探討胃內視鏡檢查導致幽門螺旋桿菌交互感染之途徑及其預防方式

Investigation of Possible Routes and Prevention of Helicobacter Pylori Cross Infection in Endoscopic Units

林淑娟(Shwu-Jiuan Lin) ； 邱艷芬(Yann-Fen Chiou) ； 陳宏曙(Hong-Shu Chen)

《護理研究》 5卷6期 (1997/12) Pp. 474-486

https://doi.org/10.7081/NR.199712.0474

摘要

許多臨床及基礎研究顯示慢性胃炎及消化性潰瘍與幽門螺旋杆菌(Helicobacter pylori, Hp)之感染有極密切的關系，本研究旨在探討胃鏡檢查導致Hp交互感染之可能性、途徑及其預防方法。研究中首先對已感染Hp之患者，於胃鏡檢查後，將該胃鏡之各部分組件、操作者手套、環境表面，在消毒前後采樣，以確定須消毒之範圍及消毒方法能否達到殺菌之效果。其次再以高濃度之Hp懸浮液，模擬污染胃鏡各部組件，用不同清潔、消毒程序來消毒期能找出一個安全且合理之消毒方法。研究中以PCR及細菌培養方法作為測量工具。研究結果：在傳染途徑方面，細菌培養結果顯示在19處有可能被污染之區域，僅組織切片夾、切片通道及切片出口三處呈現陽性反應。而PCR部分，除組織切片夾、切片通道外，另外：胃鏡控制握把、胃鏡管身下段、操作者手套，亦呈現陽性反應。而消毒方法實驗作業部份，細菌增减結果顯示以「水」沖洗污染之區域，即能有效的清除有活性的Hp。而PCR偵測發現以「水」沖洗、Cidex浸泡、及自動清洗機等繁覆之清洗消毒程序後，仍可於各部分組件中檢測到Hp DNA之存在。然據本研究細菌培養結果而推論此等PCR偵測到之Hp DNA應屬於無致病力及無繁殖力之Hp殘餘物。也於此進一步推論Hp在經由Cidex浸泡及自動清洗機清洗後，已被消毒殺菌了。

關鍵字

胃內視鏡 ； 幽門螺旋桿菌 ； 交互感染

並列摘要

Much clinical and basic research indicates that incidence of chronic gastritis and peptic ulcer is closely linked to infection with Helicobacter pylori (Hp). This study aims to explore the risk, the route, and the prevention of Hp cross-infection caused by gastroscopy. Following the gastroscopic examination of Hp-infected patients, specimens were taken from the parts of the gastroscope, the gloves worn by the operator, and exposed surfaces in the environment before and after disinfection to determine if complete disinfection was achieved. Next, high concentration Hp suspension was used to simulate gastroscope contamination; the parts of the gastroscope were then subjected to different cleansing and disinfection processes to find out an effective and feasible method. The study employed PCR and bacterial culturing as measuring tools. The results are summarized as follows: in terms of infection route, the findings of bacterial culture indicated that among 19 potentially infected sites, only three exhibited positive reactions-tissue biopsy forceps, biopsy channel and biopsy channel exit. In PCR measurements, in addition to biopsy forceps and biopsy channel, gastroscope control handle, lower section of the gastroscope body, and gloves worn by the operator were also found positive. In respect of disinfection method used for the laboratory, bacterial culture indicated rinsing the contaminated area with ”water” could effectively eliminate active Hp. By PCR detection, it was found that following the procedures of ”water” rinsing, Cidex soaking and automatic washer, Hp DNA could still be detectable on various parts of the gastroscope. According to the result of bacterial culture, we can conclude that such Hp DNA by PCR detection are probably Hp residues that are non-pathogenic and non-reproductive. We also can conclude that after Cidex soaking and automatic washer, Hp will be disinfected thoroughly.

並列關鍵字

gastroscope ； Helicobacter pylori ； cross-infection