Lynch D A, Parnell P, Porter C, Axon A T
Centre for Digestive Diseases, General Infirmary at Leeds, Great Britain.
Endoscopy. 1994 May;26(4):359-61. doi: 10.1055/s-2007-1008991.
Activated glutaraldehyde (2%) is the recommended agent for disinfection of endoscopic equipment. Exposure to the disinfectant is associated with side-effects and guidelines have been set to avoid these complications. Endoscope washing machines are used to provide automated high level disinfection of endoscopes as well as reduce exposure to the irritant aldehyde. We report a design fault in an endoscope washing machine which results in patients and staff being exposed to activated glutaraldehyde. The Auto-Disinfector (KeyMed) comprises a washing chamber supplied by three separate reservoirs (detergent, disinfectant, and rinse water) via a common channel. After the first cycle endoscopes are processed using previously used detergent and rinse water. Rinse water glutaraldehyde concentrations were measured in four machines during routine endoscopy lists on at least two occasions and showed a progressive rise in glutaraldehyde concentration up to 0.1% after two to six cycles. This results in staff being exposed to glutaraldehyde present on the processed instrument and the disinfectant being pumped from the internal channels of the endoscope into direct contact with the gastrointestinal mucosa during endoscopy at concentrations of 200-1000 ppm. The present atmospheric limit for glutaraldehyde is 0.2 ppm. Skin and mucosal irritation occur at concentrations of 0.3 ppm and severe synovitis in experimental animals at 100 pm. Tongue swelling and bloody diarrhoea with characteristic mucosal histological changes have been reported in patients exposed to activated glutaraldehyde on inadequately rinsed equipment. To reduce this problem the rinse water should be changed after every cycle and the endoscope should be dried thoroughly before use.
2%的活性戊二醛是推荐用于内镜设备消毒的试剂。接触消毒剂会产生副作用，因此已制定相关指南以避免这些并发症。内镜清洗机用于对内镜进行自动高水平消毒，并减少接触刺激性醛类物质。我们报告了一台内镜清洗机的设计缺陷，该缺陷导致患者和工作人员接触到活性戊二醛。自动消毒器（KeyMed）包括一个清洗腔室，由三个独立的储液器（洗涤剂、消毒剂和冲洗水）通过一个公共通道供应。在第一个循环后，使用之前用过的洗涤剂和冲洗水对内镜进行处理。在至少两次常规内镜检查过程中，对四台机器中的冲洗水戊二醛浓度进行了测量，结果显示在两到六个循环后，戊二醛浓度逐渐上升至0.1%。这导致工作人员接触到处理过的器械上存在的戊二醛，并且在进行内镜检查时，消毒剂从内镜的内部通道被泵出，以200 - 1000 ppm的浓度直接接触胃肠道黏膜。目前戊二醛的大气限量为0.2 ppm。在浓度为0.3 ppm时会出现皮肤和黏膜刺激，在实验动物中，浓度为100 ppm时会出现严重滑膜炎。据报道，接触未充分冲洗设备上的活性戊二醛的患者会出现舌头肿胀和血性腹泻，并伴有特征性的黏膜组织学变化。为减少这个问题，每个循环后都应更换冲洗水，并且在使用前应将内镜彻底干燥。
