本文選題：硬式內(nèi)鏡 + 清洗方法��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的隨著微創(chuàng)技術(shù)的發(fā)展,內(nèi)鏡器械在各級(jí)醫(yī)療機(jī)構(gòu)中應(yīng)用廣泛,內(nèi)鏡相關(guān)感染引起的危害嚴(yán)重。清洗是消毒滅菌的必要步驟,內(nèi)鏡器械的徹底清洗可以防止生物膜的產(chǎn)生,是控制醫(yī)院感染的關(guān)鍵性環(huán)節(jié)�，F(xiàn)臨床上硬式內(nèi)鏡相關(guān)器械清洗方法仍遵循2004版《內(nèi)鏡清洗消毒技術(shù)操作規(guī)范》。本研究采用不同的硬式內(nèi)鏡清洗方法,采用三種檢測(cè)方法對(duì)清洗效果進(jìn)行評(píng)價(jià),從而優(yōu)化硬式內(nèi)鏡清洗流程,提高內(nèi)鏡清洗質(zhì)量。方法清洗方法實(shí)驗(yàn)分為兩部分:硬式內(nèi)鏡內(nèi)窺鏡清洗實(shí)驗(yàn)和硬式內(nèi)鏡其他相關(guān)器械清洗實(shí)驗(yàn),按照2004版《內(nèi)鏡清洗消毒技術(shù)操作規(guī)范》清洗的硬式內(nèi)鏡器械為規(guī)范清洗組。硬式內(nèi)鏡內(nèi)窺鏡清洗實(shí)驗(yàn):自2015年9月-2016年1月,隨機(jī)抽取某三甲醫(yī)院腹腔鏡手術(shù)后硬式內(nèi)鏡內(nèi)窺鏡132個(gè)·次,分為規(guī)范清洗組和預(yù)處理組,每組各進(jìn)行66個(gè)內(nèi)窺鏡實(shí)驗(yàn)。內(nèi)窺鏡清洗方法:規(guī)范清洗組:初洗—多酶浸泡5min—漂洗—終末漂洗—干燥,預(yù)處理組的處理措施是:初洗前使用多酶原液進(jìn)行預(yù)處理,多酶浸泡5min后使用一次性清潔紗布擦拭3min(清洗流程為:預(yù)處理—多酶浸泡5min—多酶清洗液中擦拭3min—漂洗—終末漂洗—干燥)。硬式內(nèi)鏡其他器械清洗實(shí)驗(yàn):自2016年2月-2016年10月,隨機(jī)抽取硬式內(nèi)鏡相關(guān)器械(腹腔鏡手術(shù)器械)330套·次,分為五組,每組66套。選取每套器械中的五件器械:分離剪、分離鉗、持針器、雙極鉗、自動(dòng)結(jié)扎鉗(Hem-o-lok鉗以下均簡稱Hem-o-lok鉗)進(jìn)行實(shí)驗(yàn)。硬式內(nèi)鏡相關(guān)器械(除內(nèi)窺鏡)清洗方法:規(guī)范清洗組:器械回收后拆卸至最小單位,初洗—多酶清洗5min—超聲清洗5min—漂洗—終末漂洗—干燥;超聲噴淋清洗組(改進(jìn)后的清洗流程:初洗—多酶清洗5min—超聲噴淋清洗器清洗5min—漂洗—終末漂洗—干燥);超聲噴淋+浸油煮沸組(改進(jìn)后的清洗流程:初洗—多酶清洗5min—超聲噴淋清洗器清洗5min—浸油煮沸槽進(jìn)行處理10min—漂洗—終末漂洗—干燥);全自動(dòng)清洗消毒機(jī)組(改進(jìn)后的清洗流程:初洗—多酶清洗5min—超聲清洗5min—漂洗—全自動(dòng)清洗消毒機(jī)清洗—干燥);超聲噴淋+全自動(dòng)清洗消毒機(jī)組(改進(jìn)后的清洗流程:初洗—超聲噴淋清洗器清洗5min—漂洗—全自動(dòng)清洗消毒機(jī)清洗—干燥)。器械充分干燥后進(jìn)行清洗效果的檢測(cè),分別采用十倍帶光源放大鏡檢測(cè)法、蛋白殘留檢測(cè)法、ATP生物熒光檢測(cè)法,依次對(duì)每一件硬式內(nèi)鏡器械的清洗效果進(jìn)行評(píng)價(jià)。統(tǒng)計(jì)學(xué)方法采用Microsoft office excel 2007表格進(jìn)行數(shù)據(jù)收集和錄入,IBM SPSS statistics 23.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)處理,兩獨(dú)立樣本采用t檢驗(yàn)、Mann-Whitney U檢驗(yàn),相關(guān)樣本比較采用Friedman秩和檢驗(yàn),兩組二分類資料采用卡方檢驗(yàn),獨(dú)立多組資料比較采用Kruskal-Wallis H檢驗(yàn),P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.硬式內(nèi)鏡內(nèi)窺鏡采用兩種不同的清洗方法,結(jié)果進(jìn)行比較,采用十倍帶光源放大鏡進(jìn)行檢測(cè),兩組內(nèi)窺鏡清洗合格率差異無統(tǒng)計(jì)學(xué)意義(P0.05);采用蛋白殘留檢測(cè),規(guī)范清洗組合格率為69.70%(46/66),預(yù)處理組合格率為84.85%(56/66),χ2=4.314,P0.05,差異有統(tǒng)計(jì)學(xué)意義;采用ATP生物熒光檢測(cè),規(guī)范清洗組合格率為80.30%(53/66),預(yù)處理組合格率為92.42%(61/66),χ2=4.117,P0.05,差異有統(tǒng)計(jì)學(xué)意義。2.硬式內(nèi)鏡相關(guān)器械(除內(nèi)窺鏡)采用不同方法清洗結(jié)果:采用十倍帶光源放大鏡進(jìn)行檢測(cè),規(guī)范清洗組合格率91.52%(302/330),超聲噴淋清洗組合格率93.94%(310/330),超聲噴淋+浸油煮沸組合格率96.06%(317/330);全自動(dòng)清洗消毒機(jī)組合格率97.58%(322/330),超聲噴淋+全自動(dòng)清洗消毒機(jī)組合格率98.18%(324/330);采用蛋白殘留檢測(cè),規(guī)范清洗組合格率77.88%(257/330),超聲噴淋清洗組合格率85.76%(283/330),超聲噴淋+浸油煮沸組合格率87.27%(288/330),全自動(dòng)清洗消毒機(jī)組合格率93.03%(307/330),超聲噴淋+全自動(dòng)清洗消毒機(jī)組合格率94.24%(311/330);采用ATP生物熒光檢測(cè)儀進(jìn)行檢測(cè),規(guī)范清洗組合格率83.33%(275/330),超聲噴淋清洗組合格率86.97%(287/330),超聲噴淋+浸油煮沸組合格率87.58%(289/330),全自動(dòng)清洗消毒機(jī)組合格率94.55%(312/330),超聲噴淋+全自動(dòng)清洗消毒機(jī)組合格率95.45%(315/330)。3.硬式內(nèi)鏡(除內(nèi)窺鏡)相關(guān)器械清洗結(jié)果:采用三種檢測(cè)方法檢測(cè),各組清洗合格率進(jìn)行比較,H值分別為22.894、52.234、38.505,P0.05,5種清洗方法合格率差異有統(tǒng)計(jì)學(xué)意義。