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With the continuous development of endoscopic diagnosis and treatment technology,Fiberoptic bronchoscopy and treatmentAs a minimally invasive diagnosis and treatment technology has been more and more widely used in clinical,There areResearch Report,Infection due to endoscopy is approximately 0． 8%［1］ ,Therefore strengthen the fiber bronchoscopeDisinfection and management is an important measure to prevent and control hospital infection.In order to protect patients Medical safety of the person,Ministry of Health 2004 Promulgated in《Technical Operation Rules for Cleaning and Disinfection of EndoscopeFan》，Cleaning and disinfection of fiberoptic bronchoscope tends to be standardized,At present, the main disinfection of fiberoptic bronchoscope in ChinaUsing glutaraldehyde( Glutaraldehyde,GTA) soaking method,Glutaraldehyde is toxic,Stabexcitable,allergenicity,to the staff,The patient's health and environment are at risk.Harms［2 － 3］ .o-dicarboxaldehyde( Ortho － phthalaldehyde,OPA) as a newType of high level disinfectant,Safer than glutaraldehyde,Faster,More efficient,More gentle,More durable［4］ The advantage,1999 YearOPA has passed the United States FDA Certification,But...Due OPA relatively high price,Still not widely used in the country,This study envisages that eachDay 7 Hourly working time under maximum load operation OPA and GTA to fiber branchThe cost of disinfection of mirrors for disinfection,Endoscopic turnover rate,Medical income generation and impact on staff Comparative analysis of health effects,For domestic promotion and use OPA Provide basis.

Materials and Methods

1．1  Materials

o-phthalaldehyde; Glutaraldehyde; Five slots for manual cleaning and disinfection of endoscopes; This House ICU,

Fiberoptic bronchoscope for operating room.

  1．2    Method 

1． 2． 1  Grouping method  experimental group: Use OPA soaking disinfection,control group: Use GTAsoaking disinfection.

1． 2． 2  Fiberoptic bronchoscope disinfection method  According 2004 Department of Health in《Cleaning and disinfection of endoscopesTechnical Operation Specification》Five-slot manual cleaning and disinfection method is required.: Leak detection 2 min→Initial Wash 2 min→enzyme washing 3 min→Cleaning 2 min→Disinfection( GTA 20 min,OPA 5 min) →Final wash 2 min→Drying 1 min.

1． 2． 3  Calculation method of total turnaround time for each fiberoptic bronchoscope  Manual processing of total turnoverBetween = Handover leakage detection time 2 min + Manual cleaning and disinfection time + Delivery time 10 min.

1． 2． 4  The calculation method of the total number of disinfection in the month  in daily 7 Hours of workto calculate,Total number of bars per month = ( 7 × 60 min / Total turnaround time per strip) × 30.

1． 2． 5  Calculation method of monthly increase of fiberoptic turnover rate  Monthly increase in fiberoptic weekTurn rate =(MonthOPA Total number of group disinfection － MonthGTA Total number of group disinfection)/ MonthGTATotal number of group disinfection ×100% 。

1． 2． 6  Calculation Method of Monthly Maximum Medical Income  Fiberoptic bronchoscopy treatment charges in our hospital 250Yuan/ Every time,Maximum monthly medical income generation =Maximum total number of disinfection ×Each treatmentFee.

1． 2． 7  The calculation method of the maximum number of monthly disinfectant replacement.  According to literature reports,No.Manual cleaning by replacing the disinfectant GTA maximum disinfection 100 cycle.,OPA maximum disinfection 225 cycle.［5］ .Maximum replacement times of monthly disinfectant =Maximum total number of disinfection per month/Maximum number of disinfection cycles without replacing disinfectant.

1． 2． 8  Calculation method of monthly maximum disinfection cost  The capacity of manual disinfection immersion pool in our department 12． 5 L; GTA 2． 5 L/ Bottle,25． 4 Yuan/ Bottle,OPA 3． 78 L/ Bottle,950 Yuan/ Bottle.Maximum monthly disinfection costs =(Disinfection soaking tank capacity/ Capacity per bottle) ×Most per month.Number of replacements ×Price per bottle.

1． 2． 9  comparison method  Comparison of the experimental group and the control group monthly highest medical income netValue,Maximum monthly net medical income-generating value =Highest monthly medical revenue generation － Monthly OPA MostHigh disinfection cost［6］ .

2． 10  Methods of investigating health effects on workers  Participation in the supply room of our hospitalfiberoptic decontamination 20 Staff members do the following survey:in use OPAand GTAEffects on the body during the process of decontamination fiberoptic bronchoscopy:①Irritation of the respiratory tract is obvious,LightMicro,No three options;②The eye irritation is obvious,Slight,No three options;③SkinHave skin allergy,No two options.

