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Procestemperaturens betydning ved dekontaminering af fleksible endoskoper.Klinisk tysk undersøgelse
En klinisk tysk undersøgelse har testet
effektiviteten af maskinel desinfektion ved 43
°C,
51 °C og 56
°C.
Konklusionen er, at procestemperaturen ikke kan sænkes af hensyn til
endoskopernes holdbarhed uden, at det går ud over patientsikkerheden.
Dette må med i overvejelserne ved køb af en ny
vaskedekontaminator til de fleksible endoskoper. Det er ærgerligt, at der ikke
indgår temperaturer mellem 58,5 °C og 60 °C.
Vi accepterer ikke temperaturer under
58,5 °C
i Clean-endoscope programmet fordi det medfører et signifikant øget antal
bakterier. Den signifikante stigning, der sker i reduktionen af
mikroorganismerne ved en lille temperaturstigning i den tyske undersøgelse
viser, at det drejer sig om en varmedesinfektion og ikke en kemisk desinfektion.
Summary: Endoscopes are processed
chemo-thermally at approximately 56 °C in washer–disinfectors in
Germany. In this study we investigated the processing of
gastroscopes by an endoscope washer–disinfector at different temperatures. A
total of 87 gastroscopes were tested hygienically and microbiologically before manual cleaning
(after patient use), as well as after manual
cleaning and after endoscope washer–disinfector processing at running temperatures of 43, 51 and 56 °C.
In all tests the suction/biopsy channels of the gastroscopes were flushed
with 50 mL sterile solution throughout
their full length, from the proximal to the distal ends. The rinse solutions were plated on to various culture
media. Also, in order to detect low
bacterial counts, 3 10 mL rinse solution was
membrane filtrated. The German guideline level for total bacterial
counts, applicable since 2002, was exceeded at all temperatures tested (159 cfu/mL at 43 °C, 60 cfu/mL at
51 °C, and 8 cfu/mL at 56 °C). A temperature increase from 43 to 51 °C
resulted in a highly significant reduction of the residual contamination by aerobic bacteria (P < 0.001, Mann–Whitney U
Test), Gram-negative bacilli (P <
0.001), and pseudomonads (P = 0.002). A further temperature increase from 51 to 56 °C resulted in a further highly
significant drop in residual contamination by aerobic bacteria (P = 0.021) and pseudomonads (P = 0.036).
The aim of the user—minimizing material damage to endoscopes or prolonging their product life—cannot be achieved through lowering the processing
temperature without putting patients at risk. In order to ensure adequate processing, endoscope washer–disinfectors
should meet the requirements of current draft standards.
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