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EndoTODAY ³»½Ã°æ ±³½Ç


[Reprocessing endoscopes. ³»½Ã°æ ¼Òµ¶. ³»½Ã°æ ¼¼Ã´] - ðû

1. Guideline

2. Endoscopy-related infections

3. Liquid chemical germicides and sensitivity of microbes to liquid chemical germicides

4. Level of disinfection

5. Spaulding classification

6. Steps of disinfection

7. Ideal disinfection

8. Education

9. Checklist

10. Microbiological monitoring = Surveillance culture

11. Outbreaks

12. Cost coverage - ³»½Ã°æ ¼Òµ¶ ¼ö°¡ ½Å¼³ (2017.1.1.)

13. CÇü °£¿° »çÅÂ¿Í 1ȸ¿ë ³»½Ã°æ µµ±¸ (2016)

14. 1ȸ¿ë snare

15. News

16. FAQ - °áÇÙȯÀÚ ³»½Ã°æ¼Òµ¶, COVID-19 Äڷγª ¹ÙÀÌ·¯½º

17. References


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³»½Ã°æ ¼Òµ¶ ÁöħÀº °è¼Ó °­È­µÇ°í ÀÖ½À´Ï´Ù. ¸ðµç ÁöħÀ» ´Ù ÁöŲ´Ù´Â °ÍÀº ¸Å¿ì Èûµé°í ºñ½Ñ ¾÷¹«ÀÔ´Ï´Ù. ¾öû³ª°Ô ¸¹Àº Àη°ú ±â±¸°¡ ÇÊ¿äÇÕ´Ï´Ù. ¾ÈÀüÀº °øÂ¥°¡ ¾Æ´Õ´Ï´Ù.

»ï¼º¼­¿ïº´¿ø ³»½Ã°æ¼¼Ã´ (2017)

À§´ëÀå³»½Ã°æÇÐȸ YouTube µ¿¿µ»ó (2018)


1. ¼Òµ¶ °¡À̵å¶óÀÎ - 1Â÷ (1995), 2Â÷ (2009), 3Â÷ (2015) Áöħ ±×¸®°í 2017³â ´ÜÇົ '¼ÒÈ­°ü³»½Ã°æ ¼¼Ã´ ¹× ¼Òµ¶ÀÇ ±æÀâÀÌ'

³»½Ã°æ°Ë»ç´Â ºñ±³Àû ¾ÈÀüÇÕ´Ï´Ù. ±×·¯³ª ´Ù¸¥ ¸ðµç ½Ã¼ú°ú ¸¶Âù°¡Áö·Î 100% ¾ÈÀüÇÑ °ÍÀº ¾Æ´Õ´Ï´Ù. ÃâÇ÷, õ°ø µî Á÷Á¢ÀûÀÎ ÇÕº´ÁõÀÌ °¡´ÉÇÕ´Ï´Ù. Salmonella, Pseudomonas, Mycobacterium, HBV, HCV °¨¿°µµ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù.

´ë·« 2000³â ÀÌÀü¿¡´Â '¼Òµ¶À» Àß ÇÏ´ÂÁö ¸ø ÇÏ´ÂÁö'º¸´Ù´Â '¼Òµ¶À» ÇÏ´ÂÁö ¾È ÇÏ´ÂÁö'°¡ ¹®Á¦¿´½À´Ï´Ù. ÇöÀç´Â ¾ó¸¶³ª Àß ÇÏ´ÂÁö°¡ °ü°ÇÀÔ´Ï´Ù. ÇÑ È¯ÀÚÀÇ ³»½Ã°æ°Ë»ç°¡ ³¡³ª¸é Áï½Ã ¼Òµ¶ÇÏ´Â °ÍÀº ÇʼöÀÔ´Ï´Ù. ±×·¯³ª ÀÌ »·ÇÑ ¿øÄ¢ÀÌ ´ç¿¬ÇÏ°Ô ¹Þ¾Æµé¿©Áø °Íµµ ¾ó¸¶µÇÁö ¾Ê¾Ò½À´Ï´Ù.

¼­±¸¿¡¼­´Â 1980³â´ë ÃʺÎÅÍ ³»½Ã°æ ¼Òµ¶¿¡ ´ëÇÑ ÁöħÀÌ ¹ßÇ¥µÇ°í ÀÖ½À´Ï´Ù. ±¹³»¿¡¼­´Â 1995³â 8¿ù ù Áöħ(¾ÏÈ£: smcgi)ÀÌ ¹ßÇ¥µÈ ¹Ù ÀÖ°í 2009³â 11¿ù °³Á¤ÆÇÀÌ ³ª¿Ô½À´Ï´Ù (Á¤½ÄÀ¸·Î °øÇ¥µÇÁö ¸øÇÏ°í ³»½Ã°æ ¼¼¹Ì³ª °­ÀǸ¦ ÅëÇÏ¿© ½½±×¸Ó´Ï Á¦½ÃµÇ¾î ¾Æ½¬¾ú½À´Ï´Ù). 2015³â Á¦ 3Â÷ ³»½Ã°æ ¼Òµ¶ ÁöħÀÌ ¹ßÇ¥µÇ¾ú½À´Ï´Ù.

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¼­±¸¿¡¼­´Â Ç¥ÁØ ¼Òµ¶ÀÇ °­µµ¸¦ Á¡Â÷ ³ô¿©¿Ô½À´Ï´Ù. Glutaraldehyde ħÀû ½Ã°£¸¸ º¸´õ¶óµµ 1990³â´ë¿¡´Â 4ºÐÀ̸é ÃæºÐÇÏ´Ù°í ÀÎÁ¤µÇ¾ú½À´Ï´Ù. ÃÖ±Ù Áöħ¿¡´Â ÃÖ¼ÒÇÑ 20ºÐÀ̶ó°í ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù. 1994³â FDA´Â 25¡É 2.4% glutaraldehyde¿¡ 45ºÐ°£ ´ã±Û °ÍÀ» ÃßõÇÏ¿´½À´Ï´Ù. ÀÌó·³ ¼Òµ¶ ½Ã°£ÀÌ ´Ã¾î³­ °ÍÀº ±âÁ¸ÀÇ ¼Òµ¶ ½Ã°£(¿¹¸¦ µé¸é, 4ºÐ)ÀÌ ¹®Á¦°¡ µÇ¾ú±â ¶§¹®Àº ¾Æ´Ñ °Í °°½À´Ï´Ù. °¨¿°Áõ¿¡ ´ëÇÑ °øÆ÷°¡ ÁÖµÈ ÀÎÀÚ¿´½À´Ï´Ù. ¾à°£ overÀÎ ¼ÀÀÔ´Ï´Ù. 2015³â Á¦ 3Â÷ ³»½Ã°æ ¼Òµ¶ Áöħ¿¡¼­´Â ħÀû ½Ã°£À» ¸í½ÃÇÏÁö ¾Ê¾Ò°í, ´ÜÁö Çã°¡ ±âÁØÀ» ÁöÅ°¶ó°í¸¸ µÇ¾î ÀÖ½À´Ï´Ù. ÇöÀç ¿ì¸®³ª¶ó¿¡¼­´Â 5ºÐ Á¤µµÀÇ Ä§Àû½Ã°£À¸·Î Çã°¡¹ÞÀº ¼Òµ¶¾×ÀÌ ÁÖ·Î »ç¿ëµÇ°í ÀÖ½À´Ï´Ù.

¼Òµ¶¾×Àº ½ÄÇ°ÀǾàÇ°¾ÈÀüû, ¹Ì±¹ FDA, À¯·´ CE, ÀϺ» ÈÄ»ý¼º ¶Ç´Â º¸°Çº¹ÁöºÎÀå°üÀÌ ÀÎÁ¤ÇÑ ±â°ü¿¡¼­ ÀÎÁõ(Çã°¡, ½Å°í, µî·Ï µî Æ÷ÇÔ)À» ¹ÞÀº °ÍÀ» ¼±ÅÃÇÏ°í »ç¿ëÇÒ ¶§´Â Á¦Á¶È¸»ç¿¡¼­ Á¦½ÃÇÏ´Â ¼Òµ¶¾×ÀÇ Á¶°Ç°ú ½Ã°£À» ÁؼöÇÑ´Ù.

2017³â ´ëÇѼÒÈ­±â³»½Ã°æÇÐȸ¿¡¼­´Â '¼ÒÈ­°ü³»½Ã°æ ¼¼Ã´ ¹× ¼Òµ¶ÀÇ ±æÀâÀÌ'¸¦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù. ÀÌ Ã¥ÀÌ ÇÐȸÀÇ Á¤½Ä °¡À̵å¶óÀÎÀÎÁö ¾Æ´Ï¸é Âü°í¼­ÀÎÁö ¸íÈ®ÇÏÁö ¾ÊÁö¸¸, ÇÐȸÀÇ °øÁö»çÇ׿¡¼­´Â ¸¶Ä¡ ÀÌ Ã¥ÀÚ°¡ Á¤½Ä °¡À̵å¶óÀÎÀÎ °Íó·³ ÀοëµÇ°í ÀÖ½À´Ï´Ù.

Á¤ºÎ¿¡¼­´Â º¸°Çº¹ÁöºÎ¿¡¼­ ¹ßÇ¥ÇÑ ÀÇ·á±â°ü »ç¿ë ±â±¸ ¹× ¹°Ç° ¼Òµ¶ Áöħ [½ÃÇà 2017.6.22.] [º¸°Çº¹ÁöºÎ°í½Ã Á¦2017-101È£, 2017.6.22., ÀϺΰ³Á¤]À» Ç¥ÁØ °¡À̵å¶óÀÎó·³ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. Àü¹®Àº ¾Æ·¡¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.

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[2017-8-27] ¼¼Ã´ ¹× ¼Òµ¶ ±æÀâÀÌ °³Á¤ÆÇ

Âß »ìÆ캸¾Ò´Âµ¥¿ä.... "12ÂÊ. ±âŸ °¨¿° ¹× ÀüÆÄ"ºÎºÐÀÇ ³»¿ëÀÌ ³¸¼³¾ú½À´Ï´Ù. "±¤¿ìº´ ȯÀÚ Àü¿ë" ³»½Ã°æÀ» ÁöÁ¤Çϱâ´Â ¾î·Á¿ï °ÍÀä... ¿©ÇÏÆ° ¾Æ·¡¿¡ ¿Å±é´Ï´Ù.

