Bader L, Blumenstock G, Birkner B, Leiss O, Heesemann J, Riemann J F, Selbmann H-K
Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie (Lehrstuhl Bakteriologie), Ludwig-Maximilians-Universität München.
Z Gastroenterol. 2002 Mar;40(3):157-70. doi: 10.1055/s-2002-22326.
The quality of reprocessing gastroscopes, colonoscopes and duodenoscopes in daily routine of 25 endoscopy departments in hospitals and 30 doctors with their own practices was evaluated by microbiological testing in the HYGEA interventional study. In 2 test periods, endoscopes ready for use in patients were found contaminated at high rates (period 1: 49 % of 152 endoscopes; period 2: 39 % of 154 endoscopes). Culture of bacterial fecal flora (E. coli, coliform enterobacteriaceae, enterococci) was interpreted indicating failure of cleaning procedure and disinfection of endoscopes. Detection of Pseudomonas spp. (especially P. aeruginosa) and other non-fermenting rods - indicating microbially insufficient final rinsing and incomplete drying of the endoscope or a contaminated flushing equipment for the air/water-channel - pointed out endoscope recontamination during reprocessing or afterwards. Cause for complaint was found in more than 50 % of endoscopy facilities tested (period 2: 5 in hospitals, 25 practices). Reprocessing endoscopes in fully automatic chemo-thermally decontaminating washer-disinfectors with disinfection of final rinsing water led to much better results than manual or semi-automatic procedures (failure rate of endoscopy facilities in period 2 : 3 of 28 with fully automatic, 8 of 12 with manual, 9 of 15 with semi-automatic reprocessing). The study results give evidence for the following recommendations: 1. Manual brushing of all accessible endoscope channels has to be performed even before further automatic reprocessing; 2. For final endoscope rinsing, water or aqua dest. should only be used disinfected or sterile-filtered; 3. Endoscopes have to be dried thoroughly using compressed air prior to storage; 4. Bottle and tube for air/water-channel flushing have to be reprocessed daily by disinfection or sterilization, and in use, the bottle have to be filled exclusively with sterile water. The HYGEA study shows that microbiological testing of endoscopes is useful for detection of insufficient reprocessing and should be performed for quality assurance in doctors' practices, too. The study put recommendations for reprocessing procedures in more concrete terms.
在HYGEA干预性研究中，通过微生物检测对25家医院内镜科室的日常工作以及30名私人执业医生所使用的胃镜、结肠镜和十二指肠镜的再处理质量进行了评估。在两个测试阶段，准备用于患者的内镜被发现污染率很高（第一阶段：152台内镜中有49%；第二阶段：154台内镜中有39%）。粪便菌群（大肠杆菌、大肠埃希菌科、肠球菌）的培养结果表明内镜的清洗和消毒程序失败。假单胞菌属（尤其是铜绿假单胞菌）和其他非发酵杆菌的检测——表明内镜的最终冲洗微生物学不足、干燥不完全或空气/水通道的冲洗设备被污染——指出了再处理过程中或之后内镜的再次污染。在超过50%的受测内镜检查设施中发现了投诉原因（第二阶段：医院中有5家，私人执业机构中有25家）。在内镜全自动化学热消毒清洗机中进行再处理并对最终冲洗水进行消毒，其效果比手动或半自动程序要好得多（第二阶段内镜检查设施的故障率：全自动再处理的28台中为3台，手动再处理的12台中为8台，半自动再处理的15台中为9台）。研究结果为以下建议提供了依据：1. 即使在进一步自动再处理之前，也必须对所有可触及的内镜通道进行手动刷洗；2. 对于内镜的最终冲洗，应仅使用经过消毒或无菌过滤的水或去离子水；3. 内镜在储存前必须使用压缩空气彻底干燥；4. 空气/水通道冲洗用的瓶子和管子必须每天进行消毒或灭菌再处理，并且在使用时，瓶子必须只装无菌水。HYGEA研究表明，内镜的微生物检测有助于发现再处理不足，并且在医生的执业过程中也应进行以确保质量。该研究更具体地提出了再处理程序的建议。
