十条建议教你预防十二指肠镜多重耐药菌感染

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2017年ESGE和ESGENA最新推荐：
十条建议教你预防十二指肠镜多重耐药菌感染



整理人：陈文森


英文标题：
Prevention of multidrug-resistant infections from contaminated duodenoscopes: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA)


中文标题：
污染的十二指肠镜多重耐药菌感染预防：欧洲消化内镜学会（ESGE）和欧洲胃肠病护士协会（ESGENA）立场声明


通讯作者：Ulrike Beilenhoff, ESGENA Scientific Secretariat, Ferdinand-Sauerbruch-Weg 16, 89075 Ulm, Germanyinfo@esgena.org


10条核心推荐：
1、应当告知患者内镜下逆行胰胆管造影（ERCP）术的益处和风险。


2、只有经过专门培训有资格认证的人员才能进行内窥镜后处理。


3、十二指肠镜制造商应该提供详细的如何使用和再处理十二指肠镜的方法说明。在对其设备进行修改的情况下，制造商应提供最新的使用说明。


4、制造商使用说明书的详细再处理方案需要清晰地列出每条内镜模式不同的再处理步骤；


5、按照制造商的使用说明，十二指肠镜应使用恰当的清洁设备。


6、只能使用专门设计的，针对特定内镜类型的一次性清洁刷，以确保最佳的清洁效果。


7、一旦内镜从患者身上取下，应进行床边清洁，然后进行泄漏检测，彻底的手动清洁步骤和自动化再处理，以便：

• 清除外部和内部表面的碎屑；
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• 预防任何体液，血液或碎屑干燥；
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• 预防生物膜形成。
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除了泄漏检查之外，还应根据制造商的使用说明进行远端视觉检查以及十二指肠镜的定期维护，以便及早发现损伤。


8、内镜清洗消毒机（EWD）整个再处理程序应根据欧洲和国际标准EN ISO 15883进行验证（我国标准：《GB 30689-2014 内镜自动清洗消毒机卫生要求》）。


9、EWD的常规技术测试应根据验证报告开展。应每三个月对部门内镜进行微生物监测，要求所有使用的内镜至少每年检测一次。在怀疑与内镜相关感染情况下，应当停止相关装置（例如，内镜，EWD），直到采取了充分的纠正措施。


10、根据国家标准和/或法律，暴发管理应多学科管理，包括内镜检查、卫生和微生物学专家，制造商和监管机构。疑似多重耐药菌（MDRO）暴发的情况下，内镜检查部门与临床医疗照护提供者之间的紧密合作是必不可少的（包括感染控制部门和医院卫生员）.


对应英文：

1、Patients should be informed about the benefits and risks of endoscopic retrograde cholangiopancreatography (ERCP)
2、Only specially trained and competent personnel should carry out endoscope reprocessing.
3、Manufacturers of duodenoscopes should provide detailed instructions on how to use and reprocess their equipment. In the case of modifications to their equipment, manufacturers should provide updated instructions for use.
4、Detailed reprocessing protocols based on the manufacturer’s instructions for use should clearly lay out the different reprocessing steps necessary for each endoscope model.
5、Appropriate cleaning equipment should be used for duodenoscopes in compliance with the manufacturer’s instructions for use.
6、Only purpose-designed, endoscope type-specific, single use cleaning brushes should be used, to ensure optimal cleaning.
7、As soon as the endoscope is withdrawn from the patient, bedside cleaning should be performed, followed by leak testing, thorough manual cleaning steps, and automated reprocessing, in order to:

• Remove debris from external and internal surfaces;
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• Prevent any drying of body fluids, blood, or debris;
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• Prevent any formation of biofilms.
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In addition to the leak test, visual inspection of the distal end as well as regular maintenance of duodenoscopes should be performed according to the manufacturer’s instructions for use, in order to detect any damage at an early stage.
8、The entire reprocessing procedure in endoscope washer disinfectors (EWDs) should be validated according to the European and International Standard, EN ISO 15883.
9、Routine technical tests of EWDs should be performed according to the validation reports. Microbiological surveillance of a proportion of the department’s endoscopes should be performed every 3 months, with the requirement that all endoscopes used in the unit are tested at least once a year. In the case of suspected endoscopy-related infection, the relevant device (e. g., endoscope, EWD) should be taken out of service until adequate corrective actions have been taken.
10、Outbreaks should be managed by a multidisciplinary team, including endoscopy, hygiene, and microbiology experts, manufacturers, and regulatory bodies, according to national standards and/or laws. In the case of suspected multidrug-resistant organism (MDRO) outbreaks, close cooperation between the endoscopy unit and the clinical health provider is essential (including infection control departments and hospital hygienists).

图文：朱迪