Analysis of high-level disinfection effect of flexible endoscopes in an endoscope center_West China Medical Journal

Authors：

ZHANG Ju ¹ , LI Xiaojing ¹ , LU Wei ¹ , LI Gang ² , HUANG Yanchun ³ , YE Xiaoqin ⁴ , YANG Junhua ¹ ,  MA Li ⁵ , ZHANG Yanhua ⁶

1. Department of Nosocomial Infection Management, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
2. Department of Proctology, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
3. Department of Clinical Laboratory, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
4. Endoscopy Center, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
5. Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
6. Nosocomial Infection Management Department, Chongzhou People’s Hospital, Chengdu, Sichuan 611230, P. R. China;

Corresponding?author：

MA Li, Email: 1004500237@qq.com

Keywords：

Endoscopy Center; Flexible endoscopy; High-level disinfection; Surveillance

DOI：

10.7507/1002-0179.202101270

Video：

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Objective To evaluate the high-level disinfection effect of flexible endoscopes in the Endoscopy Center of the First People’s Hospital of Longquanyi District of Chengdu, explore the key links of flexible endoscope cleaning and disinfection, and provide theoretical guarantee and technical support for the next step of the endoscope center work.Methods We sampled and monitored the lumens, water and air injection ports and biopsy ports of 19 flexible endoscopes after high-level disinfection in the Endoscopy Center of the First People’s Hospital of Longquanyi District of Chengdu. A total of 307 specimens were collected from 108 flexible endoscopes. We compared the disinfection effects of different flexible endoscopes and different sampling sites, and compared the microbial detection status of different flexible endoscopes.Results The qualified rates of disinfection of gastroscopes, colonoscope and duodenoscopy were 79.22%, 86.21% and 100.00%, respectively, and the difference was not statistically significant (P=0.721). The qualified rates of disinfection of the endoscopic lumen, water and air injection port and biopsy port were 87.04%, 93.00% and 94.95%, respectively, and the difference was not statistically significant (χ²=4.585, P=0.101). The qualified rates of the lumen, water and air injection port and biopsy port of gastroscope, colonoscope and duodenoscope were 84.42%, 93.10%, 100.00%, 92.96%, 92.59%, 100.00%, 94.29%, 96.30%, 100.00%, respectively. There was no statistically significant difference in the disinfection effect of various parts of different flexible endoscopes (P>0.05). Bacteriological identification showed that of the 28 specimens with excess bacteriological standards, 16 gram-positive bacteria (57.1%), and 12 gram-negative bacteria (42.9%) were found.Conclusion The cleaning and disinfection effect of flexible endoscopes has certain defect. Endoscope should be treated in strict accordance with the technical specifications for cleaning and disinfection of the flexible endoscope to further improve the disinfection effect of the flexible endoscope.

Citation： ZHANG Ju, LI Xiaojing, LU Wei, LI Gang, HUANG Yanchun, YE Xiaoqin, YANG Junhua, MA Li, ZHANG Yanhua. Analysis of high-level disinfection effect of flexible endoscopes in an endoscope center. West China Medical Journal, 2021, 36(3): 353-357. doi: 10.7507/1002-0179.202101270 Copy

