《软式内镜清洗消毒技术规范》 解读.pptVIP

;主要内容;一、内镜引起的医院感染及其暴发;内镜的诞生及其作用 ;近年来有关幽门螺杆菌、肝炎病毒(HBV和HCV)、人类免疫缺陷病毒(HIV)等可能经内镜传播，已成为医学界、患者和社会媒体关注的问题。 1993年美国消化内镜学会统计：内镜相关感染的发生率是1/180万。但是这一数字也许只是冰山一角，实际的内镜相关感染率远远高于这个数字，特别是在内镜清洗消毒不严格的国家和地区。理论上各种病原微生物均有可能通过内镜诊疗操作进行传播。;从1974－1987年，全球共报道48例内镜导致的沙门氏菌感染；1988年后未再发现 1974－2005年全球共报道216例内镜相关铜绿假单孢菌感染。 病毒感染潜伏期较长，明确病毒感染与内镜操作之间的关系即对病毒感染的确定非常困难。 HCV 1993-2005，8例 HBV 1975-1999，5例 国内目前已有内镜相关感染传播的文献报道。 ;Hong KH et al. Recent Update of Gastrointestinal Endoscope Reprocessing. Clin Endosc 2013;46:267-273;Kovaleva et al. Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy. Clinical Microbiology Reviews 2013 ;26 (2): 231–254;Kovaleva et al. Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy. Clinical Microbiology Reviews 2013 ;26 (2): 231–254;TABLE 4 Infections associated with endoscopic retrograde cholangiopancreaticographya;TABLE 5 Infections associated with ?exible bronchoscopy;Kovaleva et al. Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy. Clinical Microbiology Reviews 2013 ;26 (2): 231–254;O. Bajolet et al. Journal of Hospital Infection 83 (2013) 341-343;O. Bajolet et al. Journal of Hospital Infection 83 (2013) 341-343;;the first samples(++ ) (5+3+1);结肠镜操作所引起的HCV在人与人之间的传播 Patient-to-patient transmission of hepatitis C virus during colonoscopy.新英格兰的医学杂志发表．1997;337：237-240 ;González-Candelas et al.: Patient-to-patient transmission of hepatitis C virus (HCV) during colonoscopy diagnosis. Virology Journal 2010 7:217.;González-Candelas et al.: Patient-to-patient transmission of hepatitis C virus (HCV) during colonoscopy diagnosis. Virology Journal 2010 7:217.;Figure 2 Maximum-likelihood phylogenetic tree obtained for the NS5B region. Maximum-likelihood phylogenetic tree obtained for the NS5B region of patients analyzed in this study (C1, C2 and C3) and 28 reference sequences. All sequences belong to HCV subtype 1b. Only bootstrap support values higher than 70% are indicated. The sc