經食道心臟超音波相關群突發事件探討

Investigation an outbreak related to trans-esophageal echocardiography

現行醫療環境下，經食道心臟超音波是一種實用又廣泛的臨床檢查，通常用於心臟和非心臟疾病的調查和診斷，依Dr. EH Spaulding分類屬於semi-critical items設備檢查，雖其危險性極低，感染病例很少見。但檢查後患者仍存有感染傳播的可能性，也有文獻描述相關群突發事件，病例發生原因多為超音波之探頭消毒不全、探頭損壞及水源汙染等相關因素。本文搜尋6篇經食道心臟超音波群突發事件，主要針對水源及探頭破損的汙染，文獻內單位處理方向多為依據英國心臟超音波學（BSE）會在2011年出版的消毒指引。本國目前尚無針對此檢查有關群突發事件案例發生，但相關清潔消毒多為參考消化系統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）、超音波清洗機清洗等。並無完整的經食道心臟超音波臨床消毒指引。建議建立一套有關經食道心臟超音波器械、設備之清洗消毒、儲存擺放的標準作業流程，並由專人負責且確實執行，以降低檢查相關的感染風險，會是當今更重要的任務及解決要事。

Under the current medical environment, transesophageal echocardiography is an examination widely used for the investigation and diagnosis of cardiac and non-cardiac diseases in clinical practice. According to the classification by Dr. EH Spaulding, transesophageal echocardiography is a semi-critical item, although its risk is low and infection cases are rare. After examination, the patient still has the risk of infection transmission. Studies have described infection emerging in the related group. Most of the infection cases were caused by the inadequate disinfection and damage of the ultrasonic probe, and polluted water source. Six infection episodes related to transesophageal echocardiography were mainly due to polluted water source and probe damage. The processing direction is mostly based on the disinfection guidelines published by the British Heart Ultrasonic in 2011. At present, no emerging cases related to this inspection are reported in Taiwan, including relevant cleaning and disinfection, which are recommended as infection control measures for reprocessing of digestive system endoscopes, the functional working line, endoscope reprocessing, enzyme cleaning, agent selection, endoscope attachment reprocessing, special endoscopes (e.g., duodenoscope and ultrasonic probe endoscopes), ultrasonic cleaning, machine cleaning, and so on. No guidelines have been established for clinical disinfection in transesophageal cardiac ultrasonography. We recommend that a set of standard operating procedures for the cleaning, disinfection, and storage of transesophageal cardiac ultrasonography instruments and equipment be established. The operator is responsible for implementing infection risk reduction measures related to the examination. Currently, this is the more important task and solution.