腸胃道內視鏡監測採檢之建議

Recommendations for Gastrointestinal Endoscopy Surveillance Culture in Guidelines

美國食品藥物管理局在2015年提出關於包含腸胃道在內的內視鏡再處理加強措施，其中包括微生物培養。內視鏡監測採檢可以作為內視鏡清洗、消毒品質的監測方法，早期發現清洗或消毒程序失效，提醒工作人員確實遵循內視鏡再處理標準流程的重要性，降低交叉感染的風險，亦能確認內視鏡相關感染事件的關聯性。各國指引有關內視鏡微生物培養的採檢頻率，包括每個月、每三個月、定期及特殊狀況採檢；並運用浸泡、拭子擦拭、沖洗及刷洗方式進行採檢，相關文獻亦以幫浦輔助抽吸沖洗液，以提升對內視鏡污染的偵測。但因為採檢結果受很多因素的影響，包括菌種、污染程度、使用過濾或離心方式、沖洗液是否添加消毒劑中和劑或界面活性劑、中和劑濃度、是否所有通道都被採檢、收集到的沖洗液量、採樣溶液微生物的活力及培養的溫度及時間。因此，內視鏡監測採檢，不能作為判斷內視鏡是否無菌的方法，依據標準流程執行清洗及消毒／滅菌仍是品質保證的不二法門。

Gastrointestinal endoscope monitoring and inspection serve as effective methods for verifying the quality and effectiveness of endoscopic cleaning and disinfection. They enable early detection of failures in the cleaning/ disinfection process and help remind staff of the importance of strictly following standard reprocessing procedures, thereby reducing the risk of cross-infection. Monitoring also helps establish a correlation between endoscopy-related infection events. This article presents guidelines on the recommended frequency and methods for endoscopic sampling. The suggested sampling intervals include monthly, quarterly, at regular scheduled times, and under special circumstances. Common sampling techniques include soaking, swabbing, rinsing, and brushing. Some studies also describe using pump-assisted suction of flushing fluid to improve the detection of endoscope contamination[9, 10]. However, because endoscopic sampling results are influenced by many variables, they should not be used as the sole criterion to determine whether an endoscope is sterile. Strict adherence to established cleaning, disinfection, or sterilization protocols remains the most reliable way to ensure endoscope safety and quality.