采用十倍帶光源放大鏡檢測(cè),全自動(dòng)清洗消毒機(jī)組、超聲噴淋+全自動(dòng)清洗消毒機(jī)組清洗合格率分別與規(guī)范清洗組比較,H值分別為3.736、4.110,P0.05,差異有統(tǒng)計(jì)學(xué)意義;采用蛋白殘留檢測(cè)結(jié)果顯示:超聲噴淋清洗組、超聲噴淋+浸油煮沸組、全自動(dòng)清洗消毒機(jī)組、超聲噴淋+全自動(dòng)清洗消毒機(jī)組清洗合格率分別與規(guī)范清洗組比較,H值分別為3.074、3.665、5.911、6.384,P0.05,差異有統(tǒng)計(jì)學(xué)意義,全自動(dòng)清洗消毒機(jī)組、超聲噴淋+全自動(dòng)清洗消毒機(jī)組清洗合格率分別與超聲噴淋清洗組比較,H值分別為2.837、3.310,P0.05,差異有統(tǒng)計(jì)學(xué)意義;采用ATP生物熒光檢測(cè),結(jié)果示:全自動(dòng)清洗消毒機(jī)組清洗合格率分別與規(guī)范清洗組、超聲噴淋清洗組、超聲噴淋+浸油煮沸組比較,H值分別為4.712、3.184、2.929,P0.05,差異有統(tǒng)計(jì)學(xué)意義,超聲噴淋+全自動(dòng)清洗消毒機(jī)組清洗合格率分別與規(guī)范清洗組、超聲噴淋清洗組、超聲噴淋+浸油煮沸組比較,H值分別為5.094、3.566、3.311,P0.05,差異有統(tǒng)計(jì)學(xué)意義。全自動(dòng)清洗消毒機(jī)組清洗合格率與超聲噴淋+全自動(dòng)清洗消毒機(jī)組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.三種檢測(cè)方法陽性檢出率進(jìn)行比較,十倍帶光源放大鏡陽性檢出率4.26%(76/1782),蛋白殘留檢測(cè)陽性檢出率13.13%(234/1782),ATP生物熒光檢測(cè)陽性檢出率10.66%(190/1782),十倍帶光源放大鏡檢測(cè)陽性檢出率分別與蛋白殘留檢測(cè)、ATP生物熒光檢測(cè)陽性檢出率比較,H值分別為:3.970、2.864,P0.05,差異有統(tǒng)計(jì)學(xué)意義,蛋白殘留檢測(cè)陽性檢出率和ATP生物熒光檢測(cè)陽性檢出率差異無統(tǒng)計(jì)學(xué)意義,kappa值為0.572,吻合程度一般。5.硬式內(nèi)鏡不同器械采用三種檢測(cè)方法進(jìn)行檢測(cè),清洗合格率均存在明顯差異,采用十倍帶光源放大鏡檢測(cè),分離剪的清洗合格率98.18%(324/330)與雙極鉗清洗合格率93.03%(307/330)比較,H=-3.176,P0.05,差異有統(tǒng)計(jì)學(xué)意義;采用蛋白殘留檢測(cè),分離剪的清洗合格率93.03%(307/330)、雙極鉗的清洗合格率83.63%(276/330)、分離鉗的清洗合格率85.45%(282/330),分離剪的清洗合格率分別與分離鉗、雙極鉗的清洗合格率比較,H值分別為:-2.955、-3.665,P0.05,差異有統(tǒng)計(jì)學(xué)意義;采用ATP生物熒光檢測(cè)儀檢測(cè),分離剪的清洗合格率95.76%(316/330)、分離鉗的清洗合格率86.36%(285/330)、雙極鉗的清洗合格率86.97%(287/330)、Hem-o-lok鉗的清洗合格率87.58%(289/330),分離剪的清洗合格率分別與分離鉗、雙極鉗、Hem-o-lok鉗的清洗合格率比較,H值分別為:-3.948、-3.693、-3.438,P0.05,差異有統(tǒng)計(jì)學(xué)意義。6.硬式內(nèi)鏡內(nèi)窺鏡規(guī)范清洗組與預(yù)處理組所需時(shí)間、成本的比較:規(guī)范清洗組每個(gè)內(nèi)窺鏡的清洗時(shí)間7.517±0.149min,預(yù)處理組每個(gè)內(nèi)窺鏡的清洗時(shí)間11.333±0.220min,Z=-9.960,P0.05,差異有統(tǒng)計(jì)學(xué)意義,費(fèi)用多支出1.5元;硬式內(nèi)鏡相關(guān)器械不同清洗方法所需時(shí)間、成本(除購置清洗設(shè)備所需費(fèi)用)同規(guī)范清洗組的比較:規(guī)范清洗組每套硬式內(nèi)鏡相關(guān)器械(分離剪、分離鉗、持針器、雙極鉗、Hem-o-lok鉗)清洗時(shí)間21.85±1.417min;超聲噴淋清洗組每套硬式內(nèi)鏡相關(guān)器械清洗時(shí)間21.80±1.449min,成本較規(guī)范清洗組約多支出5元/套;超聲噴淋+浸油煮沸組每套硬式內(nèi)鏡相關(guān)器械清洗時(shí)間為31.94±1.424min,成本較規(guī)范清洗組約多10元/套;全自動(dòng)清洗消毒機(jī)組每套硬式內(nèi)鏡相關(guān)器械清洗時(shí)間為33.73±1.431min,成本較規(guī)范清洗組約多42.5元/套;超聲噴淋+全自動(dòng)清洗消毒機(jī)組每套硬式內(nèi)鏡相關(guān)器械清洗時(shí)間為27.82±1.122min,成本較規(guī)范清洗組約多支出42.5元/套。各組清洗時(shí)間進(jìn)行比較,χ2=291.665,P0.05,差異有統(tǒng)計(jì)學(xué)意義,超聲噴淋+浸油煮沸組、全自動(dòng)清洗消毒機(jī)組、超聲噴淋+全自動(dòng)清洗消毒機(jī)組所用時(shí)間分別與規(guī)范清洗組比較,H值分別為:-10.717、-13.110、-5.935,P0.05,差異有統(tǒng)計(jì)學(xué)意義,分別與超聲噴淋清洗組比較,H值分別為:-10.803、-13.197、-6.022,P0.05,差異有統(tǒng)計(jì)學(xué)意義,超聲噴淋+全自動(dòng)清洗消毒機(jī)組所用時(shí)間分別與超聲噴淋+浸油煮沸組、全自動(dòng)清洗消毒機(jī)組比較,H值分別為:4.782、7.175,P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論1.硬式內(nèi)鏡內(nèi)窺鏡采用預(yù)處理及酶液下擦拭3分鐘同時(shí)進(jìn)行規(guī)范清洗,能夠提高內(nèi)窺鏡的清洗效果;硬式內(nèi)鏡相關(guān)器械(除內(nèi)窺鏡)清洗使用超聲噴淋清洗器清洗代替多酶清洗和超聲清洗,配合使用全自動(dòng)清洗消毒機(jī),可提高清洗效果。2.評(píng)價(jià)指標(biāo)的研究:ATP生物熒光檢測(cè)與十倍帶光源放大鏡檢測(cè)、蛋白殘留檢測(cè)綜合比較,其結(jié)果較客觀,檢測(cè)速度快,臨床條件允許的情況下推薦使用。