1.	周聞博, 李天慶, 焉丹, 等. 基于數據的軟式內鏡故障循證管理實踐. 華西醫學, 2019, 34(6): 618-624.
2.	夏婷婷, 施施, 楊金燕, 等. 國內外軟式內鏡清洗消毒技術最新進展. 中華醫院感染學雜志, 2019, 29(8): 1271-1276.
3.	Rutala WA, Weber DJ. Gastrointestinal endoscopes: a need to shift from disinfection to sterilization?. JAMA, 2014, 312(14): 1405-1406.
4.	秦瑾, 聞海豐, 李筱軼, 等. 軟式內鏡清洗消毒持續質量改進的效果. 中國消毒學雜志, 2015, 32(10): 1034-1035.
5.	邵春梅, 柴西英, 韓亞穎, 等. 消毒供應中心集中管理模式對軟式腔鏡消毒及滅菌質量的影響. 中華現代護理雜志, 2019, 25(20): 2578-2581.
6.	任群慧, 馮望, 肖紅. 軟式內鏡的處置流程及清洗效果監測研究進展. 中國消毒學雜志, 2018, 35(7): 534-537.
7.	李陽, 姜亦虹. 醫療機構消化內鏡清洗消毒歷史和現狀調查. 中國感染控制雜志, 2017, 16(10): 960-962, 965.
8.	中華人民共和國國家衛生和計劃生育委員會. 軟式內鏡清洗消毒技術規范WS 507-2016. 中國感染控制雜志, 2017, 16(6): 587-592.
9.	Reprocessing Guideline Task Force, Petersen BT, Cohen J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc, 2017, 85(2): 282-294.
10.	胡國慶. 新標準對醫療機構消毒滅菌的新要求. 華西醫學, 2018, 33(3): 253-258.
11.	中華人民共和國國家質量監督檢驗檢疫總局, 中國國家標準化管理委員會. 醫院消毒衛生標準. (2012-06-29)[2021-01-27]. http://www.nhc.gov.cn/ewebeditor/uploadfile/2014/10/20141029163321351.pdf.
12.	Ofstead CL, Wetzler HP, Doyle EM, et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control, 2015, 43(8): 794-801.
13.	凌琳, 胡成文, 胡敏. 某省120所醫療機構內鏡清洗消毒現狀問卷調查結果分析. 中國感染控制雜志, 2020, 19(4): 353-359.
14.	謝靜, 陳敏, 羅薛峰. 軟式內鏡消毒液過氧乙酸和戊二醛消毒效果對比Meta分析. 華西醫學, 2018, 33(3): 302-306.
15.	Beilenhoff U, Biering H, Blum R, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) - update 2018. Endoscopy, 2018, 50(12): 1205-1234.
16.	ASGE Quality Assurance in Endoscopy Committee, Calderwood AH, Day LW, et al. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc, 2018, 87(5): 1167-1179.
17.	Dirlam Langlay AM, Ofstead CL, Mueller NJ, et al. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control, 2013, 41(12): 1188-1194.
18.	雷毅, 蔣麗娟, 董小峰, 等. 陜西省省屬醫院軟式內鏡消毒質量監測與分析. 中國消毒學雜志, 2018, 35(2): 150-151.
19.	張燕華, 周英順, 陳建美, 等. 常規高水平消毒軟式內鏡細菌監測結果. 中華醫院感染學雜志, 2020, 30(24): 3832-3836.
20.	Ofstead CL, Heymann OL, Quick MR, et al. Residual moisture and waterborne pathogens inside flexible endoscopes: evidence froma multisite study of endoscope drying effectiveness. Am J Infect Control, 2018, 46(6): 689-696.
21.	McCafferty CE, Aghajani MJ, Abi-Hanna D, et al. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob, 2018, 17(1): 36.
22.	王廣芬, 朱夢捷, 廖丹, 等. 十二指腸鏡清洗消毒及監測研究新進展. 中華醫院感染學雜志, 2017, 27(24): 5751-5755.
23.	馬慧, 張婕, 李濤, 等. 十二指腸鏡消毒后微生物污染調查. 中華醫院感染學雜志, 2017, 27(12): 2853-2856.
24.	葛冬梅. 鄰苯二甲醛和酸性氧化電位水消毒軟式內鏡效果比較. 中國消毒學雜志, 2017, 34(10): 922-924.
25.	劉衛平, 何歡, 張凱, 等. 不同處理方法清除軟式內鏡生物膜的效果研究. 中國消毒學雜志, 2020, 37(4): 257-259.
26.	Roberts CG. The role of biofilms in reprocessing medical devices. Am J Infect Control, 2013, 41(5 Suppl): S77-S80.
27.	Smith ZL, Oh YS, Saeian K, et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointest Endosc, 2015, 81(4): 1041-1045.
28.	Kim S, Russell D, Mohamadnejad M, et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc, 2016, 83(6): 1121-1129.