"±â»ýÃæ, °õÆÎÀÌ µîµµ ³»½Ã°æ °Ë»ç ÈÄ ÀüÆÄµÉ ¼ö ÀÖ´Ù. ±¤¿ìº´ÀÇ ¿øÀÎÀÎ ÇÁ¸®¿ÂÀº ÁÖ·Î ³ú¿Í ô¼ö °°Àº ½Å°æ Á¶Á÷¿¡ ºÐÆ÷Çϸç, ³»½Ã°æÀÌ ÇÁ¸®¿Â °¨¿° Á¶Á÷¿¡ Á÷Á¢ÀûÀ¸·Î Á¢ÃËÇÏ´Â ÀÏÀÌ ¾øÀ¸¹Ç·Î ÀÌ·ÐÀûÀ¸·Î ÇÁ¸®¿Â¿¡ ´ëÇÑ ³»½Ã°æÀÇ Æ¯¼ö 󸮴 ÇÊ¿äÇÏÁö ¾Ê´Ù. ±×·¯³ª º¯Á¾ ±¤¿ìº´¿¡¼­´Â º¯ÀÌ ÇÁ¸®¿Â ´Ü¹éÀÌ Æíµµ¼±À̳ª À§Àå¿¡¼­ ¹ß°ßµÉ ¼ö ÀÖÀ¸¹Ç·Î º¯Á¾ ±¤¿ìº´À¸·Î ¾Ë·ÁÁø ȯÀÚ¿¡¼­´Â µÇµµ·Ï ³»½Ã°æ °Ë»ç¸¦ ÇÏÁö ¾Ê´Â °ÍÀÌ ÃßõµÇ°í ²À ³»½Ã°æÀ» ½ÃÇàÇØ¾ß ÇÑ´Ù¸é, ±× ³»½Ã°æÀº ±¤¿ìº´ ȯÀÚ Àü¿ëÀ¸·Î¸¸ ¾²µµ·Ï ÇÑ´Ù. (Axon. Endoscopy 2001).


[2020-10-26] ³»½Ã°æÇÐȸ¿¡¼­ '¼ÒÈ­±â³»½Ã°æ Àç󸮿¡ ´ëÇÑ ´ÙÇÐÁ¦-´ÙÇÐȸ Áöħ'¶ó´Â ´º½º·¹Å͸¦ º¸³»¿Ô½À´Ï´Ù.


³»½Ã°æ ¼¼Á¤½ÇÀÇ ÀÌ»óÀûÀÎ ±¸Á¶´Â ÇÐȸ¿¡¼­ Á¦½ÃÇÑ ¹Ù ÀÖ½À´Ï´Ù. ¿À¿°±¸¿ª°ú û°á±¸¿ªÀÇ ¿Ïº®ÇÑ ±¸ºÐÀÔ´Ï´Ù.

2021 ³»½Ã°æ¼¼¹Ì³ª


2. Endoscopy-related infections

³»½Ã°æ °Ë»ç¿Í °ü·ÃµÈ °¨¿°ÁõÀº 4 °¡Áö·Î ³ª´­ ¼ö ÀÖ½À´Ï´Ù.

1) Patient to patient transfer: Salmonella¿Í Pseudomonas °¨¿°ÀÌ ¹®Á¦ÀÔ´Ï´Ù. Strongyloides, Mycobacterium tuberculosis, HBV, HCV, Helicobacter pylori °¨¿°µµ °¡´ÉÇÕ´Ï´Ù. ´ÙÇེ·´°Ôµµ ¾ÆÁ÷±îÁö ³»½Ã°æÀ» ÅëÇÑ HIV °¨¿°Àº ¾ø¾ú½À´Ï´Ù. ¸¸¾à ³»½Ã°æÀ» ÅëÇÑ HIV °¨¿°ÀÌ ´Ü ÇÑ °ÇÀÌ¶óµµ ¹ß»ýµÈ´Ù¸é ÇâÈÄ ³»½Ã°æ °Ë»ç¸¦ ¹Þ°íÀÚ Çϴ ȯÀÚÀÇ ¼ö´Â ±Þ°¨ÇÒ °ÍÀÔ´Ï´Ù. ¼­¾ç¿¡¼­´Â universal precautionÀ» °­Á¶ÇÏ°í ÀÖ½À´Ï´Ù. Áï ¸ðµç »ç¶÷ÀÌ AIDS, CÇü °£¿°, °áÇ٠ȯÀÚ¶ó°í °¡Á¤ÇÏ°í ¿¹¹æ´ëÃ¥À» °­±¸Ç϶ó´Â °ÍÀÔ´Ï´Ù. ±×·¯³ª ¿ì¸® Çö½Ç¿¡¼­´Â universal precautionµµ Áß¿äÇÏÁö¸¸ high risk patient¿¡ ´ëÇÑ Æ¯º° °ü¸®µµ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.

2) Bacteremia: EGD ÈÄ 4.2%, ERCP ÈÄ 2.2%, colonoscopy ÈÄ 2.2%, sigmoidoscopy ÈÄ 4.9%, esophageal dilatationÈÄ 45%, variceal sclerotherapy ÈÄ 31%¿¡¼­ ±ÕÇ÷ÁõÀÌ ¹ß»ýÇÕ´Ï´Ù. ½ÉÁúȯÀÚ¿¡¼­ ³»½Ã°æ °Ë»ç¸¦ ÀüÈÄÇÑ antibiotic prophylaxis¿¡ ´ëÇÑ ¿¬±¸´Â Àû½À´Ï´Ù. º¸Åë Á¶Á÷°Ë»ç¸¦ Æ÷ÇÔÇÑ ³»½Ã°æ°Ë»ç¿¡¼­´Â ¿¹¹æÀû Ç×»ýÁ¦°¡ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. 2015³â ¹Ì±¹ ³»½Ã°æÇÐȸ °¡À̵å¶óÀÎÀº infective endocarditis ¿¹¹æÀ» À§ÇÑ Ç×»ýÁ¦´Â ¾î¶² °æ¿ì¿¡µµ ÇÊ¿äÇÏÁö ¾Ê´Ù°í ÇÏ¿´½À´Ï´Ù. Ç×»ýÁ¦°¡ ÇÊ¿äÇÑ °æ¿ì´Â PEG »ðÀÔ¼ú°ú ERCP °ü·Ã ¸î °¡Áö °æ¿ì µîÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¸¦ Âü°íÇϽʽÿÀ.

* Âü°í: EndoTODAY ¿¹¹æÀû Ç×»ýÁ¦

3) Aspiration pneumonia: ÈíÀμº Æó·ÅÀº ³»½Ã°æ ¼Òµ¶ÀÇ ¹®Á¦¶ó±â º¸´Ù´Â ½Ã¼ú ÀÚü¿¡ µû¸¥ À§Ç輺ÀÔ´Ï´Ù. °Ç°­ÇÑ »ç¶÷¿¡¼­ ÈíÀμº Æó·ÅÀÇ À§ÇèÀº ¸Å¿ì ³·Áö¸¸, ÁßÃ߽Űæ°è ÁúȯÀ̳ª ÅðÇ༺ ÁúȯÀÌ ÀÖ´Â °í·ÉÀÇ È¯ÀÚ¿¡¼­´Â Á¾Á¾ ¹ß»ýÇÕ´Ï´Ù. EMR/ESD¿Í °°ÀÌ Àå½Ã°£ÀÇ ½Ã¼úÀÌ ÇÊ¿äÇÑ °æ¿ì³ª PEG ½Ã¼ú ½Ã ´õ¿í ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. ÀÇ·áÁøÀÌ ¾Æ¹«¸® ÁÖÀÇÇÑ´Ù°í ÇÏ´õ¶ó°í ÈíÀμº Æó·ÅÀ» ¿Ïº®È÷ ¹æÁöÇϱâ´Â ¾î·Æ½À´Ï´Ù. ½Ã¼ú¿¡ µû¸¥ À§Ç輺À» °í·ÁÇÏ¿© ½Ã¼úÀ» ÇÒ °ÍÀÎÁö ¸» °ÍÀÎÁö¸¦ Àß °áÁ¤ÇÏ´Â °Í°ú »çÀü¿¡ Àß ¼³¸íÇÏ°í informed consent¸¦ ¹ÞÀ¸½Ê½Ã¿À.

4) Risks to staff: ³»½Ã°æ Àǻ糪 º¸Á¶Àڴ ȯÀÚÀÇ Ç÷¾×, Ÿ¾× µî¿¡ °¨¿°µÉ À§ÇèÀÌ ÀÖ½À´Ï´Ù. °áÇÙÀ̳ª MERS °°Àº È£Èí±â Áúȯ °¨¿° À§Çèµµ »ó´çÇÕ´Ï´Ù. ±×·¯³ª Ç×»ó Áß¹«Àå ÇÒ ¼öµµ ¾øÀ¸´Ï °í¹ÎÀÔ´Ï´Ù. ÃÖ¼ÒÇÑ °¡¿î, Àå°©, ¸¶½ºÅ©, º¸¾È°æÀº ÇÊ¿äÇÕ´Ï´Ù. °¡¿î, Àå°©, ¸¶½ºÅ©´Â ³Ê¹«³ª ´ç¿¬ÇϹǷΠ³íÇÒ °Íµµ ¾ø½À´Ï´Ù. ¹®Á¦´Â º¸¾È°æÀÔ´Ï´Ù.

Miliary TB ȯÀÚ°¡ melena°¡ ÀÖ´Ù°í ³»½Ã°æ °Ë»ç°¡ ÀǷڵǾú½À´Ï´Ù. VitalÀº stable ÇÏ°í hemoglobinµµ Á¶±Ý ¹Û¿¡ ¶³¾îÁöÁö ¾Ê¾Æ¼­ PPI ¾²°í, antiplatelet Áß´ÜÇÏ°í Ç×°áÇÙÄ¡·á¸¦ °è¼ÓÇ϶ó°í ±ÇÀ¯ÇÏ¿´°í ³»½Ã°æ °Ë»ç´Â Ãë¼ÒÇϵµ·Ï ±ÇÇß½À´Ï´Ù. Aerosol »ý¼º °Ë»çÀÎ À§³»½Ã°æÀÇ Á÷¿ø ¹× Ÿ ȯÀÚ¿¡ ´ëÇÑ °¨¿° À§ÇèÀÌ Áö³ªÄ¡°Ô ³ô´Ù°í ÆǴܵǾú±â ¶§¹®ÀÔ´Ï´Ù. (2015)

¾Æ·¡´Â EndoscopyÁö¿¡ ¼Ò°³µÈ ÀÇ»ç °á¸·¿° Áõ·ÊÀÔ´Ï´Ù (Endoscopy 2003). Å©·Ðº´ ȯÀÚ ´ëÀå³»½Ã°æ µµÁß ¶Ë¹°(?)ÀÌ Æ¢¾î °á¸·¿°À¸·Î °í»ýÇß´Ù´Â À̾߱âÀÔ´Ï´Ù.

EndoscopyÁö °á¸·¿° ÀÇ»ç Áõ·Ê º¸°íÀÇ Á¦¸ñÀº Need for safety goggles for endoscopyÀÔ´Ï´Ù. ¹®Á¦´Â goggleÀ» ¾´´Ù´Â °ÍÀÌ °£´ÜÇÑ ÀÏÀÌ ¾Æ´Ï¶ó´Â °ÍÀä.... ¾Æ·¡ »çÁø°ú °°ÀÌ ÁغñÇÏ°í ³»½Ã°æ °Ë»ç¸¦ Çϸé ÁÁ°ÚÁö¸¸ Çö½ÇÀûÀ¸·Î ½±Áö ¾Ê½À´Ï´Ù.