[Abstract]:Objective with the development of minimally invasive technology, endoscopic instruments are widely used in medical institutions at all levels, and endoscopy related infections are serious. Cleaning is a necessary step for disinfection and sterilization. The thorough cleaning of endoscopic instruments can prevent the production of biofilm. It is a key link to control hospital infection. The washing method still follows the 2004 edition < endoscopic cleaning and disinfection technology operation specification >. This study uses different hard endoscopic cleaning methods and uses three methods to evaluate the cleaning effect, so as to optimize the process of hard endoscopic cleaning and improve the quality of endoscopic cleaning. The method of cleaning method is divided into two parts: hard endoscopy endoscope cleaning reality The experimental and hard endoscopy related instrument cleaning experiments were conducted in accordance with the 2004 edition of the 2004 edition of the endoscopic cleaning and disinfection technique, the cleaning of the hard endoscopic instruments. The hard endoscopic endoscopy cleaning experiment: the 132 times of a hard endoscopic endoscopy after laparoscopy in a three a hospital were randomly selected from January -2016 September 2015. Cleaning group and pre treatment group, each group carried out 66 endoscopy experiments. Endoscopic cleaning method: standard cleaning group: initial washing - Multi enzyme soaking 5min - rinsing - end rinsing - drying. Pretreatment group was treated with multi enzyme original solution before initial washing, and after 5min was soaked with disposable clean gauze to wipe 3min (cleaning flow) The process is: preprocessing - Multi enzyme soaking in 5min - Multi enzyme cleaning solution, wiping 3min - rinsing end rinse - drying). Hard endoscopy other instruments cleaning experiments: from October -2016 February 2016, 330 sets of hard endoscopy related instruments (laparoscopic surgical instruments) were randomly selected and divided into five groups, 66 sets of each set. Separation shear, separation forceps, needle holder, bipolar forceps, automatic ligature forceps (Hem-o-lok forceps below Hem-o-lok forceps) for experiment. Hard endoscopy related instruments (except endoscope) cleaning methods: standard cleaning group: removal of equipment after recovery to the minimum unit, initial washing - Multi enzyme cleaning 5min - ultrasonic cleaning 5min - rinsing finish bleaching drying; ultrasonic drying; ultrasonic Spray cleaning group (improved cleaning process: first washing - Multi enzyme cleaning 5min - ultrasonic spray cleaner cleaning 5min - Rinse - end rinsing - drying); ultrasonic spray + soaked boiling - group (improved cleaning process: initial washing - Multi enzyme cleaning 5min - ultrasonic spray cleaner 5min - soaked and boiling tank for treatment of 10min - rinse - end Final rinsing - drying); automatic cleaning and disinfection unit (improved cleaning process: initial washing - Multi enzyme cleaning 5min - ultrasonic cleaning 5min - Rinse - fully automatic cleaning and disinfecting machine cleaning - drying); ultrasonic spray + fully automatic cleaning and disinfection unit (improved cleaning process: initial washing - ultrasonic spray cleaner cleaning 5min rinse - fully automatic The cleaning effect was detected by ten times light source magnifying mirror, protein residue detection and ATP biological fluorescence detection, respectively. The cleaning effect of each hard endoscope instrument was evaluated in turn. The