支氣管鏡再處理之感染管制措施

Infection Control in Reprocessing Flexible Bronchoscope

醫療體系中支氣管鏡應用於肺部病灶或結核病的診斷與治療佔有非常重要的角色，特別是支氣管肺泡灌洗術（bronchoalveolar lavage, BAL）或支氣管活體組織採檢等兩種，被認為是不可或缺的診斷工具。也因如此，支氣管鏡檢查量的需求也日趨增加；相對的，臨床上如何在有限的時間中提高支氣管鏡使用的週轉率，又必須兼顧支氣管鏡使用後的清洗、消毒未來將會是一個被關注的議題。如果為了節省時間和費用而忽略或不適當再處理程序，將會增加感染風險，進一步引起群突發。有文獻指出支氣管鏡因再處理不當、或環境汙染引起的醫療照護相關感染，危險因素包括支氣管鏡本身是否有損壞和支氣管鏡附件（accessories）等皆可能造成感染。本內容對支氣管鏡感染管制措施介紹包括六大部份：支氣管鏡室規格設計規範措施、再處理感染管制措施（檢查、清潔、消毒）、儲存區之感染管制措施、品質監測與管理、群聚處置、文件記錄保存、支氣管鏡人員資格和健康管理、支氣管鏡醫療器材消毒和滅菌的判讀等進行建議。如何嚴格遵守和落實支氣管鏡再處理作業程序是一項非常重要的感染管制措施，支氣管鏡是否需進行滅菌相信也是未來提昇支氣管鏡品質的新思維與挑戰。

Bronchoscopy is of great importance in medical systems, especially in patients with TB who cannot cough out adequate sputum samples. Bronchoalveolar lavage or biopsy has been proven an indispensable diagnostic tool. Considering the increase in the numbers of bronchoscopies being performed and its turnover, the risk of cluster and infection would increase if reprocessing is ignored or done inappropriately to save time and cost. Many studies have shown that bronchoscopy causes medical care infections due to inappropriate processing of the instrument or environmental contamination. Factors such as damage to the bronchoscope or the procedure of reprocessing the accessories can cause infection. The introduction to bronchoscope infection control measures includes six parts: design of the bronchoscope unit, infection control procedures during reprocessing (examination, cleaning, disinfection), infection control in storage rooms, quality monitoring and management, cluster management, document saving, qualification and health management of staff, sterilization of medical devices, and reading. Therefore, strict follow-up and implementation of bronchoscope reprocessing procedures are important aspects in infection control. It is believed that whether bronchoscope needs to be sanitized will be a new idea and challenge to improve the quality of the bronchoscope.