影響清洗效果的因素

　　Factors affecting cleaning effectiveness

　　消毒供應中心是負責醫療器械清洗消毒處理的部門，隨著手術量日益的增長，很多醫療機構消毒供應中心使用全自動清洗消毒機處理醫療器械清洗已經成為主要清洗手段。機械清洗分為全自動、半自動、超聲清洗機、長龍式等多種形式，有的清洗機帶加熱系統和干燥系統。

　　The disinfection supply center is the department responsible for cleaning and disinfecting medical equipment. With the increasing number of surgeries, many medical institutions' disinfection supply centers use fully automatic cleaning and disinfection machines to clean medical equipment, which has become the main cleaning method. Mechanical cleaning is divided into various forms such as fully automatic, semi-automatic, ultrasonic cleaning machines, and long queue cleaning machines. Some cleaning machines are equipped with heating and drying systems.

　　目前國內部分醫院采用機械清洗，全自動噴淋式清洗消毒機清洗手術器械前使用多酶液浸泡器械的方法，可使同一部器械表面、軸節、咬合面的清洗質量明顯提高。超聲波自動清洗機的洗凈作用是極高頻率水的擠壓產生水泡形成真空區而產生拉力，將附在器械上的污垢松動吸離，它比人工清洗好的理由是它可以清除刷子無法觸及的污物。

　　At present, some hospitals in China use mechanical cleaning and fully automatic spray cleaning and disinfection machines to soak surgical instruments in multi enzyme solution before cleaning, which can significantly improve the cleaning quality of the same instrument surface, joint, and occlusal surface. The cleaning function of an ultrasonic automatic cleaning machine is to create a vacuum zone by squeezing water at extremely high frequencies, which generates tension and loosens dirt attached to the instrument. The reason why it is better than manual cleaning is that it can remove dirt that cannot be touched by brushes.

　　相比于手工清洗，全自動清洗消毒機的機械清洗過程是一個多因素參與的復雜過程。不同廠家不同規格型號的全自動清洗消毒機清洗過程不同，清洗效果主要影響因素包括噴淋機械力，器械清洗劑，清洗溫度，清洗時間以及清洗用水的水質等。每個因素的改變不僅會影響整體清洗效果，也可能會影響到其它因素的作用效果。

　　Compared to manual cleaning, the mechanical cleaning process of fully automatic cleaning and disinfection machines is a complex process involving multiple factors. The cleaning process of fully automatic cleaning and disinfection machines of different manufacturers and specifications varies, and the main factors affecting the cleaning effect include spray mechanical force, instrument cleaning agents, cleaning temperature, cleaning time, and the quality of cleaning water. The changes in each factor not only affect the overall cleaning effect, but may also affect the effectiveness of other factors.

　　一、噴淋機械效果

　　1、 Spray mechanical effect

　　全自動清洗消毒機的噴淋清洗的出水口水壓、水量是形成噴淋機械力的主要因素。噴淋出水口的出水的水壓越大，水量越大，形成的機械清洗力越強，更容易把醫療器械表面的污染物質沖洗干凈。過大的機械力會對器械，尤其是一些精細部位造成損傷，降低器械的使用壽命，合理設置清洗機的水壓和水量保證既不損傷醫療器械又能達到良好的清洗效果尤為重要。此外，噴淋懸臂的正常運作與否，醫療器械的裝載是否合理等都會影響噴淋的作用效果。

　　The water pressure and volume at the outlet of the fully automatic cleaning and disinfection machine's spray cleaning are the main factors that form the mechanical force of the spray. The higher the water pressure and volume of the water from the sprinkler outlet, the stronger the mechanical cleaning force formed, making it easier to wash away the pollutants on the surface of medical devices. Excessive mechanical force can cause damage to medical equipment, especially some delicate parts, reducing the service life of the equipment. It is particularly important to set the water pressure and volume of the cleaning machine reasonably to ensure that it does not damage medical equipment and can achieve good cleaning results. In addition, the normal operation of the spray cantilever and the reasonable loading of medical equipment will affect the effectiveness of the spray.

