多重耐药菌感染患者清创术后内镜灭菌方法研究

Sterilization methods of endoscope in patients with multidrug-resistant organism infection after debridement

摘要:

目的 探讨过氧乙酸和环氧乙烷两种不同方法对胰腺包裹性坏死(WON)并多重耐药菌(MDRO)感染(经皮/经胃)内镜下清创术内镜的灭菌效果。 方法 选取江西省某三级甲等医院WON并MDRO感染(经皮/经胃)内镜下清创术患者使用带副送水功能的内镜, 采用随机数字表法将其分为两组: A组采用过氧乙酸浸泡灭菌, B组采用环氧乙烷低温灭菌。滤膜法采集内镜的钳子管道、送气/送水管道和副送水管道3个位点标本进行微生物培养, 比较两组内镜灭菌合格率、菌落数和检出MDRO情况。 结果 共采集78条副送水内镜, A组和B组各39条, 共234份标本, A组和B组内镜灭菌合格率分别为61.54%、100%。A组钳子管道灭菌合格率为82.05%, 送气/送水管道灭菌合格率为89.74%, 副送水管道灭菌合格率为74.36%, B组3个位点灭菌合格率均为100%。A组钳子管道、送气/送水管道和副送水管道菌落总数范围分别为0~6、0~112、0~23 CFU, 分离MDRO 36株, 以多重耐药铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和多重耐药肺炎克雷伯菌为主。将A组15条不合格的内镜转为环氧乙烷低温灭菌后, 微生物学监测合格率达100%。 结论 对于WON并MDRO感染(经皮/经胃)内镜下清创术的内镜, 环氧乙烷低温灭菌方法更有效。对内镜的微生物学监测不能仅局限于钳子管道的监测, 带副送水功能的内镜需监测副送水管道, 以降低感染风险。

Abstract:

Objective To investigate the sterilization effect of peracetic acid and ethylene oxide on endoscope used for debridement of walled-off pancreatic necrosis (WON) complicated with multidrug-resistant orgamism (MDRO) infection (percutaneous/transgastric). Methods Endoscopes with auxiliary water delivery function used for patients with WON and MDRO infection (percutaneous/transgastric) who underwent debridement in a tertiary first-class hospital in Jiangxi Province were selected and divided into two groups by random number table method: group A was sterilized with peracetic acid immersion, and group B was sterilized with ethylene oxide at low temperature. Specimens of forceps channel, air/water supply channel and auxiliary water supply channel of endoscopes were collected by filter membrane method for microbial culture. The qualified rate of endoscope sterilization, colony number and detection result of MDROs of two groups of endoscopes were compared. Results 78 auxiliary water supply endoscopes were collected, including 39 in group A and 39 in group B, with a total of 234 specimens. The qualified rates of endoscope sterilization of group A and group B were 61.54% and 100% respectively. Qualified rates of forceps channel, air/water supply channel and auxiliary water supply channel in group A were 82.05%, 89.74% and 74.36% respectively, qualified rates of three sites in group B were all 100%. In group A, the total bacterial colonies of forceps channel, air/water supply channel and auxiliary water supply channel were 0-6 CFU, 0-112 CFU and 0-23 CFU respectively. 36 strains of MDROs were isolated, mainly multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and multidrug-resistant Klebsiella pneumoniae. After 15 unqualified endoscopes in group A were sterilized with ethylene oxide at low temperature, qualified rate of microbiological monitoring reached 100%. Conclusion Low temperature sterilization with ethylene oxide is more effective for endoscopic debridement of WON complicated with MDRO infection (percutaneous/transgastric). Microbiological monitoring of endoscope should not be limited to the monitoring of forceps channel, auxiliary water supply channel of endoscope with the auxiliary water supply function should be monitored, so as to reduce the risk of infection.