statistical method was carried out by the Microsoft Office Excel 2007 form. Data collection and input, IBM SPSS statistics 23 statistical software for statistical processing, two independent samples using t test, Mann-Whitney U test, the relative samples were compared to the Friedman rank and test, two groups of two classified data using chi square test, independent multiple groups of data compared with Kruskal-Wallis H test, P0.05, the difference was statistically significant. Two different cleaning methods were used in 1. hard endoscopy endoscopy. The results were compared with ten times the light source magnifying glass. There was no significant difference between the two groups of endoscopy (P0.05). The rate of standard cleaning combined lattice was 69.70% (46/66), the pre treatment combination lattice rate was 84.85% (56/66), X 2=4.314, P. 0.05, the difference was statistically significant; using ATP bioluminescence detection, the standard cleaning combination lattice rate was 80.30% (53/66), the pretreated combined lattice rate was 92.42% (61/66), X 2=4.117, P0.05, the difference was statistically significant, and the difference between.2. hard endoscopy related instruments (except endoscope) was used in different method cleaning results: ten times with light source magnifying mirror was used for testing. The combination lattice rate of 91.52% (302/330), ultrasonic spray cleaning combined lattice rate 93.94% (310/330), ultrasonic spray + oil boiling group qualified rate 96.06% (317/330), full automatic cleaning and disinfection unit 97.58% (322/330), ultrasonic spray + fully automatic cleaning unit 98.18% (324/330), the use of protein residue detection, standardized cleaning combination lattice rate 77.88% (257/330), ultrasonic spray cleaning combined rate of 85.76% (283/330), ultrasonic spray + oil boiling group qualified rate of 87.27% (288/330), full automatic cleaning and disinfection unit 93.03% (307/330), ultrasonic spray + full automatic cleaning and disinfection unit 94.24% (311/ 330); use ATP bio fluorescence detector to test, standardize the cleaning combination rate 83.33% (275/330), 86.97% (287/330), 87.58% (289/330), 94.55% (312/330), 87.58% (312/330), 95.45% (315/ 330).3. hard endoscopy (except for endoscopy): three kinds of cleaning results The test method was used to compare the qualified rate of each group. The H value was 22.894,52.234,38.505, and the difference of the qualified rate of the P0.05,5 cleaning method was statistically significant. The ten times of the light source magnifying mirror was used for the automatic cleaning and disinfection unit, and the standard cleaning rate of the ultrasonic spray + full automatic cleaning machine group was compared with the standard cleaning group, and the H value was compared with the standard cleaning group. The difference was statistically significant in 3.736,4.110 and P0.05, and the results of the detection of protein residue showed: ultrasonic spray cleaning group, ultrasonic spray + soaked boiling group, automatic cleaning and disinfection unit, ultrasonic spray + fully automatic cleaning unit cleaning rate compared with the standard cleaning group respectively, H value was 