Department of Otolaryngology–Head and Neck Surgery, Loma Linda University, Loma Linda, CA 92354, USA.
JAMA Otolaryngol Head Neck Surg. 2013 Jun;139(6):574-8. doi: 10.1001/jamaoto.2013.3016.
If not adequately cleaned, rigid nasal endoscopes (RNEs) have the potential to cause iatrogenic cross-contamination.
To test the efficacy of various disinfection methods in reducing bacterial load on RNEs in vitro.
In vitro model.
Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae contamination was separately induced on RNEs in vitro. Two experimental sets were completed. The RNEs were disinfected using the following protocols: 30-second scrub with antimicrobial soap (ABS) and water, 30-second scrub with 70% isopropyl alcohol (IA), 30-second scrub with ABS followed by 30-second scrub with IA, 30-second scrub with germicidal cloth, isolated 5-minute soak in an enzymatic soap solution, 5- and 10-minute soaks in ortho-phthalaldehyde, 0.55%, solution (Cidex OPA), and isolated 30-second rinse with tap water, all with 30-second precleaning and postcleaning rinses with tap water. Two sets of experiments (experiment sets A and B) were carried out with a 30-second tap water rinse after inoculation of each RNE. This was followed by immediate cleaning in set A and a 1-hour air-dry delay in set B. Otherwise there were no differences in the disinfection protocols between sets for each method noted.
Effectiveness of various disinfection protocols in cleaning rigid nasal endoscopes experimentally inoculated with bacteria commonly found in the upper aerodigestive tract. Positive cultures following disinfection indicated ineffective or incomplete disinfection.
Most cleaning methods were effective in eliminating S aureus, S pneumoniae, and H influenzae from the scopes following experimental contamination. Continued growth of P aeruginosa was found after all of the disinfection trials in experiment set A with the exception of a 10-minute immersion in Cidex OPA, and in set B except for the 10-minute Cidex OPA immersion and ABS plus IA trials.
Most cleaning methods used in our trials appear to properly disinfect RNEs after in vitro inoculation with S aureus, S pneumoniae, and H influenzae. However, it appears that disinfectants may be less effective in cleaning rigid scopes experimentally inoculated with P aeruginosa. There is a paucity of published data regarding cross-contamination during rigid nasal endoscopy, and these results should guide future studies and to some extent practice to avoid iatrogenic spread of contamination.
如果未充分清洁，刚性鼻内窥镜（RNE）有可能导致医源性交叉污染。
在体外测试各种消毒方法对减少 RNE 上细菌负荷的效果。
体外模型。
在体外分别诱导金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌和流感嗜血杆菌污染 RNE。完成了两个实验集。使用以下方案对 RNE 进行消毒：用抗菌肥皂（ABS）和水进行 30 秒擦洗、用 70%异丙醇（IA）进行 30 秒擦洗、先用 ABS 擦洗 30 秒，再用 IA 擦洗 30 秒、用杀菌布擦洗 30 秒、单独浸泡在酶肥皂溶液中 5 分钟、5 分钟和 10 分钟浸泡在邻苯二甲醛、0.55%溶液（Cidex OPA）中、用自来水单独冲洗 30 秒，所有操作都要进行 30 秒预清洁和自来水冲洗。在每个 RNE 接种后，进行了两组实验（实验集 A 和 B），并用自来水进行 30 秒冲洗。然后在 A 组立即清洗，在 B 组延迟 1 小时风干。否则，每组每个方法的消毒方案之间没有差异。
各种消毒方案在体外接种常见上呼吸道细菌后清洁刚性鼻内窥镜的效果。消毒后阳性培养表明消毒不彻底或不彻底。
在实验污染后，大多数清洁方法都能有效地从内窥镜中清除金黄色葡萄球菌、肺炎链球菌和流感嗜血杆菌。除了 10 分钟浸泡在 Cidex OPA 中，以及除了 10 分钟 Cidex OPA 浸泡和 ABS+IA 试验外，在实验集 A 中进行的所有消毒试验后都发现铜绿假单胞菌持续生长。
在我们的试验中，大多数清洁方法似乎可以在体外接种金黄色葡萄球菌、肺炎链球菌和流感嗜血杆菌后对 RNE 进行适当消毒。然而，消毒剂似乎在清洁实验接种铜绿假单胞菌的刚性镜方面效果较差。关于刚性鼻内窥镜检查过程中的交叉污染，发表的数据很少，这些结果应该指导未来的研究，并在一定程度上指导实践，以避免医源性传播污染。
