本文選題：內(nèi)窺鏡　切入點：清洗消毒　出處：《新疆醫(yī)科大學(xué)》2007年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:了解烏魯木齊市醫(yī)療機構(gòu)內(nèi)窺鏡的污染和消毒現(xiàn)狀,調(diào)查全市內(nèi)窺鏡清洗消毒方法、步驟是否符合《內(nèi)窺鏡清洗消毒技術(shù)規(guī)范(2004年版)》的要求,檢測內(nèi)窺鏡使用后的污染情況和消毒效果,篩選影響胃鏡消毒效果的因素,發(fā)現(xiàn)內(nèi)窺鏡清洗消毒及其管理中存在的問題。方法:根據(jù)《內(nèi)窺鏡清洗消毒技術(shù)規(guī)范(2004年版)》要求對醫(yī)療機構(gòu)內(nèi)窺鏡消毒管理情況進行調(diào)查,了解各醫(yī)療機構(gòu)內(nèi)窺鏡檢查室、消毒室的硬件條件和內(nèi)窺鏡清洗消毒方法、步驟以及消毒劑、酶洗劑使用情況、消毒滅菌時間等內(nèi)容,填寫調(diào)查表。對使用前后的內(nèi)窺鏡采樣監(jiān)測,了解使用后的內(nèi)窺鏡污染情況及消毒效果,對收集到的數(shù)據(jù)進行統(tǒng)計學(xué)分析,得出相關(guān)結(jié)論。結(jié)果:調(diào)查結(jié)果顯示,由于無獨立的消毒室、消毒室面積不達標(biāo)、不同部位內(nèi)窺鏡的清洗消毒設(shè)備未分開,內(nèi)窺鏡工作環(huán)境符合率僅為48.31%;由于未使用流動水清洗消毒槽、刷洗步驟不合格、缺少干燥程序、酶洗劑未做到一用一更換,內(nèi)窺鏡清洗消毒步驟符合率僅為58.43%;受實際工作時間的限制,遇到病人較多時清洗消毒時間常不能得到保證,本次調(diào)查的清洗消毒時間符合率僅為55.06%;監(jiān)測結(jié)果顯示使用后的內(nèi)窺鏡以腸鏡和胃鏡污染情況最嚴重,除攜帶大量細菌外,還查出銅綠假單胞菌、幽門螺旋桿菌、金黃色葡萄球菌、HBsAg等陽性;內(nèi)窺鏡消毒后總合格率為73.66%,其中胃鏡上幽門螺旋桿和菌銅綠假單胞菌的檢出率分別達4.30%和1.08%;使用中戊二醛消毒劑菌落總數(shù)合格率為94.55%,濃度合格率為67.27%;對影響胃鏡消毒效果的因素使用SPSS11.0統(tǒng)計軟件進行多因素條件Logistic回歸分析,結(jié)果顯示有關(guān)聯(lián)的危險因素為消毒劑含量(OR=3.04 95%CI:1.12—8.27)和胃鏡每天使用次數(shù)(OR=3.00 95%CI:1.13—7.95)。結(jié)論:烏魯木齊市醫(yī)療機構(gòu)內(nèi)窺鏡消毒仍存在不少問題;內(nèi)窺鏡檢查室和消毒室的環(huán)境、設(shè)備都需要改善,工作人員的實際操作需嚴格按照相關(guān)規(guī)范開展;對使用中的戊二醛應(yīng)定期監(jiān)測、規(guī)范清洗消毒流程、及時更換,才能保證內(nèi)窺鏡消毒合格;應(yīng)加強對胃腸鏡的日常消毒管理,提高胃腸鏡消毒合格率;為保證胃鏡消毒效果,應(yīng)從管理好使用中消毒劑和控制每支胃鏡每天使用次數(shù)著手加強管理。
[Abstract]:Objective: to understand the status quo of endoscope contamination and disinfection in medical institutions in Urumqi, investigate the cleaning and disinfection methods of endoscope in Urumqi, and investigate whether the steps meet the requirements of the Technical Specification for Endoscopic cleaning and Disinfection (2004 Edition). To detect the contamination and disinfection effect of endoscope, and to screen the factors that affect the disinfection effect of endoscope. Methods: according to the Technical Specification for Endoscopic cleaning and Disinfection (2004 Edition), the management of endoscope disinfection in medical institutions was investigated, and the endoscope examination rooms of various medical institutions were understood. The hardware condition of the disinfection room, the cleaning and disinfection method of endoscope, the procedure, the use of disinfectant, enzyme lotion, the time of disinfection and sterilization, etc. To understand the contamination and disinfection effect of endoscope after use, to analyze the collected data statistically and draw the relevant conclusions. Results: the results showed that the area of disinfection room was not up to standard because there was no independent disinfection room. The cleaning and disinfecting equipment of different parts of endoscope was not separated, the coincidence rate of working environment of endoscope was only 48.31; because of not using flowing water to clean and disinfect the tank, the cleaning steps were not qualified, the drying procedure was lacking, and the enzyme lotion was not replaced with one use. The coincidence rate of the cleaning and disinfection steps of endoscope was only 58.43. Due to the limitation of actual working time, the cleaning and disinfection time could not be guaranteed when more patients were encountered. The coincidence rate of cleaning and disinfection time was only 55.06. The monitoring results showed that the contamination of endoscopy and gastroscope was the most serious after use. In addition to carrying a large number of bacteria, Pseudomonas aeruginosa and Helicobacter pylori were also detected. Staphylococcus aureus and HBsAg positive; The total qualified rate after endoscope disinfection was 73.66. The positive rate of pyloric helix rod and Pseudomonas aeruginosa on gastroscope was 4.30% and 1.08 respectively. The qualified rate of colony and concentration of glutaraldehyde disinfectant were 94.55 and 67.27 respectively. The factors of disinfection effect were analyzed by Logistic regression analysis with SPSS11.0 software. The results showed that the related risk factors were the disinfectant content: 1.12-8.27) and the number of times the gastroscope was used every day. Conclusion: there are still many problems in the disinfection of endoscope in medical institutions in Urumqi, and the environment of endoscope examination room and disinfection room, The equipment needs to be improved, and the actual operation of the staff should be carried out strictly in accordance with the relevant norms; glutaraldehyde in use should be monitored regularly, the cleaning and disinfection process should be standardized, and the disinfection process should be changed in time to ensure that the disinfection of endoscope is qualified. The daily disinfection management of gastroenteroscopy should be strengthened to improve the qualified rate of gastroenteroscopy disinfection, and to ensure the disinfection effect of gastroscope, it is necessary to strengthen the management by using disinfectant and controlling the number of times each gastroscope is used every day.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R187

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