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Since the promulgation of the endoscopic cleaning and disinfection specifications, glutaraldehyde disinfectant has been widely used in the cleaning and disinfection of gastroscopes, and is clinically recognized as an efficient, low-corrosion, stable sterilizing agent and disinfectant, and its disinfection effect has been clinically confirmed.[1]. However, due to the toxicity of glutaraldehyde disinfectant itself and improper use, the long-term or short-term harm to the health of medical staff and patients occurs from time to time, and many problems in endoscopic disinfection are gradually exposed.[2]. Therefore, the search for a safer and more efficient disinfectant has been the concern of clinical researchers.[3]. The author adopts2%Two schemes of alkaline glutaraldehyde and phthalaldehyde for gastroscope disinfection have achieved good results, which are reported as follows.

data and method

1. General Information

SelectFrom January 2013 to January 2014, 120 cases of gastroscopy after gastroscopy as the research object, according to the different

control group and observation group, each60 cases. The control group was disinfected with 2% alkaline glutaraldehyde, and the observation group was disinfected with o-phthalaldehyde. The gastroscope models used in the two groups were the Olympus Olympus electronic gastroscope colonoscopy model. The control group underwent gastroscopy in 61 patients, 32 males and 28 females, aged 36.4~55.2 years old, with an average age of (42.1±3.4) years old. In the observation group, 31 males and 29 females, aged 35.4~56.7 years old, with an average age of (41.8±3.1) years old. Both groups of patients were gastroesophageal refluxpatients, by statistical analysis, no significant difference(P> 0.05), which can be compared.

2. Cleaning Disinfectant Source

2% alkaline glutaraldehyde is produced by Shanghai Medical Institute Pharmaceutical Co., Ltd.;pHValue is7.45; The multi-enzyme cleaning agent is a full-effect multi-enzyme cleaning agent produced by Hangzhou Ruvov Company.

3. disinfection method

Each gastroscope is strictly in accordance with the Technical Specification for Cleaning and Disinfection of EndoscopesThe operations set out in [4] require cleaning, enzyme washing, disinfection, rinsing, and drying.

1. Cleaning

Remove the aspirator, air and water supply button and biopsy inlet valve, place the endoscope into a flowing cleaning tank for washing, and clean the mirror body repeatedly with sterile gauze. The pipes and biopsy channels of the aspirator shall be thoroughly scrubbed with a cleaning brush to remove the dirt completely. After the pipeline is cleaned, connect the whole pipeline perfusion device, and use high-pressure water gun to continuously flush the biopsy pipeline and air and water supply pipeline.

2. enzyme washing

The cleaned gastroscope is soaked in the prepared multi-enzyme cleaning solution, and the biopsy pipeline and air and water supply pipeline are washed with the multi-enzyme cleaning solution by syringe suction. Soak2After minutes, use a high-pressure water gun to thoroughly clean each pipe, and clean the surface of the endoscope with gauze under flowing water. Finally, use a syringe to flush each pipe to drain the water from the pipe.[5]。

3. Disinfection

The cleaned endoscopes were placed in a stock solution containing o-phthalaldehyde or containing2In the disinfection tank of% alkaline glutaraldehyde, use a syringe to suck the disinfectant to fill each hole. control group soaking10min, the observation group soaked5min.

4. Rinse

Using sterile gloves, the operator places the endoscope in the bath and injects air into each lumen to remove residual disinfectant solution. Use a syringe to repeatedly suck alkaline water to wash the disinfectant in the inner cavity of the endoscope, wipe it clean with alkaline water gauze, clean the surface of the gastroscope with gauze in flowing water, and flush each channel with a high-pressure water gun.[6]。

5. Dry

After cleaning, the endoscope is placed on the drying table, the surface of the gastroscope is dried with sterile gauze, and the water in each channel is dried with a high-pressure air gun.

4. acquisition method

The inner cavity surface of the endoscope is used as the monitoring site, and10mLThe neutralizer is injected from the entrance of the biopsy hole, paying attention to the sterile operation, and collecting the neutralizer in the sampling tube at the exit. The collected sample liquid shall be submitted for inspection in time after being fully mixed and evenly, and the viable count and pathogenic bacteria shall be detected.

5. detection method

1. Colony count

Use the whirlpool to fully oscillate the detection sample liquid, and then take it.0.5mLJoin2Only the diameter is90mmof sterile plates, each plate is added at a temperature45~48tNutrient Agar15~18mL, while pouring shake, such as agar solidification, in35tcultivation48hAfter counting. number of colonies/Mirror = Average of 2 plate colonies multiplied20.

2. Pathogenic bacteria detection

Take another0.2mLThe test sample solution was inoculated on90mmofSSPlate, Chinese blue plate, blood plate, evenly smear and place35tCultivate in the environment48hObserve the growth of pathogenic bacteria.

