Am J Infect Control,2012,40(3):233-236.
[24]Gillespie TG,Hogg L,Budge E,et al.Mycobacterium chelonae isolated from rinse water within an endoscope washer-disinfector[J].J Hosp Infect,2000,45(4):332-334.
[2]李阳,姜亦虹.医疗机构消化内镜清洗消毒历史和现状调查[J].中国感染控制杂志,2017,16(10):960-962,965.
[3]田春梅,董青,赵奇,等.医疗用水消毒质量调查分析[J].中华医院感染学杂志,2015,25(11):2632-2634.
[4]Pearson S.A practical approach to ensuring safe water[J].Health Estate,2012,66(7):41-47.
[5]Pang J,Perry P,Ross A,et al.Bacteria-free rinse water for endoscope disinfection[J].Gastrointest Endosc,2002,56(3):402-406.
[6]刘运喜,邢玉斌,巩玉秀.软式内镜清洗消毒技术规范,WS507-2016[J].中国感染控制杂志,2017,16(6):587-592.
[7]Simmons BP.CDC guideline for prevention of surgical wound infections[J].Am J Infect Control,1983,11(4):133-143.
[8]Willis C.Bacteria-free endoscopy rinse water-a realistic aim[J].Epidemiol Infect,2006,134(2):279-284.
[9]Marek A,Smith A,Peat M,et al.Endoscopy supply water and final rinse testing:five years of experience[J].J Hosp Infect,2014,88(4):207-212.
[10]Cooke RP,Whymant-Morris A,Umasankar RS,et al.Bacteria-free water for automatic washer-disinfectors:an impossible dream[J].J Hosp Infect,1998,39(1):63-65.
[11]杨彬.2013-2015年山东省医疗机构感染控制现状及其相关危险因素研究[D].山东大学,2016.
[12]纪学悦,费春楠,刘军,等.天津市消化内镜使用情况调查及消毒灭菌的影响因素分析[J].中华医院感染学杂志,2017,27(14):3354-3357.
[13]中华人民共和国卫生部.生活饮用水标准检验方法微生物指南(GB/T5750.12-2016)[OL].[2019-01-01].http://down.GB-T 5750.12-2006.
[14]Muscarella LF.Application of environmental sampling to flexible endoscope reprocessing:the importance of monitoring the rinse water[J].Infect Control Hosp Epidemiol,2002,23(5):285-289.
[15]Nelson DB,Jarvis WR,Rutala WA,et al.Multi-society guideline for reprocessing flexible gastrointestinal endoscopes[J].Dis Colon Rectum,2004,47(4):413-420.
[16]陈黎霞,王恒辉,何培彦,等.医疗机构口腔科治疗用水污染现状调查[J].中国消毒学杂志,2014,31(6):601-603.
[17]Richards J,Spencer R,Fraise A,et al.Rinse water for heat labile endoscopy equipment[J].J Hosp Infect,2002,51(1):7-16.
[18]周慧芬,吴小琴,黄玉莲,等.消毒供应中心水处理系统的质量控制[J].中国消毒学杂志,2014,31(12):1374-1375.
[19]Khalsa K,Smith A,Morrison P,et al.Contamination of a purified water system by Aspergillus fumigatus in a new endoscopy reprocessing unit[J].Am J Infect Control,2014,42(12):1337-1339.
[20]Schelenz S,French G.An outbreak of multidrug-resistant Pseudomonas aeruginosainfection associated with contamination of bronchoscopes and an endoscope washer-disinfector[J].JHosp Infect,2000,46(1):23-30.
[21]Gillespie TG,Hogg L,Budge E,et al.Mycobacterium chelonae isolated from rinse water within an endoscope washer-disinfector[J].J Hosp Infect,2000,45(4):332-334.
[22]付桂枝,张晓秀.消毒供应中心纯化水管路的消毒管理与监测[J].中国消毒学杂志,2015,32(10):1036-1037.
[23]Alfa MJ,Sepehri S,Olson N,et al.Establishing a clinically relevant bioburden benchmark:aquality indicator for adequate reprocessing and storage of flexible gastrointestinal endoscopes[J].Am J Infect Control,2012,40(3):233-236.
[24]Gillespie TG,Hogg L,Budge E,et al.Mycobacterium chelonae isolated from rinse water within an endoscope washer-disinfector[J].J Hosp Infect,2000,45(4):332-334.