1. 周聞博, 李天慶, 焉丹, 等. 基于數據的軟式內鏡故障循證管理實踐. 華西醫學, 2019, 34(6): 618-624.
2. 夏婷婷, 施施, 楊金燕, 等. 國內外軟式內鏡清洗消毒技術最新進展. 中華醫院感染學雜志, 2019, 29(8): 1271-1276.
3. Rutala WA, Weber DJ. Gastrointestinal endoscopes: a need to shift from disinfection to sterilization?. JAMA, 2014, 312(14): 1405-1406.
4. 秦瑾, 聞海豐, 李筱軼, 等. 軟式內鏡清洗消毒持續質量改進的效果. 中國消毒學雜志, 2015, 32(10): 1034-1035.
5. 邵春梅, 柴西英, 韓亞穎, 等. 消毒供應中心集中管理模式對軟式腔鏡消毒及滅菌質量的影響. 中華現代護理雜志, 2019, 25(20): 2578-2581.
6. 任群慧, 馮望, 肖紅. 軟式內鏡的處置流程及清洗效果監測研究進展. 中國消毒學雜志, 2018, 35(7): 534-537.
7. 李陽, 姜亦虹. 醫療機構消化內鏡清洗消毒歷史和現狀調查. 中國感染控制雜志, 2017, 16(10): 960-962, 965.
8. 中華人民共和國國家衛生和計劃生育委員會. 軟式內鏡清洗消毒技術規范WS 507-2016. 中國感染控制雜志, 2017, 16(6): 587-592.
9. Reprocessing Guideline Task Force, Petersen BT, Cohen J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc, 2017, 85(2): 282-294.
10. 胡國慶. 新標準對醫療機構消毒滅菌的新要求. 華西醫學, 2018, 33(3): 253-258.
11. 中華人民共和國國家質量監督檢驗檢疫總局, 中國國家標準化管理委員會. 醫院消毒衛生標準. (2012-06-29)[2021-01-27]. http://www.nhc.gov.cn/ewebeditor/uploadfile/2014/10/20141029163321351.pdf.
12. Ofstead CL, Wetzler HP, Doyle EM, et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control, 2015, 43(8): 794-801.
13. 凌琳, 胡成文, 胡敏. 某省120所醫療機構內鏡清洗消毒現狀問卷調查結果分析. 中國感染控制雜志, 2020, 19(4): 353-359.
14. 謝靜, 陳敏, 羅薛峰. 軟式內鏡消毒液過氧乙酸和戊二醛消毒效果對比Meta分析. 華西醫學, 2018, 33(3): 302-306.
15. Beilenhoff U, Biering H, Blum R, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) - update 2018. Endoscopy, 2018, 50(12): 1205-1234.
16. ASGE Quality Assurance in Endoscopy Committee, Calderwood AH, Day LW, et al. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc, 2018, 87(5): 1167-1179.
17. Dirlam Langlay AM, Ofstead CL, Mueller NJ, et al. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control, 2013, 41(12): 1188-1194.
18. 雷毅, 蔣麗娟, 董小峰, 等. 陜西省省屬醫院軟式內鏡消毒質量監測與分析. 中國消毒學雜志, 2018, 35(2): 150-151.
19. 張燕華, 周英順, 陳建美, 等. 常規高水平消毒軟式內鏡細菌監測結果. 中華醫院感染學雜志, 2020, 30(24): 3832-3836.
20. Ofstead CL, Heymann OL, Quick MR, et al. Residual moisture and waterborne pathogens inside flexible endoscopes: evidence froma multisite study of endoscope drying effectiveness. Am J Infect Control, 2018, 46(6): 689-696.
21. McCafferty CE, Aghajani MJ, Abi-Hanna D, et al. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob, 2018, 17(1): 36.
22. 王廣芬, 朱夢捷, 廖丹, 等. 十二指腸鏡清洗消毒及監測研究新進展. 中華醫院感染學雜志, 2017, 27(24): 5751-5755.
23. 馬慧, 張婕, 李濤, 等. 十二指腸鏡消毒后微生物污染調查. 中華醫院感染學雜志, 2017, 27(12): 2853-2856.
24. 葛冬梅. 鄰苯二甲醛和酸性氧化電位水消毒軟式內鏡效果比較. 中國消毒學雜志, 2017, 34(10): 922-924.
25. 劉衛平, 何歡, 張凱, 等. 不同處理方法清除軟式內鏡生物膜的效果研究. 中國消毒學雜志, 2020, 37(4): 257-259.
26. Roberts CG. The role of biofilms in reprocessing medical devices. Am J Infect Control, 2013, 41(5 Suppl): S77-S80.
27. Smith ZL, Oh YS, Saeian K, et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointest Endosc, 2015, 81(4): 1041-1045.
28. Kim S, Russell D, Mohamadnejad M, et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc, 2016, 83(6): 1121-1129.

West China Medical Journal

Analysis of high-level disinfection effect of flexible endoscopes in an endoscope center

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