根據(jù)在感染控制和流行病學(xué)專業(yè)協(xié)會(huì)(APIC)官方雜志《美國感染控制雜志》（American Journal of Infection Control）二月版上發(fā)表的一項(xiàng)研究發(fā)現(xiàn)，目前用于清潔內(nèi)窺鏡以重復(fù)使用的技術(shù)并不總是有效。 本研究結(jié)果證實(shí)需要仔細(xì)地目視檢查和清潔驗(yàn)證測試，以確保所有電子內(nèi)窺鏡在高水平消毒或滅菌和用于另一個(gè)患者之前都沒有損傷和碎片。

2017年在任感染控制和流行病學(xué)專業(yè)協(xié)會(huì)主席 Linda Greene說：“感染控制和流行病學(xué)專業(yè)協(xié)會(huì)(APIC) 關(guān)注內(nèi)窺鏡感染的風(fēng)險(xiǎn)，本研究強(qiáng)調(diào)了在所有機(jī)構(gòu)中由受過專業(yè)化培訓(xùn)的感染預(yù)防專家領(lǐng)導(dǎo)下建立強(qiáng)有力的內(nèi)窺鏡感染預(yù)防控制方案的重要性，以確保所有機(jī)構(gòu)遵循最新的基于循證的指引?！?/span>

目前，軟式內(nèi)窺鏡，包括胃腸鏡、泌尿系內(nèi)鏡和呼吸道內(nèi)鏡，在清潔和高水平消毒后重復(fù)使用。然而，由Ofstead ＆ Associates有限公司進(jìn)行的近期研究的結(jié)果表明，即使是最嚴(yán)格的內(nèi)窺鏡再處理技術(shù)也不是始終有效的，并且常常殘留著有機(jī)殘余物。

這一研究的主要作者Ofstead ＆ Associates有限公司的公共衛(wèi)生學(xué)碩士Cori L. Ofstead說：“因?yàn)獒t(yī)療機(jī)構(gòu)需要尋找方法來提高內(nèi)窺鏡清潔消毒的質(zhì)量，所以了解內(nèi)窺鏡再處理技術(shù)的有效性問題是至關(guān)重要的。即使使用了一流的方法，研究中的內(nèi)窺鏡還是有明顯的損壞和碎片跡象，并且試驗(yàn)結(jié)果表明，大部分內(nèi)鏡仍然受到污染”。

Ofstead ＆ Associates有限公司在本研究中使用了縱向設(shè)計(jì)，在七個(gè)月內(nèi)對20條內(nèi)窺鏡進(jìn)行了三次評估。評估內(nèi)容包括使用微型相機(jī)進(jìn)行檢查、微生物培養(yǎng)和蛋白質(zhì)與三磷酸腺苷（ATP）生化檢測，后者由于鑒定有機(jī)物的標(biāo)記物。這些評估用于識別需要進(jìn)一步清潔和維護(hù)的內(nèi)窺鏡。這些評估可用于識別需要進(jìn)一步清潔和維護(hù)的內(nèi)窺鏡。

在最后評估期間，研究人員發(fā)現(xiàn)，所有的20條受檢內(nèi)窺鏡都存在影像不規(guī)則的問題，例如通道中有流體、變色和碎片。此外，來自20條再處理內(nèi)窺鏡中的12條樣品具有微生物生長，表明消毒過程失敗。值得注意的是，內(nèi)窺鏡的再處理是按照現(xiàn)行推薦指南進(jìn)行的，在高水平消毒前至少清洗過兩遍，但最終還是表現(xiàn)出相似的培養(yǎng)結(jié)果。

進(jìn)一步研究結(jié)果表明，每組中約20％的內(nèi)窺鏡超過了ATP和蛋白質(zhì)殘留的清洗后基準(zhǔn)。此外，用于胃腸道手術(shù)的胃鏡的ATP水平高于用于結(jié)腸檢查的內(nèi)窺鏡。Ofstead ＆ Associates有限公司稱：“因?yàn)橄嗤募夹g(shù)人員使用相同的技術(shù)來清潔和消毒這些內(nèi)窺鏡，所以這些發(fā)現(xiàn)和觀察表明，在處理過程中發(fā)生了某些事情使胃鏡表面發(fā)生改變因而導(dǎo)致再處理的失敗?！?/span>

