Main Problems And Solving Strategy Existing In Implementing 《Technical Regulation For Cleaning And Disinfection Of Endoscope (2004 Edition)》

Research background and objectiveAlong with development of modern science, there are advantages such as little wound, slight pain and good direct viewing character for all kinds of endoscope to be used in therapy course, with application field continuously widened, especially it displays prominent effect in micro-incisive surgery with continuously increased clinical demand. Though there has been continuous improvement in aspects such as accuracy degree, technical performance, function, and use for manufacturing endoscope, many parts are not resistant to high temperature and afraid of corrosion, which brings challenge for disinfection after use. How to strength use and management of endoscope, guarantee disinfection and sterilizing quality, ensure medical safety and prolong use life of endoscope is a realistic problem for users of endoscope, persons carrying out disinfection and sterilization, management persons of infection in hospital to face. Therefore, National Institute of Health organized corresponding experts to carry out investigation on disinfection situation of endoscope in two cities and one provincial hospital in 2001 and came on《Technical regulation for Cleaning and Disinfection of Endoscope (2004 edition)》on June 1, 2004 (hereinafter called《regulation》for short).Basic requirement, rule, and procedure for cleaning, disinfection andsterilization of endoscope and accessories are put forward in the《regulation》. And it has been implemented for 3 years according to the《regulation》in hospitals. How about the compliance for hospital to implement the《regulation》and whether it can be implemented completely according to《regulation》? If it can not be implemented according to《regulation》, what is the reason? If analyzing the reason, what is the solving strategy? Today medical technology is continuously improved, whether the《regulation》needs renew or whether there is a need to add new technology and new business?The research aims at exploring existing main problems during implementation of《regulation》and search for solving primary strategy through investigating current situation of cleaning and disinfection of endoscope room in different grades hospitals, and compliance of《regulation》, so as to improve implementation power on《regulation》by hospital, further improve cleaning and disinfection quality of endoscope, and guarantee medical safety.Research methodQuestionnaire is designed by referencing to《Hospital Infection Management regulation (tentative)》,《Technical regulation of Disinfection》,《regulation》, and《Test Technical regulation of Disinfection Effect of Cleaning and Disinfection Machine of Endoscope (tentative)》of National Department of Health. And the final used questionnaire is determined after carrying out pre investigation among consultation experts and persons in endoscope room of different grades of hospitals. There are altogether 3 pieces of questionnaire; the first piece is questionnaire for management of cleaning and disinfection of endoscope and management persons in endoscope room are required to fill in it; the second pieces is questionnaire for cleaning and disinfection of endoscope and persons taking up cleaning and disinfection are required to fill in it; and the third piece is questionnaire for cleaning and disinfection knowledge of endoscope and medical persons in endoscope room (including doctors and nurses) are required to fill in it.There are altogether 40 hospitals to attend the research, with 20 GradeⅢhospitals, 11 GradeⅡhospitals, and 9 GradeⅠhospitals. And all investigated objects attending questionnaire for cleaning and disinfection knowledge of endoscope are first-line clinical and medical persons who directly offer gastrointestinal mirror therapy and nursing for patients. Clinical working time of investigated objects is more than half a year, not including intern.Results1. Statistics and research result of questionnaire for management of cleaning and disinfection of endoscopeInvestigation indicates that pass percent of bylaw is a little low, only being 52.5% (21/40). Pass percent of therapy and cleaning and disinfection room is 70% (28/40). And there are only about 30% (12/40) hospitals to reach the requirement that area of sole cleaning and disinfection room is not less than 20 square meters in《regulation》Required pass percent of cleaning and disinfection of endoscope in different parts is 77.5% (31/40) and hospitals with equipment for cleaning and disinfection of upper and lower digestive tract endoscope separated occupy 85% (34/40). Pass percent to equip defending articles in endoscope room is 52.5% (21/40) and defending articles mainly run short of anti penetration apron and eyecup to protect eyes. Pass percent of basic cleaning and disinfection facility is 37.5% (15/40). And cleaning and disinfection facility mainly runs short of high-pressure hydraulic giant and ultrasonic cleaning machine.Training rate carried out by hospital on cleaning and disinfection persons is 97.5% (39/40). And adopted training ways are professional training, meeting communication and study of hospital business. Pass percent of monitoring biology of endoscope is 97.5% (39/40) and hospitals with delivering frequency for test of 1 month occupy 52.5% (21/40) and hospitals with delivering frequency for test of 3 months occupy 45% (18/40). Monitoring pass percent of infection control department of hospital is 100%, with adopted ways including monthly checking, quarterly checking, and random checking. Monitoring pass percent of effective concentration of disinfection liquid is 55% (22/40) and among the unqualified hospitals, there are 5 hospitals to select sometimes monitoring and sometimes none monitoring and there are 13 hospitals select that change it after using test paper to find concentration is not sufficient.2. Statistics and research result of questionnaire for cleaning and disinfection of endoscopeThere are 25 hospitals adopting manual cleaning and disinfection methods (62.5%) and there are 15 hospitals adopting cleaning and disinfection machines of endoscope (38.5%). And there are altogether 39 cleaning and disinfection machines, with 33, 3, and 3 cleaning and disinfection machines respectively owned by GradeⅢhospital, GradeⅡhospitals, and GradeⅠhospitals.Correctness degree for operating procedure of cleaning and disinfection of endoscope is only 15% and pass percent of cleaning bed of endoscopes is 45%. Pass percent of manual cleaning and brushing pipeline method is 80%. However there are 10 hospitals with ratio between amount of brush cleaning pipeline and endoscope less than 1. There are only 3 hospitals to reach correct changing rate of multiple enzyme cleaning liquid according to requirement in《regulation》There are 22 hospitals to correctly grasp disinfection time of glutaraldehyde required in《regulation》. There are 5 hospitals with correct final disposing method of endoscope. When adopting 2% basic glutaraldehyde to carry out disinfection before starting work on the next day of therapy, there are 14 hospitals with correct disposing method. Correctness rate of keeping method of endoscope is a little high, with 36 qualified hospitals.2.4 Disposing method of accessories of endoscopeThere are only 67.5% hospitals that can manage correct brushing accessories of endoscope and the main existing problem is that hospital does not purchase ultrasound cleaning machine and only manual cleaning is carried out before direct disinfection. There are 26 hospitals with correct disinfection methods for accessories of endoscope.2.5 Pass percent for basic requirementThere are 39 hospitals that have used multiple enzyme cleaning liquid. 