乌鲁木齐市医疗机构内窥镜污染与消毒现状分析

发布时间：2018-03-05 13:49

本文选题：内窥镜　切入点：清洗消毒　出处：《新疆医科大学》2007年硕士论文　论文类型：学位论文

【摘要】： 目的:了解乌鲁木齐市医疗机构内窥镜的污染和消毒现状,调查全市内窥镜清洗消毒方法、步骤是否符合《内窥镜清洗消毒技术规范(2004年版)》的要求,检测内窥镜使用后的污染情况和消毒效果,筛选影响胃镜消毒效果的因素,发现内窥镜清洗消毒及其管理中存在的问题。方法:根据《内窥镜清洗消毒技术规范(2004年版)》要求对医疗机构内窥镜消毒管理情况进行调查,了解各医疗机构内窥镜检查室、消毒室的硬件条件和内窥镜清洗消毒方法、步骤以及消毒剂、酶洗剂使用情况、消毒灭菌时间等内容,填写调查表。对使用前后的内窥镜采样监测,了解使用后的内窥镜污染情况及消毒效果,对收集到的数据进行统计学分析,得出相关结论。结果:调查结果显示,由于无独立的消毒室、消毒室面积不达标、不同部位内窥镜的清洗消毒设备未分开,内窥镜工作环境符合率仅为48.31%;由于未使用流动水清洗消毒槽、刷洗步骤不合格、缺少干燥程序、酶洗剂未做到一用一更换,内窥镜清洗消毒步骤符合率仅为58.43%;受实际工作时间的限制,遇到病人较多时清洗消毒时间常不能得到保证,本次调查的清洗消毒时间符合率仅为55.06%;监测结果显示使用后的内窥镜以肠镜和胃镜污染情况最严重,除携带大量细菌外,还查出铜绿假单胞菌、幽门螺旋杆菌、金黄色葡萄球菌、HBsAg等阳性;内窥镜消毒后总合格率为73.66%,其中胃镜上幽门螺旋杆和菌铜绿假单胞菌的检出率分别达4.30%和1.08%;使用中戊二醛消毒剂菌落总数合格率为94.55%,浓度合格率为67.27%;对影响胃镜消毒效果的因素使用SPSS11.0统计软件进行多因素条件Logistic回归分析,结果显示有关联的危险因素为消毒剂含量(OR=3.04 95%CI:1.12—8.27)和胃镜每天使用次数(OR=3.00 95%CI:1.13—7.95)。结论:乌鲁木齐市医疗机构内窥镜消毒仍存在不少问题;内窥镜检查室和消毒室的环境、设备都需要改善,工作人员的实际操作需严格按照相关规范开展;对使用中的戊二醛应定期监测、规范清洗消毒流程、及时更换,才能保证内窥镜消毒合格;应加强对胃肠镜的日常消毒管理,提高胃肠镜消毒合格率;为保证胃镜消毒效果,应从管理好使用中消毒剂和控制每支胃镜每天使用次数着手加强管理。
[Abstract]:Objective: to understand the status quo of endoscope contamination and disinfection in medical institutions in Urumqi, investigate the cleaning and disinfection methods of endoscope in Urumqi, and investigate whether the steps meet the requirements of the Technical Specification for Endoscopic cleaning and Disinfection (2004 Edition). To detect the contamination and disinfection effect of endoscope, and to screen the factors that affect the disinfection effect of endoscope. Methods: according to the Technical Specification for Endoscopic cleaning and Disinfection (2004 Edition), the management of endoscope disinfection in medical institutions was investigated, and the endoscope examination rooms of various medical institutions were understood. The hardware condition of the disinfection room, the cleaning and disinfection method of endoscope, the procedure, the use of disinfectant, enzyme lotion, the time of disinfection and sterilization, etc. To understand the contamination and disinfection effect of endoscope after use, to analyze the collected data statistically and draw the relevant conclusions. Results: the results showed that the area of disinfection room was not up to standard because there was no independent disinfection room. The cleaning and disinfecting equipment of different parts of endoscope was not separated, the coincidence rate of working environment of endoscope was only 48.31; because of not using flowing water to clean and disinfect the tank, the cleaning steps were not qualified, the drying procedure was lacking, and the enzyme lotion was not replaced with one use. The coincidence rate of the cleaning and disinfection steps of endoscope was only 58.43. Due to the limitation of actual working time, the cleaning and disinfection time could not be guaranteed when more patients were encountered. The coincidence rate of cleaning and disinfection time was only 55.06. The monitoring results showed that the contamination of endoscopy and gastroscope was the most serious after use. In addition to carrying a large number of bacteria, Pseudomonas aeruginosa and Helicobacter pylori were also detected. Staphylococcus aureus and HBsAg positive; The total qualified rate after endoscope disinfection was 73.66. The positive rate of pyloric helix rod and Pseudomonas aeruginosa on gastroscope was 4.30% and 1.08 respectively. The qualified rate of colony and concentration of glutaraldehyde disinfectant were 94.55 and 67.27 respectively. The factors of disinfection effect were analyzed by Logistic regression analysis with SPSS11.0 software. The results showed that the related risk factors were the disinfectant content: 1.12-8.27) and the number of times the gastroscope was used every day. Conclusion: there are still many problems in the disinfection of endoscope in medical institutions in Urumqi, and the environment of endoscope examination room and disinfection room, The equipment needs to be improved, and the actual operation of the staff should be carried out strictly in accordance with the relevant norms; glutaraldehyde in use should be monitored regularly, the cleaning and disinfection process should be standardized, and the disinfection process should be changed in time to ensure that the disinfection of endoscope is qualified. The daily disinfection management of gastroenteroscopy should be strengthened to improve the qualified rate of gastroenteroscopy disinfection, and to ensure the disinfection effect of gastroscope, it is necessary to strengthen the management by using disinfectant and controlling the number of times each gastroscope is used every day.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R187

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