±×·¡¼­ eye protector¸¦ ³»½Ã°æ½Ç¿¡ ºñÄ¡ÇÏ¿´°í, °¡´ÉÇÏ¸é ¸ðµç ȯÀÚ¿¡¼­ ÀÌ¿ëÇϵµ·Ï (Àû¾îµµ °íÀ§Çè ȯÀÚ¿¡¼­´Â ²À »ç¿ëÇϵµ·Ï) ±ÇÀ¯ÇÏ¿´½À´Ï´Ù. ±×·±µ¥ ½ÇÁ¦ ±×·¸°Ô »ç¿ëÇÏ°í °è½Å ³»½Ã°æ ÀÇ»ç´Â ¾Æ¹«µµ ¾ø´Â °Í °°¾Ò½À´Ï´Ù. Àúµµ ¸î ¹ø ¾²´Ù ¸»¾Ò½À´Ï´Ù. »ÑÇØÁö´Â °Íµµ ¹®Á¦ÀÌ°í ¿©ÇÏÆ° ºÒÆíÇÕ´Ï´Ù. Â÷¶ó¸® ¾È°æÀ» ¾²¸é ¾î¶³±î¿ä?

2017³â 9¿ù 21ÀÏ ³»½Ã°æ Áý´ãȸ¿¡¼­ °áÇÙȯÀÚ ³»½Ã°æ °Ë»ç ½Ã ÀÇ·áÁø º¸È£¿¡ ´ëÇÏ¿© ³íÀÇ°¡ ÀÖ¾ú½À´Ï´Ù. Àú´Â ³»½Ã°æ °Ë»ç ½Ã ´Ã ¸¶½ºÅ©°ú º¸¾È°æÀ» ¾²¸é ¾î¶°ÇÒ±î Á¦¾ÈÇÏ¿´½À´Ï´Ù (universal precauteion). ¹®Á¦´Â º¸¾È°æÀÔ´Ï´Ù. Çö½ÇÀûÀ¸·Î ¾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. Àúµµ Àá½Ã °í¹ÎÇÏ´Ù°¡ Å­Á÷ÇÑ ¾È°æÀ» ½áº¸±â·Î ¸¶À½¸Ô¾ú½À´Ï´Ù. Goggle protector ´ë½Å ¾È°æ...... ²æ ´ë½Å ´ß Á¤µµÀÏÁö ¸ð¸£³ª ¾È ÇÏ´Â °Íº¸´Ù´Â ³ªÀ» °Í °°½À´Ï´Ù. ȸÁøÀ» µ¹±â Á÷Àü ±¸³» ¾È°æÁ¡¿¡ µé·¯ ¾ËÀÌ Å« ¾È°æÀ» ¸ÂÃè½À´Ï´Ù. ȸÁøÀÌ ³¡³ª°í °¡ º¸¾Ò´õ´Ï ¹ú½á ÁغñµÇ¾î ÀÖ´õ±º¿ä. µµ¼öµµ ¾ø´Â ¾È°æÀÌ´Ï ½Ã°£ÀÌ °É¸± ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. ³»ÀÏ ¿ÀÀü ³»½Ã°æ °Ë»çºÎÅÍ ½áº¸·Á°í ÇÕ´Ï´Ù.

2017-9-21. º¸¾È°æ¿ë ¾È°æ (µµ¼ö ¾øÀ½) ±¸ÀÔ ÈÄ ¼¿Ä«


3. Liquid chemical germicides and sensitivity of microbes to liquid chemical germicides

Liquid virus´Â ¼Òµ¶Á¦¿¡ ¸Å¿ì ¾àÇÕ´Ï´Ù. ¼¼±Õ¼º Æ÷ÀÚ¸¦ Á¦°ÅÇÏ´Â °ÍÀÌ °¡Àå ¾î·Æ½À´Ï´Ù. ³»½Ã°æ ¼Òµ¶¿¡ ÀÇÇÑ °¨¿°¿¡¼­ °¡Àå ¿ì·ÁµÇ´Â hepatitis B virus, hepatitis C virus, HIV µîÀº liquid virusÀ̹ǷΠ±Ý¹æ Á¦°ÅÇÒ ¼ö ÀÖ½À´Ï´Ù. ÂüÀ¸·Î ´ÙÇེ·¯¿î ÀÏÀÔ´Ï´Ù.

¼Òµ¶Á¦ Àå´ÜÁ¡ ºñ±³ (2016 À§Àå³»½Ã°æÇÐȸ)
¼Òµ¶Á¦GlutaraldehydeOrthophthaldehydePeracetic acidElectrolyzed acid water
¼Òµ¶½Ã°£20ºÐ7-10ºÐ5ºÐ5ºÐ
Èֹ߼º³ô´Ù³·´Ù³ô´Ù¾ø´Ù
³¿»õ°­ÇÏ´Ù¾àÇÏ´ÙÃʻ곿»õ¿°¼Ò³¿»õ
µ¶¼º/Àڱؼº°­ÇÏ´Ù¾àÇÏ´Ù¿ø¾×:°­ÇÏ´Ù¾ø´Ù
´Ü¹éÀÀ°íÀÖ´ÙÀÖ´Ù¾ø´Ù¾ø´Ù
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ÃÖ±Ù glutaraldehyde¿¡ ´ã±×´Â ½Ã°£(immersion time, ħÀû½Ã°£)ÀÌ 20ºÐÀ¸·Î ¹Ù²ï °ÍÀº ÁÖ·Î Mycobacterium¿¡ ´ëÇÑ ¼Òµ¶À» °í·ÁÇÑ °ÍÀÔ´Ï´Ù. HBV, HCV, HIV µî Áß¿ä ¹ÙÀÌ·¯½º´Â ÈξÀ ªÀº ¼Òµ¶ÀÌ °¡´ÉÇÕ´Ï´Ù. ¼Òµ¶Á¦¿¡ ´ã±×´Â ½Ã°£À» ´Ã¸®±âº¸´Ù´Â ¸Å ȯÀÚ¸¶´Ù ÃÖ¼ÒÇÑÀÇ ½Ã°£ÀÌ¶óµµ ¼Òµ¶ÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. ¹Ýµå½Ã ȯÀÚ¸¶´Ù ¼Òµ¶À» ÇϽʽÿä. ¼±ÅÃÀÌ ¾Æ´Ï°í ÇʼöÀÔ´Ï´Ù.


[2016-5-30. ÀÌÁØÇà] »ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç¿¡¼­´Â ÃÖ±Ù ³»½Ã°æ¼Òµ¶¾×À» º¯°æÇÏ¿´½À´Ï´Ù. °³¿ø Ãʱ⿡´Â glutaraldehyde¸¦ »ç¿ëÇÏ¿´°í Çѵ¿¾È Cydex (orthophthaldehyde)·Î º¯°æÇÏ¿´´Ù°¡ À̹ø¿¡ ³»½Ã°æ ¼Òµ¶±â¸¦ ¹Ù²Ù¸é¼­ Peracetic acid °è¿­ÀÎ Aceside¸¦ ¾²±â·Î ÇÏ¿´½À´Ï´Ù. ½ÄÃÊÇâÀÌ ³ª´Â °ÍÀ» »©¸é µ¶¼ºÀº ´úÇÑ °Í °°½À´Ï´Ù.

* Âü°í: ȸ»çÃø¿¡¼­ Á¦°øÇÑ ÀÚ·á (Aceside¿Í OPA ºñ±³)


[2017-12-12]

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[Safety issues of GI endoscope reprocessing personnel] (2018-8-26. ³»½Ã°æÇÐȸ ¼¼¹Ì³ª. ÀÌÈ­ÀÇ´ë À±¿øÀç ±³¼ö´Ô °­ÀÇ·Ï¿¡¼­)

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Áö¼Ó ³ëÃâÀÇ ±âÁ¸ÀÇ ±â°üÁö¿°, õ½Ä ¾ÇÈ­ °¡´É
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¾÷¹« ½ºÆ®·¹½º: ³»½Ã°æ Àçó¸® Á¾»çÀÚÀÇ ¾÷¹« ½ºÆ®·¹½º¿¡ ´ëÇÑ ¿¬±¸ °á°ú´Â ¸¹Áö ¾Ê´Ù. Ofstead µîÀÇ ¿¬±¸¿¡¼­ ¼³¹® ÀÀ´äÀÚÀÇ 75%°¡ ³»½Ã°æ Àçó¸® ¾÷¹«¸¦ »¡¸® ¼öÇàÇØ¾ß ÇÑ´Ù´Â ¾Ð¹ÚÀ» ´À³¤´Ù°í ÀÀ´äÇÏ¿´´Ù (Gastroenterol Nurs 2010;33:304-311). ÀÌ¿Í °°Àº ¾÷¹« stress´Â È¿°úÀûÀÎ ³»½Ã°æ Àç󸮸¦ ¹æÇØÇÒ ¼ö ÀÖÀ¸¸ç, ÁÖÀÇ·Â ÀúÇϸ¦ ºÒ·¯¿À°í ¾ÈÀü Á¶Ä¡¸¦ ¼ÒȦÇÏ°Ô ÇÏ¿© ¼¼Ã´ Á¾»çÀÚÀÇ °Ç°­¿¡µµ À§Çظ¦ ÀÏÀ¸Å³ ¿ì·Á°¡ ÀÖ´Ù (Biomed Instrum Technol 2013;47:172-179)


[¼Òµ¶¾× ³óµµ ÃøÁ¤] ³»½Ã°æ ¼Òµ¶¿¡ À־ Á¤±âÀûÀÎ ¼Òµ¶¾× ³óµµ ÃøÁ¤Àº Àǹ̰¡ ÀÖ½À´Ï´Ù. ÀÚµ¿ ¼¼Ã´±âÀÇ ¼Òµ¶¾×Àº Á¦Á¶»çÀÇ ±Ç°í¿Í ÇÐȸ Áöħ¿¡ µû¶ó ÃÖ´ë 7ÀÏ, »ç¿ë Ƚ¼ö 30ȸ ±âÁØÀ¸·Î °ü¸®ÇÕ´Ï´Ù. Àû¾îµµ ¸ÅÀÏ ³óµµ¸¦ ÃøÁ¤ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

¾Æ¼¼»çÀ̵å üĿ »ç¿ë¹ý


4. Level of disinfection

1) ¸ê±Õ (sterilization): ¸ðµç ¹Ì»ý¹°À» ¿ÏÀüÈ÷ Á¦°Å ¶Ç´Â Æı«ÇÏ´Â °úÁ¤ÀÔ´Ï´Ù. ¸ê±Õ¿¡´Â °í¾ÐÁõ±â³ª EO gas°¡ ÀÌ¿ëµË´Ï´Ù. ³»½Ã°æÀº °í¾ÐÁõ±â¿¡ °ßµðÁö ¸øÇÕ´Ï´Ù. EO gas´Â Àåºñ¸¦ ºñÄ¡Çϱ⵵ ¾î·Æ°í ½Ã°£µµ ¸¹ÀÌ ÇÊ¿äÇÕ´Ï´Ù. °á±¹ ³»½Ã°æÀº ¸ê±ÕÀÇ ´ë»óÀº ¾Æ´Õ´Ï´Ù. ³»½Ã°æ ºÎ¼Ó±â±¸, ƯÈ÷ forcepÀº ¸ê±ÕÇÏ´Â °ÍÀÌ ÀÌ»óÀûÀÔ´Ï´Ù. ÃÖ±Ù 1ȸ¿ë forcepÀ» µµÀÔÇÏ·Á´Â ¿òÁ÷ÀÓÀÌ ÀÖ½À´Ï´Ù. °ú°Å 15-20¸¸¿øÀÌ´ø 1ȸ¿ë forcepÀÌ 1-2¸¸¿ø ÀÌÇÏ·Î ¶³¾îÁ³´Ù°í ÇÏ´Ï ÃßÀ̸¦ ÁöÄÑ º¾½Ã´Ù.

