ATP生物荧光检测在气管镜清洗消毒质量监测中的应用研究

目的探讨三磷酸腺苷(ATP)生物荧光检测对气管镜清洗消毒合格参考值范围和检测方法。方法选取360条患者使用后的气管镜随机分为A、B、C三组,每组120条。A组床旁预处理后分为A1、A2两组(每组60条气管镜),B组气管镜在人工清洗后分为B1、B2两组,C组气管镜在高水平消毒后分为C1、C2两组,A1、B1、C1组采用细菌采样,A2、B2、C2组进行ATP生物荧光采样。两种采样方法对气管镜表面采样为全部长度涂抹采样,管腔的采样方法均为冲刷法。同时选取临床使用后的60条气管镜经过人工清洗后,对管腔运用冲洗法,对冲洗液进行ATP生物荧光检测,比较冲洗法和冲刷法对管腔采样的有效性。结果气管镜在人工清洗后,对管腔采样的冲洗法和冲刷法,两组ATP总量的相对发光值(RLU)差异有统计学意义(P=0.040)。气管镜在A1、B1组的细菌采样中,管腔和表面菌落数差异均有统计学意义(P均<0.001),高水平消毒后表面和管腔菌落数均为0;气管镜在A2、B2、C2三组的ATP生物荧光检测采样中,表面ATP总量RLU值A2与B2组间比较差异有统计学意义(P<0.001),B2与C2组间比较差异有统计学意义(P=0.040);管腔ATP总量RLU值A2与B2组间比较差异有统计学意义(P<0.001),B2、C2两组差异无统计学意义(P=0.450)。结论 ATP生物荧光采样冲刷法对气管镜管腔采样更有效;人工清洗环节非常重要,人工清洗后气管镜表面和管腔ATP总量建议低于10 000和3 400。

Application of ATP biofluorescence assay in quality monitoring of cleaning and disinfection of bronchoscopes

OBJECTIVE To explore the qualified reference range and the detection method of adenosine triphosphate(ATP) biofluorescence assay for bronchoscopes cleaning and disinfection. METHODS A total of 360 bronchoscopes used by patients were randomly divided into the following groups, A, B and C, 120 in each group. Group A was divided into group A1 and A2(60 bronchoscopes in each group) after bedside pretreatment, group B was divided into two groups, B1 and B2 after manual cleaning, and group C was divided into two groups, C1 and C2 after high-level disinfection. Subgroups A1, B1 and C1 were sampled with microorganism method, while subgroups A2, B2 and C2 were sampled with biofluorescence assay method. For surface sampling, the bronchoscope surface was smeared throughout its entire length. For channels, flush-brush-flush technique was adopted. At the same time, a total of 60 bronchoscopes after clinical use were selected for manual cleaning, followed by flushing of the channels, and the flushing fluid was tested by ATP biofluorescence assay, and the effectiveness of the flushing method and flush-brush-flush methods for lumen sampling was compared. RESULTS After the bronchoscope was manually cleaned, there was a significant difference in the relative luminescence value(RLU) of the total ATP between the two groups of the flush and flush-brush-flush methods for lumen sampling(P=0.04). In the bacterial sampling of the bronchoscope in the A1 and B1 groups, the number of colonies on the lumen and the surface was significantly different(P<0.001), the number of colonies on the surface and the lumen were both 0 after high-level disinfection. In the APT biofluorescence detection sampling of the three groups of A2, B2, and C2, the total surface ATP RLU value was significantly different between A2 and B2 group(P<0.001), and there was significantly difference between group B2 and C2(P=0.040). The total luminal ATP RLU value between the A2 and B2 groups was significantly different(P<0.001), and the difference between group B2 and C2 was not significant(P=0.450). CONCLUSION The ATP biofluorescence sampling method of flushing was more effective for bronchoscope lumen sampling. Manual cleaning is very important, and the total amount of ATP on the surface and lumen of bronchoscope is recommended to be less than 10,000 and 3,400 after manual cleaning.