危机、灾难或战争情况下一次性医疗设备清洁的应急方法

文献信息

中文摘要

背景： 一次性医疗设备的短缺可能在灾难或武装冲突期间严重损害医疗服务的提供。尽管在此类条件下，对一次性医疗器械（SUDs）进行再处理可能是唯一可行的选择，但支持简单、适合现场应用的清洁方法的证据有限。
方法： 在这项探索性研究中，收集了某地区医院手术后临床使用过的90件SUDs——气管导管（ETT）、喉罩气道（LMA）、静脉输液器（IVS）、注射器（SYR）、留置导尿管（IDC）和鼻胃管（NGT）。器械被随机分配使用过氧乙酸（PAA）、70%乙醇或洗洁精进行清洁。每件物品均经刷洗、浸泡十分钟，然后风干。微生物采样包括清洁前和清洁后培养，气道器械还进行了针对28种呼吸道病原体的聚合酶链反应（PCR）检测。清洁后评估了功能完整性。
结果： 三种清洁剂均实现了细菌载量的统计学显著降低（P < 0.05），各方法之间无差异。PCR检测在清洁前于47%的气道器械中检出了流感嗜血杆菌（H. influenzae）和金黄色葡萄球菌（S. aureus）等病原体；所有清洁后样本均为阴性。未观察到结构或功能损伤。
结论： 使用常用清洁剂的基本清洁程序大幅减少了微生物污染，且未损害器械功能。这些方法不能替代经过验证的灭菌，但当医疗物资严重受限时，例如在灾难或武装冲突中，它们可能是唯一可行的选择。应急准备规划应包括战略储备、激增生产能力、有韧性的供应链，以及配给和替代策略，并且——仅作为最后手段——一次性医疗设备清洁和重复使用的方案。

英文摘要

BACKGROUND: Shortages of disposable medical equipment can critically impair health care delivery during disasters or armed conflict. Although reprocessing single-use medical devices (SUDs) may represent the only feasible option under such conditions, evidence supporting simple, field-adapted cleaning methods is limited.
METHODS: In this exploratory study, 90 clinically used SUDs - endotracheal tubes (ETT), laryngeal mask airway (LMA), intravenous administration sets (IVS), syringes (SYR), indwelling urinary catheters (IDC), and nasogastric tubes (NGT) - were collected after surgery in a regional hospital. Devices were randomly allocated to cleaning with peracetic acid (PAA), 70% ethanol, or dishwashing detergent. Each item was brushed, immersed for ten minutes, and then air-dried. Microbiological sampling included pre-cleaning and post-cleaning cultures, and airway devices underwent Polymerase Chain Reaction (PCR) testing for 28 respiratory pathogens. Functional integrity was assessed after cleaning.
RESULTS: All three cleaning agents achieved statistically significant reductions in bacterial load (P < 0.05) with no difference between methods. The PCR testing detected Hemophilus influenzae (H. influenzae) and Staphylococcus aureus (S. aureus) among other pathogens in 47% of airway devices before cleaning; all post-cleaning samples were negative. No structural or functional damage was observed.
CONCLUSION: Basic cleaning procedures with commonly available agents substantially reduced microbial contamination without impairing device function. These methods cannot replace validated sterilization but may serve as the only viable option when medical supply is critically constrained, such as in disasters or in armed conflict. Preparedness planning should encompass strategic stockpiling, surge production capacity, and resilient supply chains, together with rationing and substitution strategies, and - only as a last resort - protocols for cleaning and reusing single-use medical equipment.