2) ¼Òµ¶ (disinfection): ¼Òµ¶¿¡´Â ÁÖ·Î liquid chemical germicide (LCG)°¡ ÀÌ¿ëµË´Ï´Ù. ¼Òµ¶Àº ±× °­µµ¿¡ µû¶ó ´ÙÀ½ÀÇ ¼¼°¡Áö ¼öÁØÀ¸·Î ³ª´©¾îÁý´Ï´Ù. ³»½Ã°æ ¼Òµ¶ÀÇ ¸ñÇ¥´Â ³ôÀº ¼öÁØÀÇ ¼Òµ¶(high-level disinfection)ÀÔ´Ï´Ù. ¸ê±ÕÀÌ ¾Æ´Õ´Ï´Ù. ´Ù·®ÀÇ bacterial spore¸¦ Á¦¿ÜÇÑ ¸ðµç ¹Ì»ý¹°À» Á¦°ÅÇÏ´Â °ÍÀÔ´Ï´Ù. ½ÇÁ¦ÀûÀÎ ÆÇ´Ü ±âÁØÀº °áÇÙ±ÕÀÇ ¼Ò¸ê¿©ºÎÀÔ´Ï´Ù.

(1) high-level disinfection: destroy all microorganisms, with the exception of high numbers of bacterial spores

(2) intermediate-level disinfection: inactivate M. tuberculosis, vegetative bacteria, most viruses, most fungi but does not necessarily kill bacterial spores

(3) low-level disinfection: kill most bacteria, some viruses, some fungi but cannot be relied on to kill resistant microorganisms such as tubercle bacilli or bacterial spores

3) ¼¼Ã´ (cleaning): ¸ðµç À̹°ÁúÀ» Á¦°ÅÇÏ´Â °úÁ¤À¸·Î ¹°, ¼¼Á¦°¡ ÀÌ¿ëµË´Ï´Ù. ½Ä´ç¿¡¼­´Â ´©±¸³ª ¼öÀú¸¦ »ç¿ëÇÕ´Ï´Ù. ¹°°ú ¼¼Á¦¸¦ ÀÌ¿ëÇÏ¿© ¼¼Ã´µÈ °ÍÀÔ´Ï´Ù. ´Ù¸¥ »ç¶÷ÀÌ »ç¿ëÇÑ ¼öÀú¸¦ ¼¼Ã´ÇÏ¿© Àç»ç¿ëÇÏ°í ÀÖÁö¸¸ ´ëºÎºÐ Å« º´¿¡ °É¸®Áö ¾Ê½À´Ï´Ù. ¼¼Ã´¸¸À¸·Îµµ ´ë´ÜÈ÷ ¸¹Àº ¼¼±ÕÀÌ Á¦°ÅµË´Ï´Ù.


5. Spaulding classification

1) Critical item: objects that enter sterile tissue or the vascular system. ¼ö¼úµµ±¸, catheter µîÀÔ´Ï´Ù.

2) Semi-critical item: objects that contact with mucous membranes or with skin that is not intact. ³»½Ã°æ, endotracheal tube µîÀÔ´Ï´Ù.

3) Non-critical item : objects that contact with intact skin but not with mucous membrane. ûÁø±â, °¡±¸, ÀÇ·ù µîÀÔ´Ï´Ù.

¿äÄÁµ¥ ³»½Ã°æÀº semicritical itemÀ¸·Î ºÐ·ùµÇ¸ç high-level disinfection ´ë»óÀÔ´Ï´Ù. ¸ê±ÕÀÌ ¾Æ´Õ´Ï´Ù.


6. Steps of disinfection

³»½Ã°æ ¼Òµ¶Àº 4´Ü°è·Î ¿ä¾àµË´Ï´Ù. ³»½Ã°æ ÀÚµ¿¼¼Ã´±â¸¦ °ú½ÅÇÏ´Â °ÍÀº ¹Ù¶÷Á÷ÇÏÁö ¾Ê½À´Ï´Ù. öÀúÇÑ ¼ö¼¼¹ýÀº ÀÚµ¿¼¼Ã´±â ¸øÁö ¾ÊÀº °á°ú¸¦ º¸ÀÔ´Ï´Ù.

1) Cleaning and rinsing: ³»½Ã°æÀ» ¼Òµ¶Á¦¿¡ ´ã±×±â ÀÌÀü ¸ðµç °úÁ¤À» ¸»ÇÏ¸ç ±â°èÀûÀÎ ¼¼Ã´À» öÀúÈ÷ ½ÃÇàÇÏ¸é ¹Ì»ý¹° ¿À¿°À» 1/10,000·Î ÁÙÀÏ ¼ö ÀÖ½À´Ï´Ù. öÀúÇÑ ¼¼Ã´À» ÅëÇÏ¿© À¯±â¹°À» ¿ÏÀüÈ÷ Á¦°ÅÇؾ߸¸ liquid chemical germicideÀÇ È¿°ú°¡ Áõ´ëµË´Ï´Ù. ÇÊÀÚ´Â ÀÌ °úÁ¤ÀÌ °¡Àå Áß¿äÇÑ ´Ü°è¶ó°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ³»½Ã°æ °Ë»ç Á÷ÈÄ ¾ËÄÝ°ÅÁî·Î ³»½Ã°æ Ç¥¸éÀ» ´Û´Â ºÐÀÌ °è½Ê´Ï´Ù. ±×·¯³ª ¾ËÄÝ·Î »ðÀԺΠǥ¸éÀ» ´Û´Â °ÍÀº À¯±â¹°À» ±»°Ô ¸¸µé¾î ¼Òµ¶À» ¹æÇØÇÕ´Ï´Ù. À߸øµÈ °üÇàÀ̹ǷΠÁï½Ã ÁߴܵǾî¾ß ÇÕ´Ï´Ù. ¼¼Ã´ÀÌ ÁÁÁö ¾ÊÀ¸¸é ¾Æ·¡ ±×¸²°ú °°Àº biofilmÀÌ Çü¼ºµË´Ï´Ù. BiofilmÀÌ ÀÖÀ¸¸é ¼Òµ¶Á¦¿¡ ¾Æ¹«¸® ¿À·¡ ´ã±×´õ¶óµµ ¼Òµ¶ÀÌ Àß µÉ ¼ö°¡ ¾ø½À´Ï´Ù.

ÀÏÂ÷ ¼¼Ã´ Á÷ÈÄ¿¡ ¾Æ·¡ ±×¸²°ú °°ÀÌ leak test¸¦ ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Leak°¡ ÀÖ´Â ³»½Ã°æÀ» ¾×ü¿¡ ´ã±×¸é ³»½Ã°æÀÌ ±Ý¹æ ¸Á°¡Áý´Ï´Ù.

2) Disinfection: ³»½Ã°æÀ» ¼Òµ¶Á¦¿¡ ´ã±×´Â °úÁ¤ÀÔ´Ï´Ù. °ú°Å¿¡´Â ³»½Ã°æÀÇ »ðÀԺθ¸À» ´ã°¬½À´Ï´Ù. 1980³â´ë Á߹ݺÎÅÍ ¿ÏÀü ¹æ¼ö ³»½Ã°æÀÌ »ç¿ëµÇ°í ÀÖÀ¸¹Ç·Î ÃÖ±Ù¿¡´Â ³»½Ã°æ Àüü¸¦ ´ã±×´Â °ÍÀÌ ¿øÄ¢ÀÔ´Ï´Ù. Á¤½ÄÀ¸·Î ÀÎÁ¤µÈ ¼Òµ¶Á¦´Â ´ëºÎºÐ ¹Ì»ý¹°À» Á¦°ÅÇÏ´Â È¿°ú°¡ ÁÁ½À´Ï´Ù ±×·¯³ª ¼Òµ¶Á¦¿¡ ³»½Ã°æÀ» ´ã±×´Â ½Ã°£ (contact time, immersion time)ÀÌ ³í¶õÀÔ´Ï´Ù. ±¹³» ÁöħÀº °¢ ¼Òµ¶Á¦ÀÇ °³º°ÀûÀÎ ÁöħÀ» µû¸£¶ó´Â °ÍÀÔ´Ï´Ù.

3) Further rinsing with filtered or sterile water: ¼Òµ¶Á¦¸¦ Á¦°ÅÇÏ´Â ´Ü°è¸¦ ¸»ÇÕ´Ï´Ù. Sterile water¶ó¸é ÁÁ°ÚÁö¸¸ Çö½ÇÀûÀ¸·Î´Â ¸¶½Ç ¼ö ÀÖ´Â ¼öÁØÀÇ filtered water°¡ ÀÌ¿ëµË´Ï´Ù.

4) Forced air drying and preparation for storage: ³»½Ã°æÀ» ¼Òµ¶ ÈÄ Á¥Àº »óÅ·Π½Ç¿Â¿¡ ¹æÄ¡ÇÏ¸é ¼¼±ÕÀÌ Áõ½ÄÇÒ ¼ö ÀÖ½À´Ï´Ù. °ø±â¸¦ ºü¸¥ ¼Óµµ·Î Åë°ú½ÃÄÑ ¸»¸®¸é ÁÁ½À´Ï´Ù.

±×¸®°í surveillance culture°¡ ÇÊ¿äÇÕ´Ï´Ù. ´Ü¼øÈ÷ »ý°¢Çϸé Á¤±âÀûÀ¸·Î ³»½Ã°æ¿¡¼­ °Ëü¸¦ ¾ò¾î ¹è¾çÇÏ¸é ¸¹Àº Á¤º¸¸¦ ¾òÀ» ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. °ü·áÀûÀ¸·Î Á¢±ÙÇÑ´Ù¸é surveillance culture¸¦ ÇÏ´Â °÷ÀÌ °ü¸®¸¦ ÀßÇÏ´Â º´¿øÀÌ°í ÇÏÁö ¾Ê´Â °÷Àº ±×·¸Áö ¾ÊÀº º´¿øÀÏ °ÍÀÔ´Ï´Ù. ÇÏÁö¸¸ surveillance cultureÀÇ sensitivity¿Í specificity´Â ±×¸® ½Å·ÚÇÒ ¼öÁØÀÌ ¾Æ´Õ´Ï´Ù. ¹è¾ç ¾ç¼ºÀÇ Àǹ̸¦ Çؼ®Çϱ⠾î·Æ½À´Ï´Ù. ¹è¾ç À½¼ºÀ̶ó°í ¼Òµ¶¿¡ ´ëÇÑ ÀڽۨÀ» °¡Á®µµ ¾È µË´Ï´Ù. À߸øÇϸé false sense of safety¸¦ °¡Áú ¼ö ÀÖ½À´Ï´Ù. ÁÖÀÇÇսôÙ. Surveillance culture °á°ú¿¡ µû¶ó ìéýììéÝè ÇÏÁö¸»°í Á¤ÇØÁø ¼Òµ¶ÁöħÀ» Àß ÁöÅ°°í ÀÖ´ÂÁö monitoringÇÏ´Â °ÍÀÌ ÈξÀ Áß¿äÇÕ´Ï´Ù.

* Âü°í: EndoTODAY surveillance culture


7. ÀÌ»ó°ú Çö½ÇÀº ´Ù¸£´Ù = ¾Æ¹«¸® ¿­½ÉÈ÷ ¼Òµ¶Çصµ ±ÕÀÌ ¿Ïº®È÷ ¾ø¾îÁöÁö ¾Ê´Â´Ù.

