The cleaning and disinfection of endoscopy should be carried out separately from the diagnosis and treatment of endoscopy, and separate cleaning and disinfection room and endoscopy treatment room should be set up, and the cleaning and disinfection room should be well ventilated.
Endoscopy treatment room should be equipped with diagnostic beds, suction, treatment trolley and other basic facilities. According to the needs of work, in accordance with the following requirements with the appropriate endoscopy and cleaning and disinfection equipment:
A, endoscopy and accessories: its number should be compatible with the size of the hospital and the number of patients, in order to ensure that the use of equipment before use to meet the appropriate disinfection, sterilization and qualified to protect the safety of patients.
Two, the basic cleaning and disinfection equipment: including special flow of water cleaning and disinfection tank (four or five tanks), negative pressure suction, ultrasonic cleaner, high-pressure water gun, drying equipment, timer, ventilation facilities, and the method of disinfection, sterilization methods used in the necessary disinfection, sterilization instruments, 50 ml syringes, a variety of brushes, gauze, cotton swabs and other consumables.
Three, cleaning and disinfecting agents: multi-enzyme lotion, disinfectant suitable for endoscopy, 75% ethanol. Cleaning, disinfection or sterilization of endoscopes and accessories must follow the following principles:
I. All endoscopes and accessories that enter the sterile tissues and organs of the human body or enter the sterile chambers of the human body through surgical incisions, such as laparoscopy, arthroscopy, ventriculoscopy, cystoscopy, hysteroscopy, etc., must be sterilized.
Second, all endoscopic accessories that penetrate the mucous membrane, such as biopsy forceps, high-frequency electrosurgical knife, etc., must be sterilized.
Third, where the human digestive tract, respiratory tract and other endoscopes in contact with mucous membranes, such as laryngoscopes, bronchoscopes, bronchoscopes, gastroscopes, intestinal scopes, sigmoidoscopes, proctoscopes and so on, should be sterilized in accordance with the "sterilization specifications," the requirement for a high level of disinfection.
Four, endoscopes and accessories should be cleaned, disinfected or sterilized immediately after use.
V. Disinfectants, disinfecting instruments or other disinfecting equipment used in medical institutions must comply with the provisions of the Administrative Measures for Disinfection.
VI, endoscopy and accessories cleaning, disinfection or sterilization time should be controlled using a timer.
VII, prohibit the use of non-flowing water for cleaning endoscopes. Soft endoscopes should be used immediately after the use of wet gauze to wipe off the external surface of the dirt, and repeatedly send air and water for at least 10 seconds, remove the endoscope and install a good waterproof cover, placed in a suitable container to send the cleaning and disinfection room.
Cleaning steps, methods and points include:
I. Water washing
(1) Put the endoscope into the cleaning tank:
1, rinse thoroughly under flowing water, scrub the mirror body with gauze repeatedly, and clean the operation part at the same time;
2, remove the biopsy inlet valve, the suction button and the air and water button, and brush the biopsy orifice and the guide channel thoroughly with a clean brush. Brush the biopsy orifice and the attractor pipe of the light-guiding hose thoroughly with a clean brush, the brush must be seen at both ends of the brush head, and wash the dirt on the brush head;
3, install the full pipeline irrigator, the pipeline plug, the waterproof cap and the attractor, and repeatedly suction the biopsy orifice with the attractor;
4, the full pipeline irrigator is connected to the 50ml syringe, and the water is sucked and injected into the air supply and water supply pipeline;
5, suck the biopsy orifice dry with the Suction device to suck up the water of the biopsy orifice and dry the mirror.
(ii) Rinse the removed suction button, water and air delivery button, and biopsy inlet valve with water and wipe them dry.
(iii) After use, endoscopic accessories such as biopsy forceps, cytobrush, incisional knife, guidewire, lithotripter, mesh basket, contrast catheter, and foreign body forceps, etc., are placed in clean water, and the inner surfaces of the flap and the joints are cleaned with a small brush, rinsed, and wiped dry.
(d) Cleaning gauze should be used in a single-use manner, and the cleaning brush should be sterilized once used.
II. Enzymatic washing
(I) The configuration and soaking time of the multi-enzyme washing solution is in accordance with the product instructions.
(B) the dry endoscope in the enzyme wash tank, syringe suction multi-enzyme wash solution 100 ml, rinse the air and water pipeline, with the suction device will contain enzyme wash solution into the biopsy orifice, the operation of the Department of multi-enzymatic wash with a wipe.
