软式内镜终末漂洗水每日启用前不同预排放时间水样细菌污染监测结果:一项多中心研究

Monitoring of bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use: a multicenter study

摘要:

目的 探究软式内镜终末漂洗水每日启用前不同预排放时间水样细菌污染情况,为临床选择最佳预排水时间提供参考依据。方法 2023年8—12月对江西省4所三级甲等医疗机构消化内镜中心纯化水设备生产的水,以及末端使用点不同预排放时间(预排放前,预排放1、3、5、10 min)的终末漂洗水进行现场采样,采用倾注法和滤膜法对采集后的水样进行微生物学培养,并且对不合格水样进行细菌鉴定。结果 采集48份纯化水设备生产水样, 合格率为100%。采集480份末端水样,预排放前合格率为0,预排放1、3、5、10 min合格率分别为0、 21.88%、55.21%、73.96%。 4所医疗机构不同预排放时间终末漂洗水细菌菌落数比较,差异均有统计学意义(均P＜0.001), 随着预排放时间的延长,4所医疗机构终末漂洗水细菌菌落数均呈现下降趋势。不同预排放时间终末漂洗水总体菌落数两两比较结果显示,预排放5 、10 min终末漂洗水细菌菌落数比较,差异无统计学意义(P＞0.05),其他时间点两两比较差异均具有统计学意义(均P＜0.001)。不合格水样中检出藤黄微球菌、少见贪铜菌、少动鞘氨醇单胞菌等环境污染菌。结论 随着预排放时间的延长,终末漂洗水细菌污染程度显著下降。各级医疗机构每日启用终末漂洗水需要进行预排放,预排水时间应至少持续5 min。

Abstract:

Objective To investigate the bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use, and provide reference basis for choosing the optimal pre-discharge time in clinical work. Methods From August to December 2023, the water produced by the purified water equipment of the digestive endoscopy centers of 4 tertiary first-class medical institutions in Jiangxi Province, as well as the final rinsing water at the terminal-point at different pre-discharge times (before pre-discharge, discharge of 1, 3, 5, and 10 minutes) were subjected to on-site sampling,the collected water specimens were performed microbiological cultures by pouring and filter membrane methods, unqualified water specimens were performed bacterial identification. Results 48 specimens of water produced by purified water equipment were collected, with qualified rate of 100%. 480 final water specimens were collected, with a qualified rate of 0 before pre-discharge. The qualified rates of pre-discharge at 1, 3, 5, and 10 minutes were 0, 21.88%, 55.21%, and 73.96%, respectively. Bacterial colony counts in the final rinse water with different pre-discharge times in 4 medical institutions showed statistically significant differences (all P<0.001). As the pre-discharge time increased, bacterial colony counts in the final rinse water of all four medical institutions showed a decreasing trend. The pairwise comparison of the overall bacterial colony count of the final rinse water at different pre-discharge time showed that there was no statistically significant difference in the bacterial colony count of the final rinse water at 5 and 10 minutes of pre-discharge (P>0.05), while the pairwise comparison between other time points showed statistically significant differences (all P<0.001). Environmental contaminated bacteria such as Micrococcus luteus, Cupriavidus paucula, and Sphingomonas paucimobilis were detected from the unqualified water specimens. Conclusion With the extension of pre-discharge time, the degree of bacterial contamination in the final rinse water significantly decreases. All levels of medical institutions need to pre-discharge the final rinse water daily, and the pre-discharge time should last for at least 5 minutes.