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»ç½Ç Àú´Â ÀÌ ³í¹®À» ³¡À¸·Î ³»½Ã°æ ¼Òµ¶¿¡ ´ëÇÑ ¿¬±¸¸¦ Æ÷±âÇÏ¿´½À´Ï´Ù. ÇØ º¸¾Ò´õ´Ï ¾Æ¹«¸® ¼Òµ¶Çصµ ¾à°£ÀÇ ±ÕÀÌ ³ª¿É´Ï´Ù. ±¹³» ¿©·¯ ¿¬±¸ÀÚµéÀÌ °øÅëÀûÀ¸·Î ¸»ÇÏ´Â ³»¿ëÀÔ´Ï´Ù. ±×·³¿¡µµ ºÒ±¸ÇÏ°í ¹Ì±¹À̳ª À¯·´ÀÇ ÇÐȸÁö¿¡ ³í¹®À» Á¦ÃâÇÏ¸é ¹Ù·Î reject letter°¡ ³¯¶ó¿É´Ï´Ù. "°¡À̵å¶óÀÎÀ» µû¸£¸é ±ÕÀÌ ³ª¿ÀÁö ¾Ê¾Æ¾ß ÇÑ´Ù. ±ÕÀÌ ³ª¿Ô´Ù¸é ³ÊÈñµéÀÌ À߸øÇÑ °ÍÀÌ´Ù"¶ó´Â ´äº¯°ú ÇÔ²²...... ÀÌ»ó(=°¡À̵å¶óÀÎ)°ú Çö½ÇÀÌ ´Ù¸£´Ù´Â ÁöÀûÀ» ¹Þ¾ÆµéÀÌÁö ¾Ê´Â ¹Ì±¹°ú À¯·´ÀÇ Æó¼âÀûÀÎ ÇÐdz¿¡ ³ÍÀú¸®°¡ ³µ½À´Ï´Ù. ¾Æ½Ã¾Æ °è¿­ ÇÐȸÁö¿¡ °á°ú¸¦ ¹ßÇ¥ÇÑ ÈÄ ÀÌ ºÐ¾ßÀÇ ¿¬±¸´Â Æ÷±âÇß½À´Ï´Ù. ¾ÈŸ±õÁö¸¸ Æ÷±âÇß½À´Ï´Ù. ³Ê¹« Èûµé¾ú°Åµç¿ä. ÇöÀç ±¹³»¿¡¼­ ÀÌ ºÐ¾ß¸¦ ¿¬±¸ÇÏ´Â ºÐÀº °ÅÀÇ ¾ø½À´Ï´Ù. ±ÕÀÌ ¾È ³ª¿À¸é ´ç¿¬ÇÑ °ÍÀÌ°í ±ÕÀÌ ³ª¿À¸é À߸øµÈ °ÍÀ̶ó´Ï ¾Æ¹«µµ °ü½ÉÀ» °®Áö ¾Ê´Â °ÍÀÌÁö¿ä. ´Ùµé Æ÷±âÇß´Ù´Â ¼Ò¹®ÀÔ´Ï´Ù.

¼Òµ¶À» ¸¶Ä£ ³»½Ã°æ¿¡ ´ëÇÑ surveillance culture¸¦ ÇÏ¸é ¾à°£ÀÇ ±ÕÀÌ ³ª¿À´Â °ÍÀº º¸ÅëÀÎ ¸ð¾çÀÔ´Ï´Ù. ¼­±¸¿¡¼­µµ surveillance cultureÀÇ À¯¿ë¼º¿¡ ´ëÇÑ È¸ÀÇÀû ½Ã°¢ÀÌ ¸¹½À´Ï´Ù.


8. ³»½Ã°æ ¼Òµ¶ ±³À°

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ÀÚµ¿¼Òµ¶±â°¡ ÇʼöÀûÀÎ °ÍÀº ¾Æ´Õ´Ï´Ù. Áöħ¿¡ µû¸¥ ¼Õ¼Òµ¶À¸·Îµµ ÃæºÐÇÕ´Ï´Ù.


Test stripÀ» ÀÌ¿ëÇÏ¿© ¼Òµ¶Á¦ÀÇ ¼Òµ¶·ÂÀ» Á¤±âÀûÀ¸·Î È®ÀÎÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.


ÀÚµ¿¼Òµ¶±âÀÇ Ã»°áÇÑ °ü¸®µµ ¸Å¿ì Áß¿äÇÕ´Ï´Ù.


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¼¼Á¤½Ç Á÷¿ø¿¡ ´ëÇÑ ÀûÀýÇÑ ´ë¿ìµµ Áß¿äÇÕ´Ï´Ù. ÀÌ Á¡¿¡¼­ ¿ì¸®³ª¶ó ÀÇ·áȯ°æÀº ¸Å¿ì ¿­¾ÇÇÏ´Ù°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. Àú¼ö°¡ ȯ°æÀº ÇÏ·ç »¡¸® ±Øº¹µÇ¾î¾ß ÇÕ´Ï´Ù. ÀÇ·áÀÇ ¼ö°¡´Â OECD Æò±Õ Á¤µµ´Â µÇ¾î¾ß Á¤»ó ¾Æ´Ò±î¿ä?

[2013-10-15. ÇÁ·¹½Ã¾È] Á¦´ë·Î ¼¼Ã´ ¸øÇÑ ³»½Ã°æ, "º´±Õ ¿Å±æ ¼ö Àִµ¥¡¦"

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9. ³»½Ã°æ ¼Òµ¶ checklist

³»½Ã°æ¿¡¼­ ¼Òµ¶°ú ¸ê±ÕÀº ¸Å¿ì Áß¿äÇÑ ÀÏÀÔ´Ï´Ù. °¢ÀÚ Àڱ⠳»½Ã°æ½Ç¿¡¼­ ¼Òµ¶°ú ¸ê±ÕÀÌ Àß µÇ°í ÀÖ´ÂÁö Á¤±âÀûÀÎ Á¡°ËÀ» ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ²À ÇÊ¿äÇÑ ÀÏÀÔ´Ï´Ù. »ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç°ú °¨¿°°ü¸®½ÇÀÌ »óÀÇÇÏ¿© ¸¸µç '³»½Ã°æ ¼Òµ¶°ú ¸ê±Õ checklist 2016³â °³Á¤ÆÇ'À» ¼Ò°³ÇÕ´Ï´Ù.

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10. Microbiological monitoring = Surveillance culture

Áöħ°ú ÀýÂ÷¿¡ µû¶ó ³»½Ã°æ ¼Òµ¶À» Àß ÇÏ°í ÀÖ´õ¶óµµ surveillance culture°¡ ÇÊ¿äÇÑÁö´Â ¾ÆÁ÷ ¸íÈ®ÇÏ°Ô ¹àÇôÁ® ÀÖÁö ¾Ê½À´Ï´Ù. 2015³â 9¿ù Clinical Endoscopy¿¡ °ü·Ã Á¾¼³ÀÌ ½Ç·È½À´Ï´Ù (Shin SP. Clin Endosc 2015).

¾Æ·¡ Ç¥¿¡¼­ ¾Ë ¼ö ÀÖµíÀÌ routine test¸¦ ±ÇÇÏ´Â °÷µµ ÀÖ°í ±ÇÇÏÁö ¾Ê°í ÀÖ´Â °÷µµ ÀÖ½À´Ï´Ù. »ï¼º¼­¿ïº´¿ø¿¡¼­´Â ºÐ±â¿¡ 1ȸ ½ÃÇàÇÏ°í ÀÖ½À´Ï´Ù.


¹®Á¦´Â Çؼ®(interpretation)ÀÔ´Ï´Ù. ¼¼±ÕÀÌ ¸î ¸¶¸® ³ª¿Ô´Ù°í ¼Òµ¶ÀÌ À߸øµÇ¾ú´Ù´Â °ÍÀ» ÀǹÌÇÏÁö ¾Ê½À´Ï´Ù. Á¾¼³¿¡ Àß Á¤¸®µÇ¾î À־ ¿Å±é´Ï´Ù.

It is important to know how to interpret the culture results and what to do with the results. In the BSG guidelines, the presence of skin and environmental contaminants is not interpreted as a failure of disinfection. It simply means that endoscopes are not handled in a sterile fashion after decontamination. In the ESGE-ESGENA guidelines, growth of Enterobacteriaceae means insufficient cleaning and/or disinfection procedures, whereas growth of P. aeruginosa implies insufficient final rinsing and/or insufficient drying of endoscopes before storage. Growth of staphylococci results from endoscope recontamination. In the case of atypical mycobacteria (Legionella organisms) growth, contamination of the washer-disinfector and water system is suspected. For channels, the total microbiological count should be <20 cfu/channel; for water samples, it should be <10 cfu/100 mL. According to GESA-GENCA indications, growth of low numbers of skin microorganisms means contamination during the collection process rather than a significant problem with the disinfection or cleaning process, whereas growth of Pseudomonas spp. or other non-fermentative gram-negative bacilli is cause for serious and immediate concern and response. The repeated growth of significant numbers of enteric microorganisms from one instrument implies a mechanical defect in that instrument. Significant numbers of enteric microorganisms from a variety of instruments are most likely a result of inadequate reprocessing. The isolation of any Salmonella or Shigella species is a cause for concern.


11. ¼Òµ¶ °ü·Ã °¨¿° »ç·Ê

[2014-11-6] 2013³â ERCP Ãø½Ã°æÀ» ÅëÇÑ Illinois outbreak

New Delhi metallo-¥â-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447

Results: In total, 39 case patients were identified from January 2013 through December 2013, 35 with duodenoscope exposure in 1 hospital. No lapses in duodenoscope reprocessing were identified; however, NDM-producing Escherichia coli was recovered from a reprocessed duodenoscope and shared more than 92% similarity to all case patient isolates by PFGE. Based on the case-control study, case patients had significantly higher odds of being exposed to a duodenoscope (odds ratio [OR], 78 [95% CI, 6.0-1008], P<.001). After the hospital changed its reprocessing procedure from automated high-level disinfection with ortho-phthalaldehyde to gas sterilization with ethylene oxide, no additional case patients were identified.

Conclusions: In this investigation, exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producing E coli among patients at 1 hospital. Bacterial contamination of duodenoscopes appeared to persist despite the absence of recognized reprocessing lapses. Facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route and should conduct regular reviews of their duodenoscope reprocessing procedures to ensure optimal manual cleaning and disinfection.