2. Results

1 Total turnaround time per fiberoptic bronchoscopeexperimental group: Handmade OPA Group each 27 min; control group: Handmade GTA Group each42 min.

2． 2  Maximum total number of disinfection per monthexperimental group:Handmade OPA group disinfection 450 Article;control group:Handmade GTAgroup disinfection300 Article.

2． 3  Monthly increase in fiberoptic turnover(450 － 300) /300×100%=50%.

2． 4  Maximum monthly medical income generationexperimental group:Handmade OPA Group Income 112 500 Yuan;control group:Handmade GTA GroupIncome generation 75 000 Yuan.

2． 5  The maximum number of times the disinfectant needs to be replaced per month.experimental group:Handmade OPA Group Change 2 Times;control group:Handmade GTA Group Change 3 Times.

2． 6  Maximum monthly disinfection costsexperimental group:Handmade OPA Composition 6 650 Yuan(Cost of test strips included) ;ControlGroup:Handmade GTA Composition 381 Yuan +120 Yuan(Test paper cost)=501 Yuan.

2． 7  Comparison of resultsexperimental group:OPA Group's highest monthly net medical income-generating value. =112 500 － 6 650 =105 850 Yuan;control group GTA Group's highest monthly net medical income-generating value. =75 000 －501 =74 499 Yuan,experimental group OPAThe highest monthly net medical income-generating value in the group was the control group.of 1． 4 Times,See Table for comparative data 1.

2.  8 Findings on health effects of staffSee Table 2。

3.Discussion

1   The results of this study show that OPA Although the price per bottle is significantly higher GTA,But...Due to long-lasting performance,Manual cleaning without replacing disinfectant GTA maximum disinfection 100 a followRing,OPA maximum disinfection 225 cycle.; rapid action,Each soaking disinfection only 5 min,OPA Can effectively kill the vast majority of microorganisms,5 min Killing tolerance 2%Mycobacterium glutaraldehyde,Especially the strains of Mycobacterium turtle［7］ ,Increase monthly.fiberoptic bronchoscope turnover rate 50% ，and use OPA Soak disinfection medical income-generating net ratio makesUse GTA disinfection to improve 42% 。

 2  Use of staff health impact survey data Rank Test Inspection,Results show: ①Irritation of the respiratory tract ( Z = － 4． 185,p ＜ 0． 05) there are statistical differences: MakeUseOPA When 90% Personnel feel slight,10% No feeling,while using GTA When 95% Personnel feel obvious,5% Feel slight.②Irritation of the conjunctiva of the eye ( Z = － 4． 072, p ＜ 0． 05) there are statistical differences: Use OPA When 10% Personnel feel slight,90%No feeling,while using GTA When 75% Personnel feel obvious,25% Feel slight.toThe results show that:Use GTA on respiratory mucosa,Conjunctival irritation,UseOPAAlthough there is still a slight irritation,But moreGTAThe stimulation is significantly reduced.③SkinPeritoneal laceration occurred in 26 cases,All taken Hemolock Clamping,satisfactory effect,Unturnedsurgery,No postoperative complications occurred..In addition,3DMax patch due to no need for nailscombined,Also reduces the damage of the corresponding pain triangle.Laparoscopic group of patients with postoperative painScores lower than open group,Except the incision itself is small,The use of staple-free patches also helps Reducing the incidence of postoperative discomfort and chronic pain in the groin area［12］ .

Postoperative complications are mainly acute urinary retention and chronic pain.Laparoscopy urinary retention was significantly less in the open group,May be related to the type of anesthesia and the degree of pain, The effect of open spinal epidural anesthesia on bladder contraction function and urethral sphincter is greater General anesthesia in laparoscopy,And the degree of local pain in open surgery is also heavier than that in the abdomen. endoscopic surgery,These may be the cause of postoperative acute urinary retention.Open The group also 1 Patients with fat liquefaction,Good healing after symptomatic treatment,Not outSymptoms of current infection.

Due to the use of minimally invasive instruments and differences in patch prices,Cost of treatment in the laparoscopic group Use higher than open group.due to economic considerations,Most patients still prefer open surgery, At the same time, the operation difficulty of open tension-free hernia repair is lower than that of laparoscopic surgery.,Easy to complete the standard quasi-standard treatment,More applicable to grassroots areas.Minimally invasive principle is the development of future surgery To,Clinical treatment of totally extraperitoneal laparoscopic hernia repair for bilateral inguinal hernia The effect and postoperative recovery showed a small wound.,Pain light,Fast recovery,Concurrency The advantages of less disease are worthy of recognition.,We should also strive to promote the popularization of laparoscopic technology. and application,For the majority of patients to seek maximum welfare.