Pang Julie, Perry Peta, Ross Alan, Forbes Geoffrey M
Department of Gastroenterology and Hepatology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia.
Gastrointest Endosc. 2002 Sep;56(3):402-6. doi: 10.1016/s0016-5107(02)70046-1.
Most breaches of endoscope disinfection result from inadequate manual cleaning or improper use of disinfectants. This is a description of how a quality assurance program identified rinse water as a source of bacterial contamination and how it facilitated the introduction of a novel means of delivering rinse water of high purity.
Between 1996 and 2001, weekly samples were obtained from accessory and suction channels of endoscopes as well as the internal chambers of automated washing machines. Samples were processed for routine bacterial and mycobacterial culture.
Bacteria were isolated in 8.7% of samples collected between 1996 and 1998. Of 36 positive samples, 20 (54%) were Pseudomonas sp. Analysis of rinse water from pipework downstream from filters demonstrated high growth of Pseudomonas sp, suggesting biofilm within piping was contaminating rinse water. A system of hot water flushing of pipework was developed that maintains a temperature above 60 degrees C for 60 minutes on a daily basis. This resulted in a consistently low level of bacterial contamination.
This report demonstrates the value of a quality assurance program for endoscope disinfection and shows how rinse water may contaminate disinfected endoscopes. A system of hot water purging of the rinse water delivery system markedly reduces this contamination.
大多数内镜消毒违规是由于手工清洗不充分或消毒剂使用不当所致。本文描述了一个质量保证计划如何将冲洗水确定为细菌污染的来源，以及它如何推动引入一种提供高纯度冲洗水的新方法。
1996年至2001年期间，每周从内镜的附件和吸引通道以及自动清洗机的内部腔室采集样本。对样本进行常规细菌和分枝杆菌培养。
1996年至1998年期间采集的样本中，8.7%分离出细菌。在36份阳性样本中，20份（54%）为假单胞菌属。对过滤器下游管道冲洗水的分析显示假单胞菌属大量生长，表明管道内的生物膜正在污染冲洗水。开发了一种管道热水冲洗系统，该系统每天将温度保持在60摄氏度以上60分钟。这导致细菌污染水平持续较低。
本报告证明了内镜消毒质量保证计划的价值，并展示了冲洗水可能如何污染已消毒的内镜。冲洗水输送系统的热水净化系统显著减少了这种污染。