34 hospitals (85%) use timer to control cleaning and disinfection time of endoscope and accessories.3 Reason analysis3.1 Hospital can not carry out investigation according to implementation of《regulation》.Reason analysis on that therapy room and cleaning and disinfection room can not be separated, the main reasons lie in that land occupying area is not permitted to be separated and that there is great amount of work and few persons to cause that separated work can not be managed. Among the reason analysis for irregular use of manual cleaning enzyme and cleaning liquid, the main reasons lie in that enzyme cleaning liquid is only for primary cleaning without need to be changed for too many times and in that cost of enzyme liquid is too high and the hospital can not pay for it.3.2 Reason analysis on the most important problems affecting cleaning and disinfection effect of endoscopeManagement persons and cleaning and disinfection persons of endoscope consider that top 1 reason to affect cleaning and disinfection effect of endoscope is that there is complete equipment for cleaning equipment. And the top 2 and top 3 reason is respectively professional qualification of cleaning persons and reasonable procedure of cleaning system.3.3 Reason analysis of main problems existing when implementing《regulation》Top 1 and Top 2 main problem existing when implementing the《regulation》considered by management persons and cleaning and disinfection persons of endoscope respectively lies in that equipment for cleaning equipment is not complete to cause that it can not be well implemented according to《regulation》and in that there are too few mirrors and too many patients, the hospital regulates too high standard for work amount and procedure is reduced in order to fulfill task.3.4 The most important reason analysis affecting nurses to manage well occupational defendingTop 4 among the most important reasons to affect nurses to manage well occupational defending by cleaning and disinfection persons respectively lies in recognition on occupational defending, equipment of used tools for occupational defending, recognition on toxicity of disinfection agent, and course about occupational defending. 3.5 Aspect lacked by the《regulation》itselfIt is analyzed through investigation《regulation》lacks of procedure guide of leakage detection and at the same time lacks of guide to operating cleaning machine of endoscope and admittance system of cleaning machine of endoscope.4 Statistics research result for questionnaire of cleaning and disinfection knowledge of endoscope4.1 There were altogether 105 questionnaires to be sent out for the investigation, with 101 pieces reclaimed and reclaiming rate of 96% and with 91 pieces of effective questionnaires and effective rate of 90%. Total score for the qualified 91 questionnaires is 77.45±7.682, total score for cleaning and disinfection of endoscope is 65.71±7.341 and total score of basic knowledge for infection control is 11.76±2.363. It is indicated through statistic analysis that situation for three grades of hospital doctors and nurses to grasp cleaning and disinfection knowledge and infection control knowledge of endoscope was not ideal. Comparing between doctor and doctor, nurse and nurse, doctor and nurse in each grade of hospitals, the situation to grasp leaning and disinfection knowledge and infection control knowledge of endoscope was not ideal either.4.2 Difference of recognition limitationAs far as deficiency sequencing of cleaning and disinfection knowledge of endoscope, order for GradeⅢhospital and GradeⅡhospital is generally the same. While deficiency sequencing of cleaning and disinfection knowledge of endoscope between Grade I and GradeⅢ, GradeⅡhospitals is different. Deficiency sequencing of infection control knowledge in GradeⅢ, GradeⅡand GradeⅠhospitals is different, with main deficiency of partition of danger level of infection control in hospital, concept of standard prevention, concept of hand sanitation, scope of management persons of infection control and high-level disinfection concept.Conclusion1. Improve compliance on current《regulation》by hospital.Sanitation administration department should strengthen administration on hospital to manage strict punishment and award and make implementation of《regulation》guaranteed from system. At the same time, in order to release contradiction of great work amount of endoscope therapy, and relatively shortage of amount of endoscope and medical persons, hospital should increase input to purchase automatic equipment or increase necessary equipment to guarantee implementation of《regulation》in substance.2. To strengthen training is critical to improve compliance on《regulation》.Sanitation administration department should carry out collective training on work persons taking up cleaning and disinfection of endoscope in province and leaders of Corresponding departments in different periods and in different batches to make them completely understand and grasp each requirement of《regulation》. In addition, more strength should be put to make clear the harm brought by; incomplete cleaning and disinfection of endoscope.3. To revise《regulation》again must be carried out.It is found through the investigation that there is aspect that it is not easy to implement and there is imperfect aspect in《regulation》. And it needs us to start to carry out further investigation and research according to current situation and existing problem and with pertinence.4. Selection and use guide of cleaning and disinfection machine of endoscope is one of important work for the next research.Cleaning and disinfection work of endoscope is manually carried out in many hospitals, with lagging measure. And effect of cleaning and disinfection is greatly affected by factitious factors and it is easy to cause contact infection and cross infection because of factitious factors. However as far as cleaning and disinfection machines of endoscope imported or produced in China are concerned, sampling test on them indicates that many of them can not reach nationally regulated standard. To standardize use guide and admittance standard of cleaning and disinfection machines of endoscope in China is one of the focal points for the next research.