(C) after wiping dry the accessories, all kinds of buttons and valves soaked with multi-enzyme wash solution, accessories also need to be cleaned in the ultrasonic cleaner for 5 to 10 minutes.
(iv) The multi-enzyme wash solution should be replaced after every 1 endoscope is cleaned.
III. Cleaning
(I) After soaking the endoscope in the multi-enzyme wash solution, thoroughly rinse the tubes with a water pistol or syringe to remove the multi-enzyme wash solution and loose dirt from the tubes, and rinse the outer surface of the endoscope at the same time.
(ii) Flush each tube with a 50-mL syringe to expel water from the tube so as not to dilute the disinfectant. When 2% alkaline glutaraldehyde immersion is used for disinfection or sterilization, the cleaned and dried endoscope should be placed in the disinfection tank and completely submerged in the disinfectant, and each orifice should be filled with the disinfectant with a syringe.
The operating section of a non-total immersion endoscope must be wiped with water and then disinfected by wiping with 75% ethanol. When 2% alkaline glutaraldehyde is used to sterilize endoscopes that need to be disinfected, the immersion time is:
(a) not less than 10 minutes for gastroscopes, enteroscopes, and duodenoscopes;
(b) not less than 20 minutes for bronchoscopes;
(c) not less than 45 minutes for endoscopes that are used by patients with special infections such as Mycobacterium tuberculosis and other mycobacteria. The use of other disinfectants, automatic cleaning and disinfection equipment or other disinfection equipment, must comply with the provisions of the fifth paragraph of Article 12 of these norms, and strictly in accordance with the instructions for use.
Before using the instruments for cleaning and disinfection, the endoscope must be cleaned in accordance with the provisions of Article XV. After disinfection of soft endoscopes, they should be rinsed and dried in accordance with the following methods and steps:
I. Before the endoscopes are removed from the disinfection tank, the cleaning and disinfecting personnel should change their gloves and inject air into the lumens of the tubes with a syringe to remove the disinfecting solution.
Two, the endoscope is placed in the rinsing tank, and the outer surface of the endoscope is cleaned with gauze under flowing water, and the orifices are repeatedly pumped with water to rinse them.
Third, dry the outer surface of the endoscope with gauze, and pump the water from each orifice clean. Remove all kinds of special pipes and buttons for cleaning, and replace them with all kinds of accessories for diagnosis and treatment before they can be used for the diagnosis and treatment of the next patient.
Four, bronchoscopy after the above operation, but also need to use 75% ethanol or clean compressed air and other methods of drying. Endoscopic accessories disinfection and sterilization methods and points include:
A, biopsy forceps, cell brush, incision knife, guidewire, lithotripter, mesh basket, contrast catheter, foreign body forceps and other endoscopic accessories must be a one-use one-sterilization. The preferred method is pressure steam sterilization, can also be used ethylene oxide, 2% alkaline glutaraldehyde immersion 10 hours of sterilization, or choose to comply with the provisions of the fifth paragraph of Article XII of these norms applicable to the disinfection of endoscopy disinfectant, disinfectant equipment for sterilization, the specific methods of operation in accordance with the instructions for use.
Two, curved trays, dressing cylinders, etc. should be used pressure steam sterilization; non-disposable mouth ring can be used to high-level chemical disinfectant disinfection, such as effective chlorine content of 500 mg / L of chlorine disinfectant or 2000 mg / L of peracetic acid immersion disinfection for 30 minutes. After disinfection, rinse the residual disinfectant thoroughly with water and dry it for spare; the water injection bottle and connecting tube are disinfected by soaking in non-corrosive chemical disinfectant at a high level or above, and after disinfection, the residual disinfectant is rinsed thoroughly with aseptic water and dried for spare. The water in the injection bottle should be sterile water and be replaced every day. At the end of the daily diagnosis and treatment work, use 75% ethanol to rinse and dry each tube of the sterilized endoscope, and store it in a special clean cabinet or mirror room. The mirror body should be hung, bent angle fixation knob should be placed in the free position.
The inner surface of the storage cabinet or the inner surface of the wall of the mirror room should be smooth, no gaps, easy to clean, clean and disinfected once a week. At the end of the daily diagnosis and treatment work, the suction bottle, suction tube, cleaning tank, enzyme washing tank, rinse tank must be cleaned and disinfected, the specific methods and points include:
One, suction bottles, suction tubes are cleaned and disinfected with effective chlorine content of 500 mg/L chlorine-containing disinfectant or 2,000 mg/L peracetic acid immersion disinfectant for 30 minutes, brushed and dried for spare parts.
