传统的清洁和消毒技术能否避免内镜检查时幽门螺杆菌传播的风险？

Do conventional cleaning and disinfection techniques avoid the risk of endoscopic Helicobacter pylori transmission?

作者信息

Nürnberg M, Schulz H J, Rüden H, Vogt K

机构信息

Oskar Ziethen Hospital, Lichtenberg, Berlin, Germany.

出版信息

Endoscopy. 2003 Apr;35(4):295-9. doi: 10.1055/s-2003-38149.

DOI:10.1055/s-2003-38149

PMID:12664384

Abstract

BACKGROUND AND STUDY AIMS

The aim of the present study was to determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether the disinfection technique currently recommended for manual cleaning and disinfection of the instruments completely removes the risk of H. pylori transmission.

PATIENTS AND METHODS

A prospective study was carried out in 400 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. The patients' H. pylori status of the patients was identified using a urea detection system (HUT) and culture. H. pylori contamination was assayed by culturing rinsing samples from the endoscopes before and after manual cleaning and disinfection. Gastric biopsies were assayed using rapid urease testing (Helicobacter urease test, HUT) of two antral and gastric body biopsies and cultures.

RESULTS

A total of 128 of the 400 patients examined were found to be H. pylori-positive using HUT testing. Endoscopes were contaminated in 54 of the 128 rinsing samples from endoscopes used in H. pylori-positive patients (42 %) before cleaning and disinfection. One of the 128 rinsing samples (0.8 %) was found to be contaminated with H. pylori even after routine manual cleaning and disinfection - indicating that these cleaning and disinfection procedures may be insufficient to eradicate H. pylori from endoscopes completely. No seroconversion was observed during serological follow-up in the patient who had previously been examined with an endoscope contaminated with H. pylori. The patient was still found to be seronegative 5 months after inoculation.

CONCLUSIONS

Endoscopes are frequently contaminated with H. pylori immediately after gastroduodenal endoscopy in H. pylori-infected patients. Iatrogenic transmission is possible, as H. pylori can survive manual cleaning and disinfection with 2 % glutaraldehyde, particularly when there is ineffective cleaning before disinfection.

摘要

背景与研究目的

本研究旨在确定内窥镜是否为幽门螺杆菌的储存宿主，以及目前推荐的手动清洁和消毒器械的消毒技术是否能完全消除幽门螺杆菌传播的风险。

患者与方法

对400例因常规临床指征接受上消化道内镜检查的患者进行了一项前瞻性研究。使用尿素检测系统（HUT）和培养法确定患者的幽门螺杆菌感染状况。通过培养手动清洁和消毒前后内窥镜的冲洗样本检测幽门螺杆菌污染情况。对胃活检组织采用快速尿素酶试验（幽门螺杆菌尿素酶试验，HUT）以及对两块胃窦和胃体活检组织进行培养检测。

结果

在400例接受检查的患者中，共有128例经HUT检测为幽门螺杆菌阳性。在用于幽门螺杆菌阳性患者的128份内窥镜冲洗样本中，有54份（42%）在清洁和消毒前被污染。在128份冲洗样本中，即使经过常规手动清洁和消毒后，仍有1份（0.8%）被幽门螺杆菌污染，这表明这些清洁和消毒程序可能不足以完全根除内窥镜上的幽门螺杆菌。在先前接受过被幽门螺杆菌污染的内窥镜检查的患者血清学随访期间未观察到血清转化。接种5个月后该患者仍为血清阴性。