運用多元策略提升軟式內視鏡於手工清洗後正確執行ATP檢測

Application of Multiple Strategies to Improve the Correct Performance of ATP Assay on Flexible Endoscopes after Manual Cleaning

內視鏡檢查為現今用以診斷及治療疾病的侵入性醫療處置，於美國緊急醫療研究機構2019年所公佈的10大醫療科技危害，以內視鏡消毒不當所導致病人感染排名第五，由此可知內視鏡的感染管制是非常重要的議題，故本院為確保內視鏡感染管制作業完整性，每年定期進行各檢查室單位查核。2023年修訂的內視鏡監測指引建議以採取ATP測量清潔控制和微生物汙染檢測指標作為補充措施。本院2023年同步增訂ATP採檢步驟於「軟式內視鏡清洗及消毒暨品質監測感染管制作業要點」並進行查核，結果發現人員執行ATP檢測分數僅74.1，故進行專案導入以提升ATP檢測正確性。
研究期間舉辦內視鏡清洗及消毒感染管制教育訓練提升人員認知、制定及啟用ATP檢測採檢稽核查制度、拍攝ATP檢測採檢影片、及製作採檢流程海報以輔助執行檢測過程參閱，經由改善措施後操作人員執行ATP檢測分數提升至100，確保內視鏡清潔確效品質，進而保障病人安全與醫療品質。

Endoscopic examination is an invasive medical procedure used to diagnose and treat various diseases. Patient infections caused by improper endoscope disinfection ranked fifth among the top 10 medical technology hazards announced by the Emergency Medical Research Institute of the United States in 2019. Therefore, endoscopy infection control is a critical issue [1,2]. Therefore, to ensure the integrity of endoscopy infection control operations, our hospital regularly inspects each examination room unit annually. The 2023 revised endoscopic monitoring guidelines and Food and Drug Administration recommendations use the adenosine triphosphate (ATP) bioluminescence assay to measure cleaning control and microbial contamination detection indicators, as a supplementary measure [3,4]. In 2023, our hospital simultaneously added ATP sampling and testing procedures to the“Key Points for Cleaning and Disinfection of Flexible Endoscopes and Quality Monitoring and Infection Control Operations”and conducted an audit. The results showed that the completion rate of the ATP testing performed by personnel was only 74.1%; therefore, a special project was introduced to improve this rate.
During the study period, we conducted infection control education and training on endoscope cleaning and disinfection to enhance staff awareness, developed and implemented an ATP testing and sampling audit system, filmed ATP testing and sampling videos, and produced sampling and sampling process posters to assist in the testing process reference. After the implementation of the improvement measures, the completion rate of the ATP testing performed by operators increased to 100%, ensuring the effective quality of endoscope cleaning, thereby protecting patient safety and medical quality.