Xác định tỷ lệ dụng cụ y tế dùng 1 lần có tái sử dụng an toàn tại Bệnh viện Đại học Y Dược Tp. Hồ Chí Minh=Reprocessing of single-use energy devices: Efficacy cleaning aspect

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Minh Tuấn Huỳnh, Thị Kim Chi Lê, Thị Mộng Hương Lữ, Vũ Hoàng Yến Nguyễn, Thị Châm Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.49-55

Bộ sưu tập: Metadata

ID: 243517

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Đánh giá chất lượng độ sạch của DCYT dùng 1 lần (nhóm dụng cụ cắt, hàn mạch máu - khâu nối ruột và nhóm trocar) sau quá trình làm sạch thông qua đánh giá ATP
đánh giá chức năng sử dụng của nhóm dụng cụ cắt, hàn mạch máu - khâu nối ruột sau làm sạch lần 1,2,3. Phương pháp nghiên cứu: Mô tả cắt ngang. Kết quả: Tổng là 611 DCYT dùng 1 lần được đánh giá ATP. Trong đó 269 dụng cụ nhóm cắt, hàn mạch máu - khâu nối ruột, 298 dụng cụ nhóm trocar và 44 dụng cụ khác. Thực hiện đánh giá chất lượng độ sạch qua ba lần làm sạch liên tục. Sau ba lần làm sạch liên tục ghi nhận giá trị ATP trung bình (957 RLU, 160 RLU, 62 RLU). Kết quả so sánh với ngưỡng ATP <
200 RLU (ngưỡng đánh giá đạt chất lượng độ sạch), cho thấy tất cả DCYT dùng 1 lần được đánh giá chất lượng độ sạch đạt sau bước làm sạch lần 1, lần 2, lần 3 lần lượt là 63,5%, 84,3%, 92,8%. Đối với nhóm dụng cụ cắt, mạch máu - khâu nối ruột, sau ba lần làm sạch liên tục ghi nhận giá trị ATP trung bình (1719 RLU, 316 RLU, 136 RLU) và so sánh với ngưỡng ATP <
200 RLU, cho kết quả đánh giá chất lượng độ sạch đạt là 43,5%, 69,5%, 84,4%. Đối với nhóm Trocar, sau ba lần làm sạch liên tục ghi nhận giá trị ATP trung bình (391 RLU, 43 RLU, 4 RLU) và so sánh với ngưỡng ATP <
200, cho kết quả đánh giá chất lượng độ sạch đạt là 77,2%, 95,3%, 99,3%. Kết quả đánh giá chức năng sử dụng của nhóm dụng cụ cắt, hàn mạch máu - khâu nối ruột sau làm sạch lần 1,2,3 không đạt chức năng sử dụng là 8,6%, 9,7%, 9,7%. Kết luận: ATP là phương pháp dùng để đánh giá nhanh hiệu quả của việc làm sạch, do đó ATP có thể được xem là công cụ theo dõi, đánh giá quá trình làm sạch. Đối với những DCYT dùng 1 lần vượt ngưỡng giá trị ATP (ngưỡng làm sạch an toàn) thì cần được làm sạch lại trước khi tiệt khuẩn. Do đó, Bệnh viện cần có danh mục DCYT dùng 1 lần có thể tái sử dụng, kèm theo số lần được phép tái sử dụng và kết quả đánh giá khả năng làm sạch ngay tức thời để có thể chuyển tiệt khuẩn hay làm sạch lại đối với những DCYT dùng 1 lần không đạt độ sạch.Energy devices (EDs), such as Harmonic, Ligasure, Thunderbeat and Trocar are widely used in Minimally Invasive Surgeries. They are expensive and designed for single use. However, due to the limitation of resources, they have been reused in some cases. Therefore, we aimed to assess the efficacy of EDs reprocessing by Adenosine Triphosphate (ATP) method. Methods: This was a cross-sectional description study. After first clinical using, EDs were taken to cleaning. Every ED was cleaned three times. Efficacy cleaning was assessed after each cleaning procedure by ATP method. ATP <
200 RLUs (Relative Light Units) was benchmark as efficient cleaning process. Results: A total of 611 EDs were studied, including 269 of Harmonic, Ligasure, Thunderbeat, 298 of Trocar, and 44 other types. Detachable devices accounted for about 32.7%. Overall, after three consecutive cleanings, the median ATP values were decreased dramatically (957 RLUs, 160 RLUs, and 62 RLUs, respectively). This was a significant reduction in ATP levels between three stages (p <
0.05). There were 63.5%, 84.3%, and 92.8% EDs that had ATP <
200 RLUs after first, second, third cleaning respectively. Approximately 90% of EDs were still functional after three cleaning times. Nondetachable items were to be more difficult to clean than detachable ones (p = 0.0003, OR 1.3 [1.1 – 1.5]). Conclusions: Our data suggest that monitoring efficacy cleaning of surgical instruments in general and single-use energy devices in particular with ATP can identify a number of different influence factors, like the instrument condition, reprocessing procedure, or especially their structure. ATP measurement seems to be a valid technique that allows an immediate repeat of the manual cleaning if the results exceed the established cutoff of 200 RLUs.

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