Honeybourne D, Neumann C S
Department of Thoracic Medicine, City Hospital NHS Trust, Birmingham, UK.
Thorax. 1997 Aug;52(8):709-13. doi: 10.1136/thx.52.8.709.
Both patient and staff safety are of major importance during the procedure of fibreoptic bronchoscopy. Patient safety depends partly on adequate disinfection of instruments and accessories used as well as careful monitoring during the procedure. Adequate facilities, manpower and training are also essential. Staff safety depends partly on adequate procedures to minimise any risks of sensitisation to agents such as glutaraldehyde. An audit was carried out of bronchoscopy procedures in hospitals in the UK and the findings were compared with published guidelines on good practice and clinical consensus.
A postal questionnaire was sent to 218 bronchoscopy units in the UK. Findings were then compared with published evidence of good practice in the areas of disinfection, including the use of glutaraldehyde, patient monitoring, manpower, facilities, and training.
A 73% response rate was obtained. Recommended minimum disinfection times before and after routine bronchoscopies were not achieved by 35% of units. No disinfection was carried out in 34% of units before emergency bronchoscopies and in 19% of units after suspected cases of tuberculosis. Adequate rinsing of the bronchoscope with sterile or filtered water was not carried out by 43% of units. Contrary to recommendations, 31% of departments were still using glutaraldehyde in the patient examination room and inadequate room ventilation was common. Protective clothing was often not worn by staff during bronchoscopy. Inadequate intravenous access and use of supplementary oxygen were found in many units. Practice standards were higher in departments where dedicated bronchoscopy/endoscopy units of the hospital were used, and also where staff had been on external training courses.
This audit has shown that many units do not adhere to guidelines on disinfection procedures and patient monitoring. Unnecessary potential risks due to staff exposure to glutaraldehyde were apparent. National guidelines on good practice are not being followed in areas which may potentially affect patient and staff safety.
在纤维支气管镜检查过程中，患者和工作人员的安全都至关重要。患者安全部分取决于所用器械和附件的充分消毒以及检查过程中的仔细监测。充足的设施、人力和培训也必不可少。工作人员的安全部分取决于采取适当程序以尽量减少对戊二醛等试剂致敏的任何风险。对英国医院的支气管镜检查程序进行了一次审计，并将结果与已发表的关于良好操作规范和临床共识的指南进行了比较。
向英国的218个支气管镜检查单位发送了邮政调查问卷。然后将结果与在消毒领域（包括戊二醛的使用）、患者监测、人力、设施和培训等方面已发表的良好操作证据进行比较。
获得了73%的回复率。35%的单位未达到常规支气管镜检查前后建议的最短消毒时间。34%的单位在急诊支气管镜检查前未进行消毒，19%的单位在疑似结核病例后未进行消毒。43%的单位未用无菌水或过滤水对支气管镜进行充分冲洗。与建议相反，31%的科室仍在患者检查室使用戊二醛，而且室内通风不足很常见。在支气管镜检查期间，工作人员经常不穿防护服。许多单位发现静脉通路不足且补充氧气的使用不当。在使用医院专门的支气管镜/内镜检查单位的科室以及工作人员参加过外部培训课程的科室，操作标准更高。
本次审计表明，许多单位未遵守消毒程序和患者监测指南。工作人员接触戊二醛带来的不必要潜在风险显而易见。在可能影响患者和工作人员安全的领域，未遵循国家关于良好操作规范的指南。