6. evaluation criteria

The disinfection of gastroscope conforms to the standard and refers to the technical specification for cleaning and disinfection of endoscopes.The number of bacterial colonies is less<20(cfu/piece), no pathogenic bacteria growth is qualified.

7. statistical processing

UseSPSS15.0 software for statistical processing, counting data expressed in%, meters.X2Inspection, measurement dataX±sIndicates that the meter is tested..P<0.05 was considered statistically significant.

Results

Comparison of disinfection effect and disinfection time between two 1. groups

Disinfection pass rate of two groups were100The observation group and the control group in the disinfection effect is consistent, the difference is not statistically significant.(P> 0.05); the disinfection time of the observation group was 5min, lower than the control group's10min, the difference is significant(P<0.05)。

Comparison of working efficiency of gastroscope between two 2. groups

The work efficiency of the observation group (appointment time, disinfection endoscopy) was better than that of the control group, and the difference was significant (P<0.05), with statistical significance. The appointment time of the observation group is (8.25±2.12)dCompared with the control group, it took less time, and the number of sterilized endoscopes was (117.25±6.35)/d, much larger than the number of sterilized endoscopes in the control group, indicating that the efficiency of the observation group is higher than that of the control group, as shown in the table.1.

Discussion

Due to the rapid development of minimally invasive technology, endoscopic diagnosis and treatment technology has been widely carried out in major hospitals, and the number of patients receiving endoscopic diagnosis and treatment has also increased.[7]. The material of digestive endoscopy is special, with complex structure and high precision, and its disinfection after use

The work is very difficult. However, if digestive endoscopy is not effectively and thoroughly disinfected, it will affect the medical safety of patients and pose a threat to their health. There are scholars[8] Through investigation, it is found that the main microorganisms contaminated by endoscopes are hepatitis B virus, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, etc. Therefore, high-efficiency disinfectants are selected to further strengthen the cleaning, disinfection and sterilization of endoscopes. It is of great significance to prevent and eliminate iatrogenic cross-infection caused by unqualified endoscopic disinfection quality and ensure the safety of patient diagnosis and treatment. This study120cases of gastroscopy after gastroscopy as the research object, respectively, using2% alkaline glutaraldehyde and o-phthalaldehyde for disinfection, the results showed that the observation group (o-phthalaldehyde) and the control group of disinfection pass rate were100%, and there was no pathogenic bacteria growth after disinfection, the disinfection effect of the two groups was compared, the difference was not statistically significant.(P> 0.05), but the disinfection time and work efficiency of the observation group were better than those of the control group, and the difference was significant.（P<0.05). It shows that the disinfection effect of o-phthalaldehyde and glutaraldehyde has no obvious difference, but the former has the advantage of time. Shi Yuyuan et al [9] Scholars have also shown that there is no significant difference between the disinfection effect of o-phthalaldehyde and glutaraldehyde, but the former can shorten the disinfection time and relieve the supply pressure of endoscopes. This study is basically consistent with its conclusions. This isSince o-phthalaldehyde is inpHValue is7.5,and the concentration isA light blue clear liquid at 0.55 percent [10].It can form a strong protective barrier when it interacts with the bacterial cell wall.,With anti-penetration effect,Can lead to abnormal material exchange function inside and outside the cell,Causes the normal physiological function of the bacteria to fail to function properly,thereby promoting cell death[11].and the formation of o-phthalaldehyde in water is different from that of glutaraldehyde,Phthalaldehyde is dissolved in water as a single molecule,Under the same concentration,The number of free aldehydes of o-phthalaldehyde is much higher

2% of glutaraldehyde,Therefore, o-phthalaldehyde can effectively play a disinfection,The role of sterilization.In addition,

o-phthalaldehyde at room temperature5minA high level of disinfection can be achieved in the case,And2% of glutaraldehyde is required10minAbove,In this group of research are reflected[12].Endoscope disinfection for one person disinfection,Using o-phthalaldehyde disinfection can significantly shorten the disinfection time of gastroscope,Relieve the supply pressure of gastroscope.In addition,Phthalaldehyde almost no smell,No irritation to the skin and mucous membranes,Its chemical properties are stable.While glutaraldehyde is highly irritating,on human skin,Mucosal irritation,Especially on the respiratory tract mucosa of the strong stimulation[13-14].Therefore, clinical rational application of o-phthalaldehyde and E

Dialdehyde can effectively improve work efficiency.To sum up the above,2% alkaline glutaraldehyde and o-phthalaldehyde have good disinfection effect for gastroscope disinfection,Its disinfection qualified rate is high,But the phthalaldehyde is more2Short disinfection time of% glutaraldehyde;The rational use of the two can significantly improve the performance of the work.,Relieve pressure on endoscopic supply.