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内镜消毒

Author
George W Meyer, MD, MACP, MACG
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
胡益群, 副主任医师，副教授

引言

虽然已发现内镜设备可造成感染传播，但原因似乎基本上都是设备清洁和消毒过程中出现差错或一般感染控制方法发生问题[1-3]。

本专题将讨论可能会在胃肠道内镜操作过程中传播的感染因子，并概述各个学会对胃肠道内镜清洁和消毒做出的推荐。

感染的风险

乙型肝炎 — 曾有一名患者在内镜检查后被传染了乙型肝炎病毒[4]。在一名已知有慢性乙型肝炎的患者行内镜检查的第二日，一名女性患者也用同一内镜进行了检查，结果在检查后96日发生乙型肝炎感染，最终顺利恢复。还有其他患者在第一名乙肝患者检查后的第3、4、5日用同一内镜进行检查，但未发生乙型肝炎。当时(1980年)的内镜不能完全浸没在液体中，而且气/水通道没有专门用戊二醛处理[2]。自20世纪80年代起，内镜的设计就变得越来越简单且更容易清洁。1980年前后的几项报道表明，适当的清洁和消毒可以充分清除内镜中的乙型肝炎病毒[5-7]。

丙型肝炎 — 一些病例报道证实，丙型肝炎病毒(一种RNA病毒)能通过内镜传播[8-10]。两名患者在结肠镜检查后被传染丙型肝炎[8]，还有一名患者在内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)后遭到传染[10]。导致上述两例结肠镜后传染的结肠镜没有以推荐的持续时间进行消毒，而且有可能是传染源的活检钳虽然进行了清洁但并未消毒[9]。还有研究发现丙型肝炎的传播率在内镜活检患者中有所增加[11]。

对有丙型肝炎病毒污染的内镜适当消毒能有效消除传播风险[12,13]。在一项报道中，按照现行美国胃肠内镜学会(American Society for Gastrointestinal Endoscopy, ASGE)指南处理内镜后未出现确证的丙型肝炎传播病例[14]。

                                

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-15.
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