軟式內視鏡再處理之感染管制措施建議

Infection Control in the Reprocessing of Flexible Gastrointestinal Endoscopes

現今醫療環境當中，侵入性導管及治療處置是現在常見的醫療處置行為，但是也產生了不少醫療照護相關感染的問題。自1970年代以來，有相關文獻報導與內視鏡檢查有關的感染。大多數病例發生原因為內視鏡再處理不完全、內視鏡損壞、水源和自動清洗機汙染等有關。本篇參考各國內視鏡消毒滅菌指引，包括我國台灣消化系內視鏡醫學會、衛生福利部疾病管制署、歐盟內視鏡醫學會、世界衛生組織及相關文獻資料提供內視鏡再處理之感染管制措施建議，如功能性工作動線、內視鏡再處理、酵素清潔劑選擇、內視鏡附件再處理、特殊內視鏡（如十二指腸鏡及超音波探頭式內視鏡）、延遲再處理、超音波清洗機清洗、再處理區個人防護用具、再處理區環境整理、內視鏡感染管制監測、記錄與保存及群聚處置等內容進行介紹。內視鏡檢查在預防、診斷和治療胃腸疾病中具發揮不可或缺的作用。也許單次使用內視鏡附件是未來發展的重要方向。但面臨重新再處理、交叉污染的問題，或許目前制定更優化、標準化的作業流程會是當今更重要的任務及解決。

With the current advancements in healthcare technology, many types of invasive devices and procedures have become ubiquitous in medical treatments. However, this has led to a multitude of medical care problems related to infections. Since the 1970s, there have been sporadic reports of nosocomial infections related to endoscopic procedures. The reasons for endoscopy-related infections include inadequate reprocessing, damage, or inappropriate storage of endoscopes and contaminated water, and contaminated endoscope washer-disinfectors. This article refers to endoscope sterilization guidelines, including those set forth by the Digestive Endoscopy Society of Taiwan, Taiwan Centers for Disease Control, European Society of Gastrointestinal Endoscopy, and World Health Organization (WHO). Consequently, the topics dealt with in the article are as follows: reprocessing workflow, design and construction of endoscopy suites, endoscope reprocessing, enzymatic detergent, endoscope accessories reprocessing, special endoscope reprocessing, delayed reprocessing, staff education, environmental cleaning, monitoring quality of flexible endoscope disinfection by microbiologic surveillance cultures, documentation, and outbreak management. Endoscopic evaluation plays an indispensable role in preventing, diagnosing, and curing GI disease. Disposable use of endoscope accessories is an important area for future development. However, considering the problems regarding reprocessing and crosscontamination, it is perhaps more important to formulate a better, more standardized operation process.