中国经食道超声心动图探头清洗消毒指南出炉

2020-06-05 循环 中国循环杂志

经食道超声心动图(TEE)在临床常用,但探头“金贵”,清洁消毒不规范会损坏探头,消毒不够会潜存安全隐患,怎样更好清洗消毒?

经食道超声心动图(TEE)在临床常用,但探头“金贵”,清洁消毒不规范会损坏探头,消毒不够会潜存安全隐患,怎样更好清洗消毒?

近日发表在我刊的《中国经食道超声心动图探头清洗消毒指南》带来了规范和标准。

清洗

首先在经食道超声心动图检查结束后,断开探头与设备的连接,去除探头保护套,在流动水下冲洗探头,然后应用含酶清洁剂或普通清洁剂浸泡探头镜身5~10 min,使用流动水彻底冲洗或刷洗探头镜身以清除残留的清洁剂,用一次性干纱布擦干。

操作部用一次性湿纱布擦拭后直接用一次性干纱布擦干。最后使用蒸馏水再冲洗一遍镜身,完毕后用一次性干纱布擦干探头顶端及管体。操作部用一次性湿纱布擦拭后直接用一次性干纱布擦干。

消毒

经食道超声心动图探头顶端及管体部分需高水平消毒,高温、环氧乙烷、紫外线、过氧化氢等离子体低温灭菌、低温甲醛蒸汽灭菌均不适宜。可用的方法见表1:

表1 经食道超声心动图探头常用的高水平消毒及使用方法

操作柄、连接导线、插座部分需低水平消毒,消毒剂包括:季铵盐类消毒剂和双胍类消毒剂。

注意不可将消毒剂直接喷在手柄或连接器上。不可让任何液体进入手柄或操纵装置,也不可让任何液体通过电接触面、保护套、连接器外壳或锁定杆手柄周围的区域进入连接器。

自动内镜处理器(AER)可将探头浸没,避免手柄、线缆及插头接触液体(因此这些部分需要手工消毒)。如果条件允许,推荐使用专用 AER。此外,由于 AER 也可能成为污染源,每天使用之前,需要对 AER 设备进行消毒。

被感染朊病毒患者或疑似感染病毒患者高度或中度危险组织污染的 TEE 探头采用 10 000 mg/L 的含氯消毒剂或 1 mol/L 氢氧化钠溶液擦拭或浸泡消毒,至少作用 15 min,并确保所有污染表面均接触到消毒剂。操作完成后,按常规高水平消毒和灭菌程序处理 TEE 探头。

气性坏疽污染,应先采用含氯或含溴消毒剂1 000~2 000 mg/L 浸泡 30~45 min。有明显污染物时应采用含氯消毒剂 5 000~10 000 mg/L 浸泡至少60 min 后,再按常规高水平消毒和灭菌程序处理。

注意使用的清洁剂、消毒剂应每次更换。每次处理工作结束后,应立即消毒清洗器具,更换个人保护用品,进行洗手和手消毒。

储存与维护

每日首次使用经食道超声心动图探头之前,用清洁的自来水(水质符合 GB5749 规定,并保证细菌总数≤ 10 CFU/100 ml)、纯化水(生产纯化水的滤膜孔径应≤ 0.2 μm,并定期更换 )、无菌水(经过灭菌工艺处理的水 )清洗探头并干燥。

暂时不使用经食道超声心动图探头时,应把探头放置在机器侧方的支架上,或者放置在固定牢靠、清洁的墙壁挂架上。当日不用者,消毒储存柜中存放。

管理规范

指南还指出,经食道超声心动图检查室与清洗消毒室应分开。

此外,强调指南经食道超声心动图探头管理应做好质量监测、并做好质控过程记录与可追溯要求。

质量监测包括探头清洗质量监测、使用中消毒剂浓度监测、探头消毒质量监测、手卫生和环境消毒质量监测。

质控过程记录与可追溯要求包括记录每件经食道超声心动图探头的使用及清洗消毒情况、使用中消毒剂浓度及染菌量的监测结果、探头的生物学监测结果、留存探头清洗消毒机运行参数打印资料、记录手卫生和环境消毒质量监测结;记录应具有可追溯性,消毒剂浓度监测记录的保存期应≥6个月,其他监测资料的保存期应≥3年。

遇可疑经食道超声心动图 检查引起的感染,必须记录并报至本机构负责感染控制的部门,相关的卫生行政机构,超声仪器生产厂家、消毒剂生产厂家或自动清洗消毒机生产厂家。

来源:经食道超声心动图临床应用的中国专家共识专家组. 中国经食道超声心动图探头清洗消毒指南. 中国循环杂志, 2020, 35: 419-426.

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    2020-06-07 huperzia
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