| ObjectiveWith the rising number of endoscopic examinations in hospitals,the importance of endoscopic instruments reprocessing is also increasing.Issues regarding endoscopy-associate infection are serious.Endoscopic equipment cleaning thoroughly can prevent the formation of biofilm.Incomplete cleaning will affect the efficacy of endoscope disinfection or sterilization.Now the cleaning methods of the rigid endoscopes still following the specification for cleaning and disinfection of endoscopes(2004 edition).The aim of this study was to observe the cleaning effect of rigid endoscopic instruments after different cleaning methods improvement,to optimize the rigid endoscopes cleaning process,to improve the cleaning effect of rigid endoscopes and to find an effective cleaning procedure.MethodsCleaning methodsFrom September 2015 to January 2016,a total of 132 contaminated rigid endoscopes were selected randomly from urological or laparoscopic surgery and divided into 2 groups randomly.The cleaning method of the norm washing group:(standard process)washing-5min enzyme soaking and cleaning-rinsing-final rinsing-drying;the cleaning method of the pre-cleaning group: pre-cleaning-washing-5min enzyme soaking and cleaning-3min enzyme soaking and wiping-rinsing-final rinsing-drying.From February 2016 to October 2016,a total of 1650 contaminated endoscopic instruments(separated shears,separated pliers,needle-holders,bipolar forceps,Hem-o-lok pliers)were selected randomly from urological or laparoscopic surgery and divided into 5 groups randomly.Every group has 66 separated shears,66 separated pliers,66 needle-holders,66 bipolar forceps,66 Hem-o-lok pliers.The cleaning method of the norm washing group:(standard process)washing-5min enzyme soaking and cleaning-5min ultrasonic cleaning-rinsing-final rinsing-drying.The cleaning method of the ultrasonic cleaning and spraying group: washing-5min enzyme soaking and cleaning-5min ultrasonic spray cleaners cleaning-rinsing-final rinsing-drying.The cleaning method of the ultrasonic cleaning and spraying & oil soaking and boiling group: washing-5min enzyme soaking and cleaning-5min ultrasonic spray cleaners cleaning-10 min soaking in oil and boiling-rinsing-final rinsing-drying.The cleaning method of the automated washer-disinfector cleaning group: washing-5min enzyme soaking and cleaning-5min ultrasonic cleaning-rinsing-automated washer-disinfector cleaning-drying.The cleaning method of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group: washing-5min ultrasonic spray cleaners cleaning-rinsing-automated washer-disinfector cleaning-drying.Using 10 x magnifier visual inspection with light source and Residual protein test and ATP bioluminescence detection detect the cleaning effect of rigid endoscopic instruments.Assess the value of three monitoring methods.Statistical methodsUsing Microsoft office excel 2007 for data collection.Statistical analyses were performed using IBM SPSS statistics 23.0 software.T test or Mann-Whitney U test for 2 independent samples.Friedman rank test for related samples.Qualitative data by chi-square test.Kruskal-Wallis H test for k independent multiple samples.The significance level for statistical difference was 5%(P=0.05).Results1.The cleaning effect of two differents rigid endscopes cleaning methods: detecting by Residual protein: the compliance rate of the norm washing group was 69.70%(46/66),the pre-cleaning group compliance rate was 84.85%(56/66),there was statistical significance between the norm washing group and the pre-cleaning group(P<0.05);the results of the detection with ATP bioluminescence indicated that the compliance rate of the norm washing group was 80.30%(53/66).The pre-cleaning group compliance rate was 92.42%(61/66),there was statistical significance between the norm washing group and the pre-cleaning group(P<0.05).2.The cleaning effect of five different endoscopic instruments cleaning methods: detecting by 10 x magnifier visual inspection with light source: the compliance rate of the norm washing group was 91.52%(302/330),the compliance rate of the the ultrasonic cleaning and spraying group was 93.94%(310/330),the compliance rate of the ultrasonic cleaning and spraying & oil soaking and boiling group was 96.06%(317/330),the compliance rate of the automated washer-disinfector cleaning group was 97.58%(322/330),the compliance rate of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group was 98.18%(324/330);detecting by Residual protein: the norm washing group compliance rate was 77.88%(257/330),the compliance rate of the ultrasonic cleaning and spraying group was 85.76%(283/330),the compliance rate of the ultrasonic cleaning and spraying & oil soaking and boiling group was 87.27%(288/330),the compliance rate of the automated washer-disinfector cleaning group was 93.03%(307/330),the compliance rate of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group was 94.24%(311/330);the results of the detection with ATP bioluminescence indicated that the norm washing group compliance rate was 83.33%(275/330),the