Second, the cleaning tank, enzyme washing tank, rinsing tank after sufficient scrubbing, with effective chlorine content of 500mg / L of chlorine disinfectant or 2000 mg / L peroxyacetic acid wipe.
Disinfection tanks must be thoroughly scrubbed when replacing disinfectant. Before the start of each day's diagnostic work, the sterilized endoscopes to be used on that day must be sterilized again. If 2% alkaline glutaraldehyde immersion is used, the disinfection time is not less than 20 minutes, rinsed and dried before being used for patient consultation.
Chapter IV Cleaning and disinfection of rigid endoscopes Steps, methods and points of cleaning of rigid endoscopes include:
I. Immediately after use, wash thoroughly with running water to remove blood, mucus and other residual substances, and wipe dry.
Two, the endoscope after drying is placed in the multi-enzyme washing solution to soak for the time according to the instructions for use.
Third, thoroughly clean all parts of the endoscope, the lumen should be thoroughly rinsed with a high-pressure water gun, the removable part must be disassembled and cleaned, and ultrasonic cleaner for 5 to 10 minutes.
Fourth, the axial section of the instrument, the curved part, the lumen of the tube with soft bristles brush thoroughly scrubbing, scrubbing care to avoid scratching the mirror surface. Rigid endoscopy disinfection or sterilization methods and points include:
I. Suitable for pressure steam sterilization of endoscopy or endoscopic components should be used pressure steam sterilization, pay attention to the endoscopy manual requirements to select the temperature and time.
Second, ethylene oxide sterilization method is suitable for sterilization of various endoscopes and accessories.
Three, can not be used to pressure steam sterilization of endoscopes and accessories can be used 2% alkaline glutaraldehyde immersion 10 hours sterilization.
Four, to meet the sterilization requirements of hard endoscopes, such as laryngoscopes, colposcopes, etc., can be used to boil sterilization for 20 minutes.
V. When disinfecting and sterilizing with disinfectant solution, instruments with axial joints should be fully opened axial joints, and the lumen of instruments with lumen should be fully injected with disinfectant solution.
VI, the use of other disinfectants, disinfection of instruments must comply with the provisions of Article 12, paragraph 5 of this specification, the specific methods of operation in accordance with the instructions for use. The use of chemical disinfectant immersion disinfection of rigid endoscopy, disinfection should be rinsed with flowing water, and then dried with sterile gauze.
Rigid endoscopes sterilized by chemical disinfectant immersion should be thoroughly rinsed with sterile water after sterilization and then dried with sterile gauze. Sterilized endoscopes and accessories should be stored in accordance with the requirements for the storage of sterile articles.
Chapter V Monitoring of the effect of disinfection and sterilization of endoscopes The concentration of disinfectant must be regularly monitored and recorded on a daily basis to ensure the effect of disinfection.
The disinfectant should not be used for longer than the period of use specified in the product specification. Sterilized endoscopy should be quarterly biological monitoring and monitoring records.
Sterilized endoscopes should be biologically monitored on a monthly basis and a monitoring record should be made.
Sterilization of endoscopes after qualifying standards for: total bacteria & lt; 20cfu / piece, can not detect pathogenic bacteria; sterilization of endoscopes after qualifying standards for: sterility test pass. The sterilization effect of endoscopy is monitored using the following methods:
(a) Sampling method: monitoring the sampling site for the internal cavity surface of the endoscope. Use a sterile syringe to extract 10ml of buffer containing the corresponding neutralizing agent, injected from the biopsy port of the endoscope to be examined, and collected from the biopsy outlet with a 15ml sterile test tube, and sent to the test in a timely manner, and detected within 2 hours.
(ii) colony counting: send the liquid with vortexer fully shaken, take 0.5ml, add 2 diameter 90mm sterile petri dishes, each petri dish were added to have melted 45 ℃ -48 ℃ nutrient agar 15 ml-18ml, pouring while shaking, wait for the agar to solidify, and then cultured at 35 ℃ for 48 hours after counting.
Results judgment: the number of colonies/mirror = the average number of colonies in 2 petri dishes × 20.
(C) pathogenic bacteria detection: the delivery of the liquid with a vortexer to fully shake, take 0.2ml were inoculated with 90mm blood dishes, Chinese orchid petri dishes and SS petri dishes, evenly coated, cultured at 35 ℃ for 48 hours, to observe the presence or absence of pathogenic bacteria growth.