　　二、多酶清洗劑

　　2、 Multi enzyme cleaning agent

　　研究表明，發現單純的機械清洗對殘存有有機物的器械達不到理想的清洗效果，而使用多酶液浸泡手工刷洗再清洗機清洗的效果更好。用于醫療器械清洗的含酶清洗劑本身的性質，使用時的稀釋濃度，稀釋用水的水質都會直接影響清洗效果。如果清洗劑與醫療器械材質不兼容，不僅會造成污染物殘留，還會對醫療器械造成損傷；如果清洗劑稀釋使用濃度過低，容易造成污染物質殘留，經過后續干燥過程，污物在醫療器械表面干涸，更難去除，而如果使用清洗劑的濃度過高，則會成為成本上的浪費。另外，稀釋用水的水質過硬或者含有有機物質，很容易造成清洗劑失活。同時，清洗時的水溫溫度，清洗劑接觸時間也會影響清洗劑的作用，常規清洗劑的時間不低于120秒鐘。

　　Research has shown that mechanical cleaning alone does not achieve ideal cleaning results for instruments with residual organic matter, while using a multi enzyme solution soaked in manual scrubbing followed by cleaning with a cleaning machine yields better results. The properties of enzyme based cleaning agents used for medical device cleaning, the dilution concentration during use, and the water quality of the dilution water all directly affect the cleaning effect. If the cleaning agent is incompatible with the material of the medical device, it will not only cause residual pollutants, but also damage the medical device; If the dilution concentration of the cleaning agent is too low, it is easy to cause residual pollutants. After the subsequent drying process, the dirt will dry up on the surface of the medical device, making it more difficult to remove. If the concentration of the cleaning agent is too high, it will become a waste of cost. In addition, the water used for dilution is of high quality or contains organic substances, which can easily cause the cleaning agent to become inactive. At the same time, the water temperature during cleaning and the contact time of the cleaning agent can also affect the effectiveness of the cleaning agent. The time for conventional cleaning agents is not less than 120 seconds.

　　三、清洗溫度

　　3、 Cleaning temperature

　　常規清洗劑清洗時水溫的溫度越高，越容易發揮清洗劑效果，清洗效果也越好。但是醫療器械清洗溫度的設定應該考慮到污物在高溫下凝結變性問題，酶清洗劑在過高的溫度下容易失去活性，一般含酶清洗劑要求水溫25℃～55℃之間。

　　The higher the water temperature during regular cleaning with cleaning agents, the easier it is to achieve the cleaning effect and the better the cleaning effect. However, the setting of the cleaning temperature for medical devices should take into account the problem of dirt condensation and denaturation at high temperatures. Enzyme cleaning agents are prone to lose their activity at excessively high temperatures, and generally require a water temperature between 25 ℃ and 55 ℃ for enzyme containing cleaning agents.

　　需要特別注意的是清洗劑中表面活性劑發揮作用也需要適宜的溫度。

　　It should be noted that the surfactant in the cleaning agent also requires a suitable temperature to function effectively.

　　四、清洗時間

　　4、 Cleaning time

　　清洗時間越長，越有利于清洗徹底。但是過長的清洗時間不僅造成成本上的浪費，也會影響整個醫療器械再處理的進度。清洗時間設定過短則不利于清洗劑在醫療器械表面停留。

　　The longer the cleaning time, the more conducive it is to thorough cleaning. However, excessive cleaning time not only results in cost waste, but also affects the progress of the entire medical device reprocessing. Setting the cleaning time too short is not conducive to the cleaning agent staying on the surface of medical devices.

　　影響醫療器械清洗效果的因素繁多復雜且互相影響，臨床操作要嚴格按照產品廠家說明書操作和執行，每批次監測清洗消毒器的物理參數及運轉情況，記錄并歸檔，對清洗消毒器的效果可每年采用清洗效果指示物進行監測，每年檢測清洗消毒器的主要性能參數，如時間、溫度、A0值等。清洗消毒器新安裝、更新、大修更換清洗劑、改變消毒參數或裝載方法等時，應遵循生產廠家的使用說明或指導手冊進行檢測，清洗消毒質量檢測合格后，清洗消毒器方可使用。

　　There are numerous and complex factors that affect the cleaning effect of medical devices, and they interact with each other. Clinical operations must strictly follow the product manufacturer's instructions, monitor the physical parameters and operation of each batch of cleaning and disinfection equipment, record and archive them, and monitor the effectiveness of cleaning and disinfection equipment annually using cleaning effect indicators. The main performance parameters of the cleaning and disinfection equipment, such as time, temperature, A0 value, etc., should be tested annually. When installing, updating, repairing, replacing cleaning agents, changing disinfection parameters or loading methods, etc., the cleaning and disinfection equipment should be tested according to the manufacturer's instructions or guidance manual. After passing the quality inspection of cleaning and disinfection, the cleaning and disinfection equipment can be used.

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