3.074,3.665,5.911,6.384, P0.05, respectively. The difference has statistical significance, the total automatic cleaning and disinfection unit, ultrasonic spray + full automatic cleaning unit cleaning rate are compared with the ultrasonic spray cleaning group respectively, H value is 2.837,3.310, P0.05, the difference is statistically significant; ATP bio fluorescence detection, the results show that the full automatic cleaning and disinfection unit cleaning rate and the standard clear, respectively. Washing group, ultrasonic spray cleaning group, ultrasonic spray + soaked boiling group, H value was 4.712,3.184,2.929, P0.05 respectively, the difference was statistically significant, ultrasonic spray + full automatic cleaning unit cleaning rate was compared with the standard cleaning group, ultrasonic spray cleaning group, ultrasonic spray + soaked oil boiling group, H value was 5.094,3.566,3.311, P0.05 respectively. The difference was statistically significant. There was no significant difference between the cleaning rate of the automatic cleaning and disinfection unit and the ultrasonic spray + full automatic cleaning unit (P0.05), the positive detection rate of the three.4. detection methods was compared, the positive rate of the ten times with the light source magnifier was 4.26% (76/ 1782), and the positive detection rate of protein residue was 13.13% (234/1782 The positive detection rate of ATP bioluminescence detection was 10.66% (190/1782), the positive detection rate of the ten times with the light source magnifying mirror was compared with the protein residue detection, and the positive detection rate of ATP bioluminescence detection was compared. The H values were respectively 3.970,2.864 and P0.05, the difference was statistically significant, the positive detection rate of egg white residue detection and the positive detection of ATP bioluminescence detection were positive. There was no statistically significant difference in rate of rate, kappa value was 0.572, the degree of anastomosis of.5. hard endoscopy was generally detected by three methods, and there were obvious differences in the rate of qualified cleaning. Ten times the ten times with light source magnifying mirror, 98.18% (324/330) and 93.03% (307/330) of the bipolar forceps cleaning rate (307/330), H=-3.17 6, P0.05, the difference is statistically significant; using protein residue detection, separation scissors cleaning rate 93.03% (307/330), the cleaning rate of bipolar forceps 83.63% (276/330), separation forceps cleaning rate of 85.45% (282/330), separation scissors cleaning rate and separation forceps and bipolar forceps cleaning rate respectively compared, H values are: -2.955, -3.665, P0.0, respectively. 