Áö±Ý±îÁö ³»½Ã°æÀ» ÅëÇÑ °¨¿°ÁõÀº ¼Òµ¶ °úÁ¤À» ¼ÒȦÈ÷ ÇÏ¿´°Å³ª, ³»½Ã°æ ¹× ±âŸ ±â±¸¿¡ ÀÌ»óÀÌ ÀÖ¾ú±â ¶§¹®À̾ú½À´Ï´Ù. ±×·¯³ª 2013³â ¹Ì±¹¿¡¼­ ¹ß»ýÇÑ outbreak »ç·Ê¿¡¼­´Â ¼Òµ¶ °úÁ¤À̳ª ±â±¸¿¡´Â ¹®Á¦°¡ ¾ø¾ú½À´Ï´Ù. ¼Òµ¶À» Àß ÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í NDM (New Delhi metallo-beta-lactamase) »ý¼º ´ëÀå±ÕÀ̶ó´Â µå¹® ÀúÇ×±ÕÁÖ°¡ ERCP Ãø½Ã°æÀ» ÅëÇÏ¿© Àü¿°µÇ¾ú½À´Ï´Ù. JAMA¿¡ º¸°íµÈ Illinois º´¿øÀÇ outbrek¿¡¼­ 39¸í Áß 35¸í¿¡¼­ Ãø½Ã°æÀÌ »ç¿ëµÇ¾ú½À´Ï´Ù. Ãø½Ã°æ 2°³ÀÇ elevator channel¿¡¼­ NDM »ý¼º ´ëÀå±ÕÀÌ ¹è¾çµÇ¾ú½À´Ï´Ù. EO °¡½º¸¦ ÀÌ¿ëÇÑ ³»½Ã°æ ¸ê±Õ ÈÄ ´õ ÀÌ»óÀÇ °¨¿° ¹ß»ýÀº ¸·À» ¼ö ÀÖ¾ú´Ù°í ÇÕ´Ï´Ù.

³»½Ã°æÀº ¸ê±Õ(sterizilation)º¸´Ù´Â ³ôÀº ¼öÁØÀÇ ¼Òµ¶(high-level disinfection)À» ½ÃÇàÇÏ´Â µµ±¸ÀÔ´Ï´Ù. ³»½Ã°æ ¸ê±ÕÀº ½Ã°£ÀÌ ¿À·¡ °É¸®°í, µ¶¼ºÀÇ ¿ì·Á°¡ ÀÖ°í, ¸ê±ÕÇÒ ¼ö ¾ø´Â µµ±¸°¡ Àֱ⠶§¹®ÀÔ´Ï´Ù. À̹ø outbreak¸¦ ÅëÇÏ¿© ¼Òµ¶ÀÌ Àß µÈ Ãø½Ã°æÀ» ÅëÇÑ Ç×»ýÁ¦ ³»¼º ±ÕÁÖ °¨¿°ÀÌ °¡´ÉÇÏ´Ù°í È®ÀεǾúÀ¸¹Ç·Î ÇâÈÄ º¸´Ù ¼¶¼¼ÇÑ ¼Òµ¶°ú Á¤±âÀûÀÎ °Ë»ç°¡ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù.


[2015-2-26] carbapenem-resistent enterobacteriaceae (CRE)

ERCP¿ë Ãø½Ã°æ ¼Òµ¶Àº ¾î·Æ½À´Ï´Ù. ÀÏÀü¿¡ ERCP ÈÄ carbapenem-resistant Escherichia coli °¨¿° »ç·Ê°¡ New England Journal of Medicine¿¡ ¹ßÇ¥µÈ ¹Ù ÀÖ½À´Ï´Ù. ±×·±µ¥ ÃÖ±Ù ERCP °ü·ÃÇÏ¿© carbapenem-resistent enterobacteriaceae (CRE) °¨¿° »ç·Ê°¡ ¶Ç º¸°íµÇ¾ú½À´Ï´Ù. »ç¸Á·Êµµ ÀÖ¾úÀ¸´Ï À̹ø »ç°Çµµ ½É°¢ÇÑ ¹®Á¦ÀÔ´Ï´Ù. ÀÌ¿¡ ´ëÇÏ¿© ´ëÇÑÃé´ãµµÇÐȸ¿¡¼­ ȸ¿øµé²² ±Ç°í»çÇ×À» Á¦½ÃÇÏ¿´½À´Ï´Ù. ±Ç°í »çÇ×ÀÌ ¾ø´Â °Í º¸´Ù´Â ÀÖ´Â °ÍÀÌ ³´°ÚÁö¸¸, ±Ç°íÇÑ´Ù°í ´Ù ÁÁ¾ÆÁúÁö´Â Àǹ®ÀÔ´Ï´Ù. ¿ì¸®³ª¶ó ÀÇ·áȯ°æÀÌ ¿ö³« ¿­¾ÇÇؼ­... ¿©ÇÏÆ° ÀÏ´Ü ¼Ò°³ÇÕ´Ï´Ù.

°ü·Ã ´º½º


[2015-5-21]

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ÀúÈñ´Â À̹ø ÀÏ°ú °ü·ÃÇÏ¿© (1) ³»½Ã°æ ¼¼Ã´/¼Òµ¶ÀÇ Àüóġ ¹æ¹ý°ú surveillance culture ¹æ¹ýÀ» °­È­ÇÏ¿´°í, (2) ³»½Ã°æ¿¡ ´ëÇÑ ´ëû¼Ò¸¦ ÇÏ¿´°í, (3) EO °¡½º ¼Òµ¶ (¿Âµµ¸¦ ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. °í¿ÂÀÌ µÇÁö ¾Êµµ·Ï)À» ÇÏ¿´½À´Ï´Ù. ³»½Ã°æ¿¡ ´ëÇÑ ¼¼Ã´/¼Òµ¶Àº ¾Æ¹«¸® °­Á¶Çصµ Áö³ªÄ¡Áö ¾Ê½À´Ï´Ù.


CRE (Ä«¹ÙÆä³Û ³»¼º Àå³»¼¼±Õ)´Â plasmid¸¦ ÅëÇØ ÀúÇ× À¯ÀüÀÚ°¡ ¹øÁö´Â ±ÕÀÔ´Ï´Ù. ¸î ³â Àü ¹Ì±¹¿¡¼­ ERCP ȯÀÚ°¡ ÀÌ ±Õ¿¡ °¨¿°µÇ¾î »ç¸ÁÇϸ鼭 Å©°Ô ¹®Á¦µÈ ÀûÀÌ ÀÖ½À´Ï´Ù. ±¹³»¿¡µµ ÀÌ ±ÕÁÖ°¡ µé¾î¿Í ¹øÁö°í ÀÖ´Â »óȲÀε¥, ÇöÀç ¹ýÁ¤°¨¿°º´À¸·Î ÁöÁ¤µÇ¾ú½À´Ï´Ù. Áø´ÜµÇ¸é ȯÀÚ´Â °Ý¸®ÇØ¾ß ÇÏ°í, »ç·Ê´Â º¸°Ç¼Ò¿¡ ½Å°íÇØ¾ß ÇÕ´Ï´Ù. ÃÖ±Ù ¿ì¸®³ª¶ó¿¡¼­´Â ÁßȯÀÚ½ÇÀÇ outbreak°¡ ¹®Á¦°¡ µÇ°í ÀÖ½À´Ï´Ù. ½ÉÇϸé ÀϽÃÀûÀ¸·Î ÁßȯÀÚ½ÇÀ» Æó¼âÇØ¾ß ÇÑ´Ù°í ÇÕ´Ï´Ù.

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[2016-9-3] ÀÏÀü¿¡ SBS¿¡ º¸µµµÇ¾ú´ø ³»½Ã°æ °ü·Ã ¼øâ CÇü °£¿° Áý´Ü°¨¿° »ç·Ê´Â ¿Àº¸¿´´ø °ÍÀ¸·Î È®ÀεǾú½À´Ï´Ù. ´ç¿¬ÇÑ ÀÏÀÌÁö¸¸ ÀÌó·³ È®ÀεÇÁö ¾ÊÀº ³»¿ëÀÌ º¸µµµÇ¸é ¾È µÇ°Ú½À´Ï´Ù (2016-9-24. Doctor's News. ¸¶³à»ç³É ´çÇÑ ¼øâ A¿øÀå "³Ê¹« ¾ï¿ïÇØ" ºÐÅë). »çȸÀûÀ¸·Î Áß¿äÇÑ issueÀ̹ǷΠÁö¿ìÁö´Â ¾Ê°í ÀÛÀº ±Û¾¾·Î ó¸®ÇÏ¿´½À´Ï´Ù.


[2016-8-31. SBS ´º½º] 2¹é ¸í Áý´Ü CÇü °£¿°¡¦³»½Ã°æ ¼Òµ¶ ÁßÁ¡ Á¶»ç

"¼­¿ï¿¡ ÀÌ¾î ¶Ç ÀüºÏ ¼øâ¿¡¼­ 200¿© ¸íÀÌ Áý´ÜÀ¸·Î CÇü °£¿°¿¡ °¨¿°µÈ »ç·Ê°¡ È®ÀεƽÀ´Ï´Ù. °°Àº º´¿ø¿¡¼­ ½ÂÀιÞÁö ¾ÊÀº ³»½Ã°æ ¼Òµ¶Á¦¸¦ ¾´ °Ô ¿øÀÎÀ¸·Î Áö¸ñµÇ°í ÀÖ½À´Ï´Ù."


[2016-9-2. ¾Öµ¶ÀÚ ÆíÁö]

¼±»ý´Ô, À̹ø ±â»ç(2¹é ¸í Áý´Ü CÇü °£¿°¡¦³»½Ã°æ ¼Òµ¶ ÁßÁ¡ Á¶»ç)¸¦ º¸°í °ÆÁ¤ÀÌ µé¾î ¸ÞÀÏÀ» µå¸³´Ï´Ù. ³»½Ã°æ ¼Òµ¶ÀÌ ¿øÀÎÀÎÁö È®½ÇÇÏÁö ¾Ê°í, ½Ä¾àó ½ÂÀÎÀ» ¹ÞÁö ¾ÊÀº ¼Òµ¶Á¦·Î ¼Òµ¶ ½Ã CÇü °£¿° ¹ÙÀÌ·¯½º°¡ ¾ó¸¶³ª »ýÁ¸ÇÒ ¼ö ÀÖ´ÂÁö ¹àÇôÁöÁö ¾ÊÀº »óȲ¿¡¼­, ÀÌ·± ´º½º°¡ CÇü °£¿° ÀüÆĹæÁö¿¡ Á¤¸» µµ¿òÀÌ µÉ Áö ¿ì·Á½º·´½À´Ï´Ù.

¿©·¯ ¾ð·Ð¿¡¼­ °æÀïÀûÀ¸·Î È®ÀÎÀÌ ³¡³ªÁö ¾ÊÀº ÀÇ·á ±â°ü¿¡¼­ÀÇ CÇü °£¿° È®»ê°ü·Ã ´º½º¸¦ ³»´Â°Ô Àú´Â ¾à°£ °ÆÁ¤µË´Ï´Ù.

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°¨»çÇÕ´Ï´Ù. Àúµµ °°Àº ÀÇ°ßÀÔ´Ï´Ù. ±×·¡¼­ÀÎÁö SBS ÀÌ¿ÜÀÇ ´Ù¸¥ ¾ð·Ð¿¡¼­´Â ¾Æ¿¹ ¾ð±Þµµ ÇÏÁö ¾Ê¾Ò´õ±º¿ä. »ç½Ç ³»½Ã°æ¿¡ ÀÇÇÏ¿© 200¸íÀ̳ª Áý´ãÀ¸·Î °¨¿°µÇ±â´Â ½±Áö ¾Ê¾Æ º¸ÀÔ´Ï´Ù.

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Evidence¿Í Practice »çÀÌ¿¡¼­...

