313所医疗机构十二指肠镜和线阵超声内镜微生物学监测现状

Microbiological monitoring status of duodenoscopes and linear array ultrasound endoscopes in 313 medical institutions

摘要:

目的 调查分析中国十二指肠镜和线阵超声内镜微生物学监测现状及存在的问题。 方法 采用便利抽样法, 采用《十二指肠镜和线阵超声内镜微生物学监测现状调查问卷》对全国313所医疗机构消化内镜中心的十二指肠镜和线阵超声内镜微生物学监测的执行情况、监测频率、采样方法, 以及结果判定等方面进行问卷调查。 结果 313所三级医疗机构覆盖27个省级行政区。97.76%的医疗机构对十二指肠镜和线阵超声内镜进行微生物学监测, 监测频率主要为每月监测1次(分别为49.32%、44.10%)和每季度监测1次(分别为44.22%、46.58%), 检测数量以全部检测(分别为52.72%、45.34%)和按比例轮换抽检(分别为34.69%、43.48%)为主。大部分医疗机构对十二指肠镜和线阵超声内镜腔道进行活检腔道采样(分别为91.50%、93.79%), 采样方法多为普通冲洗法(分别为83.22%、78.48%), 泵辅助采样法(分别为8.39%、11.39%)和刷辅助采样法(分别为5.59%、5.70%)占比较少。大部分医疗机构对十二指肠镜和线阵超声内镜的特殊结构抬钳器采样(分别为82.99%、85.71%), 采样方法主要为冲洗法(分别为56.15%、52.17%); 65.99%的医疗机构对十二指肠镜先端帽采样, 采样方法主要为拭子法(54.12%)。十二指肠镜和线阵超声内镜微生物学监测结果判定, 分别有60.20%、58.39%的医疗机构以活检腔道微生物数量判断, 其余医疗机构以多个腔道(部位)中最高微生物数量(分别为26.87%、29.19%)或多个腔道(部位)的微生物数量相加(分别为12.93%、12.42%)作为结果判定指标。 结论 中国医疗机构对十二指肠镜和线阵超声内镜微生物学监测的规范性和执行力有待提高, 临床实际操作中需建立针对十二指肠镜和线阵超声内镜的监测规范及检测标准, 以更好地推进内镜质量监测的有效实施与执行。

Abstract:

Objective To analyze the current status and existing problems of microbiological monitoring on duodenoscopes and linear array ultrasound endoscopes in China. Methods A convenience sampling method was used to conduct a questionnaire survey, titled "Questionnaire on the Current Status of Microbiological Monitoring of Duodenoscopes and Linear Array Ultrasound Endoscopes", among digestive endoscopy centers in 313 medical institutions (MIs) nationwide. The survey covered the implementation of microbiological monitoring, monitoring frequency, sampling methods, and result determination. Results The 313 tertiary MIs cover 27 provincial-level administrative regions. 97.76% of MIs performed microbiological monitoring on duodenoscopes and linear array ultrasound endoscopes, with monitoring frequency mainly being once a month (49.32%, 44.10%, respectively) and once a quarter (44.22%, 46.58%, respectively). Either full inspections (52.72%, 45.34%) or proportionately sampled inspections on a rotational basis (34.69%, 43.48%) were performed. Most MIs conducted biopsy channel sampling for duodenoscopes and linear array ultrasound endoscopes (91.50%, 93.79%, respectively), with common flushing method (83.22%, 78.48%, respectively) being the most common. Pump-assisted sampling (8.39%, 11.39%, respectively) and brush-assisted sampling (5.59%, 5.70%, respectively) were less used. Most MIs performed sampling of forceps with special structure for duodenoscopes and linear array ultrasound endoscopes (82.99%, 85.71%, respectively), primarily using the flushing method (56.15%, 52.17%, respectively). 65.99% of the MIs sampled the distal caps of duodenoscopes, with swab sampling (54.12%) being the primary method. For the determination of microbiological monitoring results of duodenoscopes and linear array ultrasound endoscopes, 60.20% and 58.39% of MIs used the quantity of microorganisms in the biopsy channel as the judgement criteria, while other MIs used the highest microbial number among multiple channels (sites) (26.87% and 29.19%, respectively) or the sum of microbial number in multiple channels (sites) (12.93% and 12.42%, respectively). Conclusion The standardization and implementation of microbiological monitoring on duodenoscopes and linear array ultrasound endoscopes in Chinese MIs need to be improved. In clinical practice, it is necessary to establish monitoring standards and detection criteria for duodenoscopes and linear array ultrasound endoscopes, so as to promote the effective implementation of endoscopy quality monitoring.