所測試的內(nèi)窺鏡中95％存在殘余液體的發(fā)現(xiàn)具有重大意義，因?yàn)樗帜艽龠M(jìn)微生物生長和生物膜的發(fā)展，這可能是內(nèi)鏡再處理的難題。換句話說，這證實(shí)了為確?；颊叩陌踩?，內(nèi)窺鏡清潔、消毒和干燥的重要性。

來源：感染控制和流行病學(xué)專業(yè)協(xié)會(huì)(APIC)

Existing Reprocessing Techniques Prove to be Insufficient for Flexible Endoscopes

Current techniques used to clean endoscopes for reuse are not consistently effective, according to a study published in the February issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC). The findings of this study support the need for careful visual inspection and cleaning verification tests to ensure that all endoscopes are free of damage and debris before they are high-level disinfected or sterilized and used on another patient.

“APIC is concerned about the risk of infections related to endoscopic procedures, said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. “This study reinforces the importance of having strong infection prevention and control programs at all types of facilities, led by highly trained infection preventionists, to ensure that facilities are following the latest evidenced-based guidance.”

Currently, flexible endoscopes, including gastrointestinal, urological, and respiratory endoscopes, are reused following cleaning and high-level disinfection. However, results from the new study conducted by Ofstead & Associates, Inc., suggest that even more rigorous reprocessing techniques of endoscopes are not consistently effective, and organic residues often remain.

“Understanding issues with the effectiveness of reprocessing techniques is critically important as institutions seek to improve the quality of endoscope cleaning and disinfection,” said lead study author Cori L. Ofstead, MSPH, of Ofstead & Associates, Inc. “Even though top-notch methods were used, the endoscopes in this study had visible signs of damage and debris, and tests showed a high proportion were still contaminated.”

Using a longitudinal study design, Ofstead, et al. performed three assessments of 20 endoscopes over a seven-month period. The assessments involved visual inspections with a tiny camera, microbial cultures, and biochemical tests to detect protein and adenosine triphosphate (ATP) – a marker that identifies organic matter. These assessments were used to identify endoscopes that required further cleaning and maintenance.

During the final assessment, the researchers found that all 20 endoscopes examined had visual irregularities, such as fluid, discoloration and debris in channels. Furthermore, samples from 12 of 20 reprocessed endoscopes (60 percent) had microbial growth, indicating a failure of the disinfection process. Of note, endoscopes reprocessed using current recommended guidelines and those that were cleaned at least twice before high-level disinfection exhibited similar culture results.

Further results indicated that about 20 percent of endoscopes in each group exceeded post-cleaning benchmarks for ATP and protein residue. Moreover, ATP levels were higher for gastroscopes, which are used for upper GI procedures, than the endoscopes used for colonoscopy. “Since the same technicians used the same techniques to clean and disinfect these scopes, the findings and our visual observations suggest that something is happening to gastroscopes during procedures that changes the surfaces and causes reprocessing failures,” says Ofstead.

This study comes on the heels of a 2015 report of Carbapenem-resistant Enterobacteriaceae (CRE) infections related to Endoscopic Retrograde Cholangio-Pancreatography (ERCP) duodenoscopes - devices that are threaded through the mouth, throat, and stomach into the top of the small intestine (duodenum) for examinations and treatment. No breaches in reprocessing were identified and yet infections related to the duodenoscopes were uncovered, raising concerns that current reprocessing techniques were ineffective, and illuminating the challenges in reprocessing of such intricate medical devices.

“The finding of residual fluid in 95 percent of endoscopes tested was significant because moisture fosters microbial growth and the development of biofilm—which can be difficult or impossible to remove,” said Ofstead. “This confirms the importance of cleaning, disinfecting, and drying to ensure patient safety.”

“Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures,” Cori L. Ofstead; Harry P. Wetzler; Otis L. Heymann; Ellen A. Johnson; John E. Eiland; and Michael J. Shaw appears in the American Journal of Infection Control, Volume 45, Issue 2 (February 2017).

Source: APIC