¼±»ý´Ô, ÷ºÎÇØÁֽŠ±â»ç(°Ç±¹´ë ÃæÁÖº´¿øÀå "¿ø³» °¨¿° °¡´É¼º¡¦Áý´Ü°¨¿°Àº ¾Æ³Ä") Áß "CÇü °£¿°Àº °ø±â·Î °¨¿°µÇ´Â Áúº´ÀÌ ¾Æ´Ï¾î¼­ º°µµ °ø°£±îÁö ¾²Áø ¾Ê°í, Àü¿ë Åõ¼®±â¸¦ »ç¿ëÇÑ´Ù. ¾ÕÀ¸·Î º°µµ °ø°£À» ¸¶·ÃÇÏ´Â °Íµµ °ËÅäÇÏ°Ú´Ù"´Â ³»¿ëÀÌ ÀÖ¾ú½À´Ï´Ù.

CÇü °£¿°Àº Åõ¼®±â°è¸¦ µû·Î »ç¿ëÇÏÁö ¾Ê¾Æµµ µÇ´Â °ÍÀ¸·Î (ÀϹÝȯÀÚ¿Í °°Àº ±â°è·Î Åõ¼®Çصµ µÇ´Â °ÍÀ¸·Î) ¾Ë°í ÀÖ¾î, CDC ȨÆäÀÌÁö¿¡¼­ È®ÀÎÇØ º¸´Ï (http://www.cdc.gov) BÇü °£¿°Àº Åõ¼®±â°è¸¦ µû·Î »ç¿ëÇÏ¿©¾ß Çϳª, HCV´Â µû·Î Åõ¼®±â°è¸¦ »ç¿ëÇÏÁö ¾Ê¾Æµµ µÇ´Â °ÍÀ¸·Î µÇ¾î ÀÖ¾ú½À´Ï´Ù. CDC¿¡¼­ È®ÀÎÇÑ ¹®ÀåÀÔ´Ï´Ù.

"HCV-Positive Patients. Patients who are anti-HCV positive (or HCV RNA positive) do not have to be isolated from other patients or dialyzed separately on dedicated machines. Furthermore, they can participate in dialyzer reuse programs. Unlike HBV, HCV is not transmitted efficiently through occupational exposures."

ÃÖ±Ù cochrane database °á°úÀÔ´Ï´Ù (Cochrane Database Syst Rev. 2016 Aug 11;8:CD006420).

"The benefits and harms of isolation of HCV-infected patients during haemodialysis on the transmission of HCV to other patients are uncertain. Evidence from one short-duration cluster-randomised study with a high risk of bias did not find differences in terms of the number of participants developing HCV infection when comparing the use of dedicated haemodialysis machines for HCV infected patients with the use of non-dedicated machines."

ÇÏÁö¸¸ °Ç±¹´ë ÃæÁÖº´¿ø ¼±»ý´Ô ÀÎÅÍºä ³»¿ëÀ» º¸¸é, CÇü °£¿° ȯÀÚ¿ë Àü¿ë Åõ¼®±â¸¦ »ç¿ëÇÏ°í °è¼Ì´ø °Í °°½À´Ï´Ù. Evidence¿Í practice°¡ ´Ù¸¥ ÀÌÀ¯´Â Á¦°¡ Á¤È®È÷ ÆľÇÇÏÁö´Â ¸øÇÏ°í ÀÖ½À´Ï´Ù.

CDC¿¡¼­´Â CÇü °£¿° Àü¿°¶õ¿¡ ¾Æ·¡¿Í °°ÀÌ ±â¼úÀÌ ÀÖ½À´Ï´Ù.

"HCV is most efficiently transmitted by direct percutaneous exposure to infectious blood, and like HBV, the chronically infected person is central to the epidemiology of HCV transmission. Risk factors associated with HCV infection among hemodialysis patients include history of blood transfusions, the volume of blood transfused, and years on dialysis. The number of years on dialysis is the major risk factor independently associated with higher rates of HCV infection. As the time patients spent on dialysis increased, their prevalence of HCV infection increased from an average of 12% for patients receiving dialysis <5 years to an average of 37% for patients receiving dialysis >5 years.

These studies, as well as investigations of dialysis-associated outbreaks of hepatitis C, indicate that HCV transmission most likely occurs because of inadequate infection control practices. During 1999--2000, CDC investigated three outbreaks of HCV infection among patients in chronic hemodialysis centers (CDC, unpublished data, 1999 and 2000). In two of the outbreaks, multiple transmissions of HCV occurred during periods of 16--24 months (attack rates: 6.6%--17.5%), and seroconversions were associated with receiving dialysis immediately after a chronically infected patient. Multiple opportunities for cross-contamination among patients were observed, including a) equipment and supplies that were not disinfected between patient use; b) use of common medication carts to prepare and distribute medications at patients' stations; c) sharing of multiple dose medication vials, which were placed at patients' stations on top of hemodialysis machines; d) contaminated priming buckets that were not routinely changed or cleaned and disinfected between patients; e) machine surfaces that were not routinely cleaned and disinfected between patients; and f) blood spills that were not cleaned up promptly. In the third outbreak, multiple new infections clustered at one point in time (attack rate: 27%), suggesting a common exposure event. Although the specific results of this investigation are pending, multiple opportunities for cross-contamination from chronically infected patients also were observed in this unit. In particular, supply carts were moved from one station to another and contained both clean supplies and blood-contaminated items, including small biohazard containers, sharps disposal boxes, and used vacutainers containing patients' blood."

À̹ø ±â»ç ÀÎÅͺ信¼­ º°µµ Åõ¼®±â¸¦ »ç¿ëÇÏ´Â °ÍÀ» ³Ñ¾î º°µµ °ø°£À» ¸¶·ÃÇÏ°Ú´Ù´Â ¶æÀº ¾Æ¸¶µµ °°Àº °ø°£³»¿¡ Ȥ½Ã¶óµµ ¿À¿°µÉ ¸ðµç °¡´É¼º(supply carts ¹®Á¦ µî)±îÁö ¸ðµÎ À» ¸·°Ú´Ù´Â ¶æ °°À¸½Åµ¥, ¿ª½Ã "ºñ¿ë"ÀÌ µå´Â ¹®Á¦ÀÎ °Í °°½À´Ï´Ù. CÇü °£¿°Àº °¨¿°ÀÌ È®ÀÎµÈ´Ù¸é ´ëºÎºÐ ¹ÙÀÌ·¯½º ¹Ú¸ê(¿ÏÄ¡)°¡ °¡´ÉÇÑ ÁúȯÀÔ´Ï´Ù. °£¼¶À¯È­°¡ ÁøÇàµÇ±â Àü(°£°æº¯ ÁøÇà Àü), ¹ÙÀÌ·¯½º°¡ ¹Ú¸êµÇ¸é °£°æº¯ ¹× °£¾ÏÀ¸·Î ÀÎÇÑ »ç¸ÁÀÇ À§Çèµµ ¸Å¿ì¸Å¿ì¸Å¿ì ³·½À´Ï´Ù.

µû¶ó¼­ Àú´Â º°µµÀÇ °ø°£À» ¸¶·ÃÇÏ´Â µî ¸ðµç ´ëÃ¥À» °£±¸ÇÏ¿© °¨¿° °¡´É¼ºÀÌ 0%°¡ µÇ°Ô ³ë·ÂÇÏ´Â °Íº¸´Ù´Â, Ç÷¾×¿¡ ³ëÃâµÈ À§ÇèÀÌ ³ôÀº ÀÇ·á ȯ°æ(Åõ¼®½Ç)¿¡¼­´Â Áö±Ý Åõ¼®½Ç¿¡¼­ ±Ç°íµÇ°í ½ÃÇàµÇ°í ÀÖ´Â, Á¤±âÀûÀº anti-HCV °Ë»ç·Î »õ·Î¿î °¨¿°À» »¡¸® È®ÀÎÇÏ°í Ä¡·áÇÏ´Â °ÍÀÌ ÈξÀ Çö½ÇÀûÀÎ ´ë¾ÈÀ̶ó°í »ý°¢µË´Ï´Ù.

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[ÀÌÁØÇà comment] ÀüüÀûÀ¸·Î Ÿ´çÇÏÁö¸¸ ¸î °¡Áö ¹®±¸´Â Á¶±Ý °ÆÁ¤µË´Ï´Ù. 4°¡Áö °è¿­ ¾àÁ¦¸¦ »ç¿ëÇØ¾ß ÇÏ´Â °ÍÀÌ ¸Â½À´Ï´Ù. 'µî'ÀÌ ¿Ö µé¾î°¡¾ß ÇÏ´ÂÁö ¾Ë ¼ö ¾ø½À´Ï´Ù. 4 °¡Áö ¹Û¿¡ ¾ø´Âµ¥ ¿Ö 'µî'ÀÌ µé¾î°¬À»±î¿ä? Àß ¸ø Çؼ®µÉ À§ÇèÀÌ ÀÖÀ¸´Ï ÁÖÀÇÇϽʽÿÀ. ŸÀÌ¸Ó¿Í ¿Âµµ°è´Â 'ÀÌ¿ëÇØ¾ß ÇÑ´Ù'°¡ ¸ÂÁö ¾ÊÀ»±î ½Í½À´Ï´Ù.


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Àú´Â ¼ÒÈ­±â³»°ú ºÀÁ÷ÀÇÀÔ´Ï´Ù. ³»½Ã°æ ¼¼Ã´±â Áß ¿ÀÁ¸ (ozone) ¼¼Ã´±â¿¡ ´ëÇÏ¿© ¹®Àǵ帳´Ï´Ù. º°µµÀÇ ¼¼Ã´Á¦¸¦ ÇÊ¿ä·Î ÇÏÁö ¾Ê°í, ¿ÀÁ¸¸¸À¸·Î ¼¼Ã´ÀÌ °¡´ÉÇÏ´Ù°í ÇÏ¿© ¸î¸î º´¿ø¿¡¼­ »ç¿ëÇÏ´Â °ÍÀ¸·Î ¾Ð´Ï´Ù. ±âÁ¸ ¼¼Ã´Á¦¿Í µ¿ÀÏÇÑ È¿°ú¸¦ ³ªÅ¸³»´ÂÁö, ¾ÈÀüÇÑ ¼¼Á¤ ¹æ¹ýÀÎÁö, ÀϹÝÀûÀÎ consensus´Â ¾î¶°ÇÑÁö ¿©Âã°í ½Í½À´Ï´Ù.

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³»½Ã°æ ¼Òµ¶Àº "°í¼öÁØ(high-level)" ¼Òµ¶¾×À» »ç¿ëÇØ¾ß Çϴµ¥, ¿ì¸®³ª¶ó º¸°Çº¹ÁöºÎ¿¡¼­ ÀÎÁ¤ÇÑ "°í¼öÁØ" ¼Òµ¶Á¦´Â ÃÑ 4°¡Áö ÀÔ´Ï´Ù (±Û·çŸ¸£¾Ëµ¥È÷µå, ¿ÃÅäÇÁÅ»µ¥È÷µå, °úÃÊ»ê, ÀüÇػ꼺¼ö). µû¶ó¼­ ±¹°¡¾Ï°ËÁø ³»½Ã°æ ÁúÆò°¡¿Í ¿ì¼ö³»½Ã°æ½Ç Æò°¡¿¡¼­´Â ³»½Ã°æ ¼Òµ¶¾×ÀÌ À§ 4°¡Áö¿¡ ÇØ´çµÇ¾î¾ß¸¸ ÀÎÁ¤¹ÞÀ» ¼ö ÀÖ½À´Ï´Ù. ¹Ì±¹ FDA °øÀÎ ¼Òµ¶¾×Àº ÃÑ 6°¡ÁöÀε¥ À§ 4°¡Áö¸¦ Æ÷ÇÔÇÏ°í ÀÖ½À´Ï´Ù (FDA ÀÚ·á ¸µÅ©).

