軟式內視鏡高層次消毒後安全儲存期之探討

Investigation into the Safe Storage of Flexible Endoscopes After High Level Disinfection

內視鏡再處理（Endoscope reprocessing）流程繁瑣，其中包括高層次消毒（High level disinfection）後的乾燥（Drying／alcohol and forced air）及存放（Storage）。軟式內視鏡管腔細長且構造複雜乾燥不易，儲存過程中若因乾燥不足，易使微生物繁殖，所以適當控制內視鏡乾燥和儲存條件的是相當重要的，可以避免微生物的繁殖，降低下一個使用病人被感染風險。但因台灣地處亞熱帶，屬海島型氣候，溫度和環境相對濕度較高，軟式內視鏡經過有效的再處理及妥善保存是否能夠合乎安全標準，是應該受到關切的。本研究收集胃鏡、大腸鏡及十二指腸鏡各2支，每次採集的樣本隨機設定，於高層次消毒後重新計算靜置日，分別於每支內視鏡靜置第1天、第2天⋯至第8天進行細菌培養，在採檢內視鏡同時，亦對置放的管鏡櫃進行採檢。期間內視鏡採集樣本數96件、管鏡櫃24件，共120件，同時記錄各管鏡櫃溫度及濕度。結果發現，管鏡櫃24件檢體中，有11件（11／24，45.8％）培養出環境菌，因此管鏡櫃的溫、濕度監測及清潔消毒是有必要的；內視鏡在觀察靜置後8天，每天的培養報告皆呈現陰性，所以，依照現行的再處理機制，內視鏡經過適當的再處理、乾燥及儲存，存放一週仍是安全的。

The steps involved in reprocessing endoscopes, including drying (dry/alcohol and forced air) and storage after high-level disinfection, are very complex. Due to the thin lumen and complicated structures of soft endoscopes, it is difficult to dry them sufficiently without damaging them. Establishing a correct control process for drying and storing endoscopes could prevent the growth of microorganisms and reduce the risk of infection. As a result of Taiwan's island-type climate, with its high humidity levels, there have been concerns about whether soft endoscopes meet the required safety standards for being reused for the next patient, after effective reprocessing and proper preservation. Two units each of esophagogastroduodenoscopes (EGDs), colonoscopes, and duodenoscopes were used in this study. The collected samples were obtained randomly for each experiment. The resting date was reset after a high level of disinfection. We sent the collected samples for bacterial culture, not only from the endoscopes but also from the storage cabinet, every day for eight days. During the study period, a total of 120 samples were collected from the endoscopes (n = 96) and the storage cabinet (n = 24). We found 11 specimens (11/24, 45.8%) with positive cultures of environmental bacteria from the storage cabinet. Therefore, monitoring temperature and humidity, as well as cleaning and disinfection, are indispensable in the reprocessing of storage cabinets. During the study, bacterial cultures from the endoscopes showed negative findings for every day. Thus, it is safe to store endoscopes for one week after endoscopic reprocessing, drying, and proper storage, following the current reprocessing procedures.