Li C-G, Ye L-L, He Y-H, Cai Y-X, Li S-Y, Zhang H, Li H, Chen A-Q
Administration Department of Nosocomial Infection Prevention and Control, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Guangzhou, PR China.
Central Sterile Supply Department, Dongguan People's Hospital, Dongguan, China.
J Hosp Infect. 2025 May;159:23-31. doi: 10.1016/j.jhin.2025.01.005. Epub 2025 Jan 20.
To investigate the impact of different pretreatment strategies and cleaning methods on the cleaning efficacy of electrosurgical instruments, with the aim of proposing an optimal protocol.
In total, 573 electrosurgical instruments were collected from three large-scale hospitals within 2 h of use between December 2023 and July 2024. The instruments were categorized into six groups: medical alkaline cleaner, multi-enzyme cleaner and instant foam-type multi-enzyme humectant followed by manual cleaning; and medical alkaline cleaner, multi-enzyme cleaner and instant foam-type multi-enzyme humectant followed by mechanical cleaning with a vacuum boiling washer. Cleaning quality was assessed through visual estimation, residual protein detection, and adenosine triphosphate (ATP) biological fluorescence detection.
Visual assessment indicated that different pretreatment and cleaning methods did not affect cleaning quality significantly (P>0.05). Residual protein detection analysis revealed that mechanical cleaning outperformed manual cleaning [adjusted odds ratio (AOR) 2.20, 95% confidence interval (CI) 1.18-4.11; P=0.013], with both medical multi-enzyme cleaners (AOR 3.72, 95% CI 1.11-12.44; P=0.033) and instant foam-type multi-enzyme humectants (AOR 3.27, 95% CI 1.07-10.03; P=0.038) combined with mechanical cleaning demonstrating superior performance. ATP detection confirmed that mechanical cleaning was more effective than manual cleaning (AOR 5.10, 95% CI 2.00-12.95; P<0.001), particularly when using a medical alkaline cleaner (AOR 6.79, 95% CI1.36-33.83; P=0.019) or a multi-enzyme cleaner (AOR 6.77, 95% CI 1.43-31.95; P=0.016) before mechanical cleaning.
Mechanical cleaning emerged as the critical factor for improving the cleaning efficacy of electrosurgical instruments, and no significant differences were observed between the three pretreatment strategies: medical alkaline cleaner, medical multi-enzyme cleaner, and instant foam-type multi-enzyme humectant. Furthermore, even electrosurgical instruments with complex structures maintain adequate cleanliness after standardized pretreatment and cleaning protocols.
探讨不同预处理策略和清洗方法对电外科器械清洗效果的影响，旨在提出最佳方案。
2023年12月至2024年7月期间，在使用后2小时内从三家大型医院收集了总共573件电外科器械。这些器械被分为六组：医用碱性清洗剂、多酶清洗剂和即时泡沫型多酶保湿剂，随后进行手工清洗；以及医用碱性清洗剂、多酶清洗剂和即时泡沫型多酶保湿剂，随后使用真空煮沸清洗机进行机械清洗。通过目视评估、残留蛋白质检测和三磷酸腺苷（ATP）生物荧光检测来评估清洗质量。
目视评估表明，不同的预处理和清洗方法对清洗质量没有显著影响（P>0.05）。残留蛋白质检测分析显示，机械清洗优于手工清洗[调整优势比（AOR）2.20，95%置信区间（CI）1.18 - 4.11；P = 0.013]，医用多酶清洗剂（AOR 3.72，95% CI 1.11 - 12.44；P = 0.033）和即时泡沫型多酶保湿剂（AOR 3.27，95% CI 1.07 - 10.03；P = 0.038）与机械清洗相结合均表现出卓越性能。ATP检测证实机械清洗比手工清洗更有效（AOR 5.10，95% CI 2.00 - 12.95；P < 0.001），特别是在机械清洗前使用医用碱性清洗剂（AOR 6.79，95% CI 1.36 - 33.83；P = 0.019）或多酶清洗剂（AOR 6.77，95% CI 1.43 - 31.95；P = 0.016）时。
机械清洗是提高电外科器械清洗效果的关键因素，医用碱性清洗剂、医用多酶清洗剂和即时泡沫型多酶保湿剂这三种预处理策略之间未观察到显著差异。此外，即使是结构复杂的电外科器械，经过标准化的预处理和清洗方案后也能保持足够的清洁度。