compliance rate of the ultrasonic cleaning and spraying group was 86.97%(287/330),the compliance rate of the ultrasonic cleaning and spraying & oil soaking and boiling group was 87.58%(289/330),the compliance rate of the automated washer-disinfector cleaning group was 94.55%(312/330),the compliance rate of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group was 95.45%(315/330).3.The comparison of cleaning effect of 5 cleaning methods: detecting by 10 x magnifier visual inspection with light source: the compliance rate of the automated washer-disinfector cleaning group,the compliance rate of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group compared with the norm washing group,there was statistical significance(P<0.05);detecting by Residual protein: the compliance rate of the other intervention groups compared with the norm washing group,there was statistical significance(P<0.05),and the compliance rate of the automated washer-disinfector cleaning group,the compliance rate of the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group was higher than the ultrasonic cleaning and spraying group,there was statistical significance(P<0.05);the results of the detection with ATP bioluminescence: the compliance rate of the automated washer-disinfector cleaning group and the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group was higher than the norm washing group,higher than the ultrasonic cleaning and spraying group,higher than the ultrasonic cleaning and spraying & oil soaking and boiling group,there was statistical significance(P < 0.05).There was not statistical significance between automated washer-disinfector cleaning group and ultrasonic cleaning and spraying & automated washer-disinfector cleaning group(P>0.05).4.The comparison of detection effect of 3 detection methods: The positive detection rates with 10 x magnifier visual inspection with light source was 4.26%(76/1782);the positive detection rates with Residual protein test was 13.13%(234/1782);the positive detection rates with ATP bioluminescence detect was 10.66%(190/1782),the positive detection rates with Residual protein test were significantly higher than those with 10 x magnifier visual inspection with light source,there was statistical significance(P < 0.05).The positive detection rates with ATP bioluminescence detect were significantly higher than those with 10 x magnifier visual inspection with light source,there was statistical significance(P<0.05).There was not statistical significance between ATP bioluminescence detect and Residual protein test(P>0.05).5.There was significant difference between the endoscopic instruments cleaning effect.Detecting by 10 x magnifier visual inspection with light source: the compliance rate of the separated shears(98.18%)was higher than the compliance rate of bipolar forceps(93.03%),there was statistical significance(P<0.05);detecting by Residual protein: the separated shears compliance rate was 93.03%(307/330),the compliance rate of bipolar forceps was 83.63%(276/330),the compliance rate of separated pliers was 85.45%(282/330),the compliance rate of the separated shears was higher than the others,there was statistical significance(P < 0.05);the results of ATP bioluminescence detection: the separated shears compliance rate was 95.76%(316/330),the compliance rate of separated pliers was 86.36%(285/330),the compliance rate of bipolar forceps was 86.97%(287/330),the compliance rate of Hem-o-lok pliers was 87.58%(289/330),the compliance rate of the separated shears was higher than the others,there was statistical significance(P<0.05).6.There was significant difference between different endoscopic instruments cleaning methods.Two different rigid endoscopes cleaning methods: The norm washing group it takes(7.517±0.149)min.The pre-cleaning group it takes(11.333±0.22)min,there was statistical significance(P<0.05);five different endoscopic instruments cleaning methods,The norm washing group: it takes(21.85±1.417)min,the ultrasonic cleaning and spraying group: it takes(21.80 ± 1.449)min,the ultrasonic cleaning and spraying & oil soaking and boiling group: It takes(31.94±1.424)min,the automated washer-disinfector cleaning group: It takes(33.73±1.431)min,the ultrasonic cleaning and spraying & automated washer-disinfector cleaning group: It takes(27.82±1.122)min.There was statistical significance(P<0.05).They spend much more money on cleaning endoscopic instruments which in the intervention groups.Conclusion1.Pre-cleaning and enzyme soaking and wiping can improve the rigid endoscope cleaning quality.The application of the ultrasonic spray cleaners and automated washer-disinfector cleaning instead of 5min enzyme soaking and 5min ultrasonic cleaning can improve the cleaning effect.2.Detection methods of cleaning quality of rigid endoscopes: Compared with the 10 x magnifier visual inspection with light source and the Residual protein test,the ATP bioluminescence monitoring method is objective and the detection speed is fast. |
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