消化器内視鏡診療の感染対策―COVID-19感染症を含めて―

Infection control in gastrointestinal endoscopy

要旨

消化器内視鏡を介したさまざまな感染事故が報告され，内視鏡における感染対策はきわめて重要である。内視鏡機器はガイドランを遵守した１回使用ごとの再生処理が必要である。また，内視鏡従事者全員が清潔操作への意識を高め，内視鏡室全体の衛生環境に配慮しなければならない。内視鏡従事者自身への感染予防も大切で，内視鏡診療時には必ず個人用防護具を着用して行う。2019年に始まったCOVID-19感染症のパンデミックによって一般診療だけでなく，内視鏡診療においても大きな混乱が生じた。すなわち，飛沫感染をきたすCOVID-19は従来の接触型感染を中心とした対策だけでは不十分で，COVID-19蔓延期における消化器内視鏡診療の在り方が日本消化器内視鏡学会より提言された。現在COVID-19感染症は2類から5類へ引き下げられ，終息はしていないものの弱毒化した。内視鏡診療における感染対策は「通常時」となり，一時全国的に減少した内視鏡診療数は増加傾向を示している。

　Many infectious complications of gastrointestinal （GI） endoscopy with microorganisms have been reported; therefore infection control in GI endoscopy is very important. Endoscopes and apparatus should be reprocessed before each endoscopic examination and treatment according to guidelines for cleaning and disinfection of equipment for GI endoscopy. All endoscopic staff members must always be conscious of clean handling, and of keeping endoscopic suites clean. They should make efforts to prevent not only infection from patient to patient, but also infection from patient to endoscopic staff by using personal protective equipment.

　The COVID-19 pandemic had a big impact on the world of medicine, and it caused confusion in GI endoscopy. COVID-19 is infectious from human to human by not only contact route but also droplet route, so past protective measures of infection control in endoscopy were not enough because they were based on the assumption that the only infection route was the contact one. Various suggestions of infection control of GI endoscopy during the spread of COVID-19 were released by the Japan Gastroenterological Endoscopy Society. Recently, the Government of Japan reduced the classification of COVID-19 from grade 2 to grade 5. COVID-19 infections have not ended yet; however, the toxicity of COVID-19 was thought to be weak compared with the beginning of the pandemic. The level of infection control in GI endoscopy has improved, and the number of GI endoscopies is recovering nationwide.