Spach D H, Silverstein F E, Stamm W E
University of Washington, Seattle.
Ann Intern Med. 1993 Jan 15;118(2):117-28. doi: 10.7326/0003-4819-118-2-199301150-00008.
To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction.
Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles.
All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail.
Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by gastrointestinal endoscopy, spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems.
The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.
回顾有关通过可弯曲胃肠内镜和支气管镜传播感染的报告，以确定常见的感染微生物、传播情况及降低风险的方法。
通过重要综述文章及医学索引数据库检索（1966年至1992年7月）确定相关英文文章；从已识别文章的参考文献中选取其他参考文献。
所有选定文章均与胃肠内镜或支气管镜传播感染相关；对265篇文章进行了详细综述。
胃肠内镜传播了281例感染，支气管镜传播了96例感染，这些感染范围从无症状定植到死亡。沙门氏菌属和铜绿假单胞菌被反复确定为胃肠内镜传播感染的病原体，结核分枝杆菌、非典型分枝杆菌和铜绿假单胞菌是支气管镜传播感染的最常见原因。记录了1例通过胃肠内镜传播乙型肝炎病毒的病例。传播的主要原因是清洗和消毒程序不当；自动清洗机对内镜的污染；以及尽管使用了标准消毒技术，但由于内镜复杂的通道和阀门系统而无法对其进行消毒。
内镜传播感染最常见的病原体是沙门氏菌、假单胞菌和分枝杆菌属。为防止内镜传播感染，必须遵循推荐的消毒指南，仔细监测自动清洗机的有效性，并且需要改进内镜设计以利于有效清洗和消毒。
