【摘要】 目的 了解消化内镜清洗消毒现状,选择实用可靠的内镜清洗消毒方法。方法 在北京部分三级甲等医院进行内镜清洗时加或不加酶洁液、2％戊二醛7min消毒效果的测试;并抽查国产自动清洗消毒机的消毒效果。结果 测试部分:使用酶洁液清洗组301例,2％戊二醛浸泡消毒7min,不长菌例数为283例（94、02％）;不使用酶洁液组155例,2％戊二醛浸泡消毒7min,不长菌例数为137例（88.39％）。以清洗消毒后每条胃镜≤20个非致病细菌数为合格标准,使用酶洁液组合格为298例（99.00％）,不使用酶洁液组147例（94.84％）,两组清洗消毒效果差异有统计学意义（P<0.01）。抽查部分:清洗消毒机135例,清洗消毒3 min后不长菌为4例（11.43％）,以清洗消毒后每条胃镜≤20个非致病细菌数作为合格标准,合格为5例（14.29％）;清洗消毒机 Ⅱ29例,清洗消毒 3min,不长菌为2例（6.90％）,合格例数为6例（20.69％）;清洗消毒机Ⅱ20例,更换消毒液,清洗消毒3 min 2次,不长菌为17例（85.00％）,合格例数为18例（90.00％）。结论 内镜使用后各个部分的彻底清洗是保证消毒质量的重要环节,清洗过程中使用酶洁液明显增加了清洁度,在此基础上2％戊二醛浸泡消毒7min可达到内镜消毒标准。目前使用的国产内镜清洗消毒机常规单一的3min和6min的消毒程序达不到更多还原

【Abstract】 Objective To select a practical and reliable method in cleaning and disinfecting endo-scope, and to investigate the efficacy of endoscope disinfection. Methods A study was done on the disinfection efficacy using or not using enzyme cleaning plus 2% glutaraldehyde immersion, and disinfection efficacy of automated washer/disinfectors for endoscopes at tertiary hospitals in Beijing. Results In 301 cases of en-doscopes cleaned with enzyme ( Epizyme rapid multi enzyme cleanse) and immersed in 2% glutaraldehyde for 7 minutes, culture was negative in 283 cases (94. 02% ) ; in 155 cases without enzyme cleaning but with immersion for 7 minutes in 2% glutaraldehyde, culture was negative in 137 cases (88. 39 % ). Taking 20 or less bacteria per endoscope as the eligibility criterion, there were 298(99.00% ) and 147(94. 84% ) cases eligible in enzyme treated and enzyme untreated group respectively , P < 0.01. Sample survey of cleaning and disinfection efficacy of automated washer/disinfector : (1) Machine I in 35 cases, after cleaning and disinfection for 3 minutes, culture was negative in 4 cases ( 11. 43 % ) , taking 20 or less bacteria per endoscope as the eligibility criterion, 5 cases were eligible (14. 29%). (2) Machine II in 29 cases, after cleaning and disinfection for 3 minutes,culture was negative in 2 cases ( 6. 90% ) , taking 20 or less bacteria per endoscope as the eligibility criterion, 6 cases were eligible ( 20.69% ). (3) Machine II in 20 cases, after cleaning and disinfection for 6 minutes, culture was negative in 17 cases ( 85. 00% ) , taking 20 or less bacteria per endoscope as the eligibility criterion, 18 cases were eligible ( 90. 00% ) . All results of the auto-mated washer/disinfectors fell short of the sterilization standard. Conclusions Thorough cleaning of every part of the endoscope is necessary to ensure disinfection efficacy. The use of enzymes in the cleaning process enhances the cleanness; on that basis, immersion in 2% glutaraldehyde for 7 minutes achieves adequate sterilization. The currently employed home made automated washer/disinfector routine method, cleaning and disinfection for 3 or 6 minutes, is insufficient to attain the standard of safe disinfection of endoscope.更多还原