5, the difference is statistically significant; using ATP bioluminescence detector, the qualified rate of the separation scissors is 95.76% (316/330), the qualified rate of the separation forceps is 86.36% (285/330), the qualified rate of the bipolar forceps is 86.97% (287/330), the qualified rate of the Hem-o-lok forceps is 87.58% (289/330), and the qualified rate of the separation shear is respectively with the separation clamp, the bipolar forceps, Hem-. The comparison of the qualified rate of o-lok forceps, the H values were -3.948, -3.693, -3.438, P0.05, the difference was statistically significant, the time required for the standard cleaning group and the pre treatment group of.6. hard endoscopic endoscopy, the comparison of the cost: the cleaning time of each endoscope in the standard cleaning group was 7.517 + 0.149min, and the cleaning time of each endoscope in the pretreated group was 11.333 + 0.220mi N, Z=-9.960, P0.05, the difference is statistically significant, the cost is 1.5 yuan; the time required for different cleaning methods for hard endoscopy related instruments, the cost (except for the purchase of the cleaning equipment) and the standard cleaning group: the cleaning time for each set of hard endoscopy related instruments (separation clips, separation forceps, needle holder, bipolar forceps, Hem-o-lok forceps) in the standard cleaning group 21.85 + 1.417min, the cleaning time of each set of hard endoscope related instruments in the ultrasonic spray cleaning group was 21.80 + 1.449min, the cost was 5 yuan more than the standard cleaning group, and the cleaning time of each set of hard endoscope related instruments was 31.94 + 1.424min, and the cost was 10 yuan more than that of the standard cleaning group. The cleaning time of the hard endoscope related instruments was 33.73 + 1.431min, the cost was 42.5 yuan more than that of the standard cleaning group, and the cleaning time of each set of hard endoscope related instruments was 27.82 + 1.122min, and the cost was 42.5 yuan more than the standard cleaning group. The cleaning time of each group was compared, X 2=291.665, P0.05, The difference has statistical significance, the ultrasonic spray + oil soaked boiling group, the fully automatic cleaning and disinfection unit, the ultrasonic spray + full automatic cleaning unit time compared with the standard cleaning group respectively, H values are -10.717, -13.110, -5.935, P0.05, the difference is statistically significant, respectively compared with the ultrasonic spray cleaning group, respectively, H values are -10.803, -13.197, respectively. -6.022, P0.05, the difference was statistically significant. The time used by ultrasonic spray + full automatic cleaning and disinfection unit was compared with the ultrasonic spray + soaked boiling group and the full automatic cleaning and disinfection unit. The H value was 4.782,7.175, P0.05, respectively. Conclusion the 1. hard endoscope endoscope was pretreated with the enzyme liquid wiping for 3 minutes at the same time. Standard cleaning can improve the cleaning effect of endoscope; hard endoscopic related instruments (except endoscope) cleaning use ultrasonic spray cleaner to replace multi enzyme cleaning and ultrasonic cleaning, and the use of automatic cleaning machine can improve the.2. evaluation index of cleaning effect: ATP bioluminescence detection and ten times band light magnifying mirror examination The results showed that the results of protein residue detection were more objective and fast, and recommended for clinical conditions.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R472.1

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