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GUIDELINE
Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011
The beneficial role of GI endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection. To date, all published occurrences of pathogen transmission related to GI endoscopy have been associated with
failure to follow established cleaning and disinfection/ sterilization guidelines or use of defective equipment. Despite
the strong published data regarding the safety of
endoscope reprocessing, concern over the potential for
pathogen transmission during endoscopy has raised questions
about the best methods for disinfection or sterilization
of these devices between patient uses.
To this end, in 2003, the American Society for Gastrointestinal
Endoscopy (ASGE) and the Society for Healthcare
Epidemiology of America collaborated with multiple
physician and nursing organizations, infection prevention
and control organizations, federal and state agencies,
and industry leaders to develop evidence-based
guidelines for reprocessing GI endoscopes.1,2 Since that
time, high-level disinfectants, automated reprocessing machines,
endoscopes and endoscopic accessories have all
evolved.3-6 However, the efficacy of decontamination and
high-level disinfection is unchanged and the principles
guiding both remain valid.7
Additional outbreaks of infection related to suboptimal
infection prevention practices during endoscopy or lapses
in endoscope reprocessing have been well publicized. A
cluster of hepatitis C cases was attributed to grossly inappropriate
intravenous medication and sedation practices.
8 In numerous other instances, risk of infection transmission
has been linked to less willful, but incorrect,
reprocessing as a result of unfamiliarity with endoscope
channels, accessories, and the specific steps required for
reprocessing of attachments.9 Recent on-site ambulatory
surgery center surveys confirm widespread gaps in infection
prevention practices.10 Given the ongoing occurrences
of endoscopy-associated infections attributed to
lapses in infection prevention, an update of the multisociety
guideline is warranted.
This document provides an update of the previous
guideline, with additional discussion of new or evolving
reprocessing issues and updated literature citations, where
appropriate. Specific additions or changes include review
of expanded details related to critical reprocessing steps
(including cleaning and drying), reprocessing issues for
various endoscope attachments such as flushing catheters,
discussion of risks related to selected periprocedural practices
including medication administration, and mention
of newly recognized issues for which there are incomplete
data with which to guide practice. They include endoscope
shelf life or “hang time” (the interval of storage after which
endoscopes should be reprocessed before use), the role of
microbiological surveillance testing of endoscopes after
reprocessing and questions regarding endoscope durability
and longevity from the standpoint of infection prevention.
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发表于 2011-12-13 21:25
发表于 2011-12-13 23:31
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