内镜全程追溯系统在内镜中心清洗消毒质量管理中的应用

医院数字化管理DIGITALIZED HOSPITAL MANAGEMENT

引言

随着越来越多的复杂性治疗内镜进入传统的外科领域, 内镜接触人体血液机会增多。由于内镜材料特殊、管腔细长、结构复杂，不宜采用高温高压灭菌，造成了清洗消毒困难，又因其使用频率高、价格昂贵致配备不足等特点[1-3]，因此给院感带来严峻问题：内镜相关性感染几率增加。理论上说，内镜清洗消毒不彻底，各种病原体均可通过内镜传播，美国急救研究所2015年、2017年和2018年便将内窥镜清洗消毒不充分列入了威胁患者的十大安全问题。预防内镜医源性感染的重要前提是保证清洗消毒时间[4]，但供需不平衡的结果则是挤压清洗消毒时间，而因缺乏有效手段监控，可能存在人为缩减操作时间或减少清洗步骤的现象。我院内镜中心通过对内镜清洗消毒和使用实施全程信息化追溯，有效确保了内镜的清洗消毒质量，现报道如下。

1 资料与方法

1.1 一般资料

我院内镜中心于2017年8月成立，纳入中心管理的软式内镜有胃镜、肠镜、十二指肠镜、喉镜、气管镜，其中胃镜8条、肠镜4条、十二指肠镜2条、喉镜3条、气管镜2条，全院所有软式内镜包括ICU的气管镜和手术室的胆道镜、输尿管镜均由中心采取集中清洗消毒。2017年8

内镜全程追溯系统在内镜中心清洗

消毒质量管理中的应用

刘明秀

重庆市璧山区人民医院内镜中心，重庆 402760

[摘 要] 目的 探讨全程追溯系统应用于内镜清洗消毒质量管理中的效果，进一步提升内镜的清洗消毒质量并达到有效追溯。方法 使用信息化系统对内镜测漏、清洗、漂洗、消毒、终末漂洗、干燥六个操作流程和使用进行过程监控，结合现场督查，实现对内镜清洗、消毒和使用的全程质量追溯管理，内镜清洗、消毒质量监测采用目测、ATP监测和生物学监测。结果 通过追溯记录，发现了我院内窥镜使用过程中的56次不规范洗消操作流程，并对其进行持续改进；采取143次现场督查，发现3次不规范洗消操作流程并持续改进；内镜目测、A TP监测和生物学监测合格率100%。结论应用全程追溯系统完善了内镜清洗消毒环节无缝隙闭环管理，可有效确保内镜的清洗消毒质量，从而降低内镜医源性感染，并对临床医疗安全具有举证的关键作用。[关键词] 内镜；全程追溯；内窥镜信息化管理；内镜中心；清洗消毒

Application of Endoscopic Full Traceability System in Quality Management

of Endoscope Center Cleaning and Disinfection

LIU Mingxiu

Endoscopic Center, People’s Hospital of Chongqing Bishan District, Chongqing 402760, China

Abstract: Objective To explore the effect of whole-process traceability system in the quality management of endoscopic cleaning and disinfection, so as to improve the quality of endoscopic cleaning and disinfection and achieve effective traceability. Methods The six operating procedures and process monitoring of endoscopic leak detection, cleaning, rinsing, disinfection, final rinsing and drying were conducted using the information system. Combined with on-site inspection, the whole process of cleaning, disinfection and use of the endoscope was managed retrospectively. Then, the methods of visual, A TP and biological monitoring were used to monitor the quality of endoscopic cleaning and disinfection. Results By tracing the records, we found 56 times of non-standard washing and elimination procedures during the use of endoscope in our hospital and made continuous improvement. Adopted 143 on-site inspections, we found that there were 3 times did not regulate the cleaning operation process and continued to improve. The qualified rates of endoscopic visual inspection, A TP monitoring and biological monitoring were all 100%. Conclusion Application of whole-process traceability system has improved the seamless closed loop management of endoscopic cleaning and disinfection, which can effectively ensure the quality of endoscopic cleaning and disinfection, thus reducing endoscopic iatrogenic infection. This study plays a key role in clinical medical safety. Key words: endoscopy; full trace; endoscopic information-based management; endoscopy center; cleaning and disinfection

[中图分类号] R197.3; TH776+.1 [文献标识码] C

doi：10.3969/j.issn.1674-1633.2018.11.051 [文章编号] 1674-1633(2018)11-0178-03

收稿日期：2018-07-16 修回日期：2018-08-20

作者邮箱：lmxjcj@

中国医疗设备 2018年第33卷 11期 V OL.33 No.11

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