Babb J R, Bradley C R
Hospital Infection Research Laboratory, City Hospital NHS Trust, Birmingham, UK.
J Hosp Infect. 1995 Jun;30 Suppl:543-51. doi: 10.1016/0195-6701(95)90061-6.
Thorough cleaning and disinfection or sterilization of endoscopes and associated equipment will reduce the likelihood of misdiagnosis and post-procedural infection. It will also prevent instrument deterioration and malfunction. With a rapid escalation in demand for endoscopy, particularly that associated with minimally invasive surgery, it is important that we have the processing technology to match the diagnostic and therapeutic value of these instruments without exposing staff and patients to unnecessary risk. Wherever possible staff should purchase heat tolerant endoscopic equipment that is readily accessible for cleaning. Automated processors, e.g. washer disinfectors and ultrasonic cleaners, improve the quality of the decontamination process but machines must have a self-disinfect function to prevent instrument recontamination during processing. Sterile, or filtered bacteria-free, water is essential for bronchoscopes and invasive instruments. Glutaraldehyde is still the most widely used disinfectant, particularly for the heat sensitive flexible endoscopes, but it is irritant and sensitizing and a safer alternative is sought. Peracetic acid is more rapidly efficacious and probably less irritant and, provided it does not damage endoscopes and processing equipment, may prove a suitable alternative. Unfortunately there are no nationally agreed test methods for assessing this and other new endoscope disinfectants and therefore no register of suitable or approved products. There is also no proven safe alternative to ethylene oxide for sterilizing invasive heat labile flexible endoscopes. It is important that, if toxic disinfectants and sterilants are used, staff and patients are suitably protected from exposure. Update training is essential for all processing staff if infection risks are to be minimized and sensitization problems avoided.
对内镜及相关设备进行彻底清洁、消毒或灭菌，将降低误诊及术后感染的可能性。这也将防止器械老化和故障。随着内窥镜检查需求的迅速增加，尤其是与微创手术相关的需求，拥有能匹配这些器械诊断和治疗价值的处理技术，同时又不使工作人员和患者面临不必要风险，至关重要。只要有可能，工作人员应购买易于清洁的耐热内镜设备。自动化处理设备，如清洗消毒器和超声波清洗器，可提高去污过程的质量，但机器必须具备自消毒功能，以防止器械在处理过程中再次污染。无菌水或经过滤的无细菌水对于支气管镜和侵入性器械至关重要。戊二醛仍是使用最广泛的消毒剂，特别是对于对热敏感的软性内镜，但它具有刺激性和致敏性，因此正在寻找更安全的替代品。过氧乙酸起效更快，刺激性可能更小，并且只要不损坏内镜和处理设备，可能是一种合适的替代品。不幸的是，目前尚无全国公认的评估这种及其他新型内镜消毒剂的测试方法，因此也没有合适或批准产品的登记册。对于对热不稳定的侵入性软性内镜进行灭菌，也没有经证实的环氧乙烷安全替代品。如果使用有毒消毒剂和灭菌剂，确保工作人员和患者得到适当保护，避免接触至关重要。若要将感染风险降至最低并避免致敏问题，对所有处理人员进行更新培训必不可少。