Âü°í·Î 2012³â 8¿ù¿¡ ³ª¿Â "¼ÒÈ­°ü³»½Ã°æ ¼¼Ã´ ¹× ¼Òµ¶ÀÇ ±æÀâÀÌ"¿¡ "¿ÀÁ¸¼ö"¿¡ ´ëÇØ ¾ð±ÞÀÌ µÇ¾î Àִµ¥, "¿ÀÁ¸¼ö´Â °­·ÂÇÑ »êÈ­·ÂÀÌ ÀÖÀ¸¸ç È¿°úµµ ½Å¼ÓÇÑ ¼Òµ¶¾×ÀÌ´Ù. ÀÚµ¿ ¼Òµ¶±â ³»¿¡¼­ ¼öµ¾¹°À» ÀÌ¿ëÇÏ¿© ¿ÀÁ¸¼ö¸¦ »ý¼ºÇϹǷΠÀ¯Áö ºñ¿ëÀÌ ¸Å¿ì Àú·ÅÇÏ´Ù. ±×·¯³ª ¿ÀÁ¸¼ö¸¦ ÀÌ¿ëÇÑ ³»½Ã°æ ¼Òµ¶°ú °ü·ÃµÈ Á¤º¸´Â ¾ÆÁ÷ ºÎÁ·ÇÑ ½ÇÁ¤ÀÌ´Ù"¶ó°í µÇ¾î ÀÖ½À´Ï´Ù. ¾îÂîµÇ¾úµç "¿ÀÁ¸¼ö"´Â À§ÀÇ 4°¡Áö¿¡ Æ÷ÇÔÀÌ ¾È µÇ¹Ç·Î È¿°ú¿©ºÎ¿Í »ó°ü¾øÀÌ ÀÎÁ¤µÇÁö ¾Ê°í ÀÖÀ¸¹Ç·Î À¯ÀÇÇØ¾ß ÇÕ´Ï´Ù.

ÃÖ±Ù ÀüÇػ꼺¼ö°¡ ³í¶õÀÌ µÇ°í ÀÖ°í ¹®ÀÇ°¡ ¸¹ÀÌ µé¾î¿À´Âµ¥, ¿øÄ¢Àº ±âÁ¸ »óÇ°È­µÈ ÀüÇػ꼺¼ö(¿¹, ¸Þµð·Ï½º, ¾Ö´Ï·Ï½º µî)´Â ±Ù°Å ºÒÃæºÐÀ¸·Î ÀÎÁ¤ÀÌ ¾ÈµÇ°í, ¼Òµ¶ ÇöÀå¿¡¼­ ÀüÇػ꼺¼ö¸¦ ¸¸µå´Â ±â°è¸¦ ÅëÇØ ¹Ù·Î ¸¸µé¾î¼­ »ç¿ëÇؾ߸¸ ÀÎÁ¤µË´Ï´Ù. FDA¿¡¼­µµ "generated on site"¶ó°í ¸í±âµÇ¾î ÀÖ½À´Ï´Ù.


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¾î¶² ¼±»ý´ÔÀÇ ¼Òµ¶¿¡ °üÇÑ Áú¹®¿¡ ´äÀ» ÁÖ½ÉÀ» º¸°í, Àúµµ °¨»çÇÑ ¸¶À½¿¡ ¿ë±â¸¦ ³»¾î Áú¹®µå¸³´Ï´Ù. ¡°COOLENDO(Äð¿£µµ)¡± ¶ó´Â ÀÚµ¿¼¼Ã´±â´Â ¡°PHMB-DBAC (polyhexamethylenebiguanide hydrochloride-alkyldimethylbenzylammonium chloride)¡± À̶ó´Â ¼Òµ¶¾×À» »ç¿ëÇÑ´Ù°í ÇÕ´Ï´Ù. Çѹø »ç¿ëÇÑ ¼Òµ¶¾×À» Àç»ç¿ëÇÏÁö ¾Ê´Â ÀÏȸ¿ë ¼Òµ¶¾×À̶ó°í ÇÕ´Ï´Ù. º¸Á¸ ±â°£ÀÌ µû·Î ÀûÇôÀÖÁö ¾ÊÀº°ÍÀ¸·Î ºÁ¼­, ³»½Ã°æ °Ç¼ö°¡ ¾ÆÁÖ ÀûÀº ÀÇ¿ø¿¡¼­ »ç¿ëÇϱ⿡ ±¦ÂúÀ» °Í °°Àº »ý°¢ÀÌ µì´Ï´Ù¸¸, ÇÐȸ³ª ¿¬¼ö°­Á¿¡ °¡µµ ¾ð±ÞµÇÁö ¾Ê´õ±º¿ä. °Ë»öÇغ¸´Ï °ü·Ã ³í¹®ÀÌ ÇÑ °³ °Ë»öÀÌ µË´Ï´Ù (Kim SY. Clin Endosc 2011). µÎ °¡Áö ¹®Àǵ帳´Ï´Ù.

(1) PHMB-DBAC ÀÇ ³»½Ã°æ ¼Òµ¶ È¿°ú°¡ ¾î¶²Áö ¹®Àǵ帳´Ï´Ù

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Á¦°¡ ÀÌ ºÐ¾ß¸¦ Àü¹®ÀûÀ¸·Î °øºÎÇÒ ±âȸ°¡ ¾ø¾ú½À´Ï´Ù. °ü·Ã ¾÷¹«¸¦ º¸°í °è½Ã´Â ¼±»ý´Ô²² ¹®ÀÇÇÏ¿© ¾Æ·¡¿Í °°Àº ´äº¯À» ¹Þ¾Ò½À´Ï´Ù. È¿°ú À¯¹«µµ Áß¿äÇÏÁö¸¸ °øÀÎÀ» ¹Þ¾Ò´ÂÁö°¡ °ü°ÇÀÏ °Í °°½À´Ï´Ù.

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±¹°¡¾Ï°ËÁø ³»½Ã°æ Áú Æò°¡ÀÇ ¼Òµ¶ºÎºÐÀÇ Æò°¡ ±âÁØÀº ¾Æ·¡¿Í °°½À´Ï´Ù.

µû¶ó¼­ PHMB-DBACÀÇ ³»½Ã°æ ¼Òµ¶ È¿°ú¿Í »ó°ü ¾øÀÌ ¿øÄ¢ÀûÀ¸·Î ÇöÀç±îÁö´Â À§ÀÇ 4°¡Áö °í¼öÁؼҵ¶Á¦°¡ ¾Æ´Ñ °æ¿ì¿¡´Â ±¹°¡¾Ï°ËÁø ³»½Ã°æ Áú Æò°¡¿¡¼­ ÀÎÁ¤µÇÁö ¾Ê½À´Ï´Ù. ±×¸®°í À§ 4°¡Áö °í¼öÁؼҵ¶Á¦´Â ¼ÒÈ­±â³»½Ã°æÇÐȸÀÇ ¿ì¼ö³»½Ã°æ½Ç ÀÎÁõ ±âÁØ »Ó ¾Æ´Ï¶ó º¸°Çº¹ÁöºÎ ¹× °ø´Ü¿¡¼­ ½ÃÇàÇÏ´Â ±¹°¡¾Ï°ËÁø ³»½Ã°æ Áú Æò°¡ÀÇ ±âÁØÀÔ´Ï´Ù.


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Àú´Â Áö±Ý ÀϹÝÀÇ¿ø ³»½Ã°æ½Ç¿¡ ÀÖ½À´Ï´Ù. 6°³¿ù¿¡ ÇÑ ¹ø º´¿ø Àåºñ¿¡¼­ Á¤±â ¹è¾ç°Ë»ç¸¦ ³ª°©´Ï´Ù. ±Ý¹ø ³»½Ã°æ ½ºÄß ¹è¾ç¿¡¼­ a few non-fermenting gram negative bacilli°¡ ÀÚ¶õ´Ù°í º¸°íµÇ¾ú½À´Ï´Ù. °ÇÁ¶ º¸°ü Áß ³ª°£ °Ë»ç¿¡¼­ º¸°íµÈ ÀÌ °á°ú·Î Çö ¼Òµ¶°úÁ¤¿¡ ¹®Á¦°¡ ÀÖ´Ù°í ÇÒ ¼ö ÀÖ´ÂÁö, ȤÀº biofilmÀÌ Çü¼ºµÈ °ÍÀÏÁö Àß ¸ð¸£°Ú½À´Ï´Ù. µ¡ºÙ¿© ÀÌ·± °Ë»ç¸¦ ÇÏ´Â °ÍÀÌ Àǹ̰¡ ÀÖÀ»Áöµµ ±Ã±ÝÇÕ´Ï´Ù.

ÇöÀç ³»½Ã°æ½Ç ¼Òµ¶Àº ´ëÇѼÒÈ­±â³»½Ã°æÇÐȸ ±Ç°í»çÇ×À» ÁؼöÇÏ°í ÀÖÀ¸¸ç °£È£»çµéµµ ´ëÇк´¿ø ³»½Ã°æ½Ç ±Ù¹«°æ·ÂÀÌ »ï³â ÀÌ»ó µÈ Àü¹®ÀηµéÀÔ´Ï´Ù. ¸Å³â ±¹¸³¾Ï¼¾ÅÍ ¼Òµ¶±³À°µµ °¡°í ÀÖ½À´Ï´Ù.

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Àú´Â Áö±Ý ÀϹÝÀÇ¿ø ³»½Ã°æ½Ç¿¡ ÀÖ½À´Ï´Ù. 6°³¿ù¿¡ ÇÑ ¹ø º´¿ø Àåºñ¿¡¼­ Á¤±â ¹è¾ç°Ë»ç¸¦ ³ª°©´Ï´Ù. ±Ý¹ø ³»½Ã°æ ½ºÄß ¹è¾ç¿¡¼­ a few non-fermenting gram negative bacilli°¡ ÀÚ¶õ´Ù°í º¸°íµÇ¾ú½À´Ï´Ù. °ÇÁ¶ º¸°ü Áß ³ª°£ °Ë»ç¿¡¼­ º¸°íµÈ ÀÌ °á°ú·Î Çö ¼Òµ¶°úÁ¤¿¡ ¹®Á¦°¡ ÀÖ´Ù°í ÇÒ ¼ö ÀÖ´ÂÁö, ȤÀº biofilmÀÌ Çü¼ºµÈ °ÍÀÏÁö Àß ¸ð¸£°Ú½À´Ï´Ù. µ¡ºÙ¿© ÀÌ·± °Ë»ç¸¦ ÇÏ´Â °ÍÀÌ Àǹ̰¡ ÀÖÀ»Áöµµ ±Ã±ÝÇÕ´Ï´Ù.

ÇöÀç ³»½Ã°æ½Ç ¼Òµ¶Àº ´ëÇѼÒÈ­±â³»½Ã°æÇÐȸ ±Ç°í»çÇ×À» ÁؼöÇÏ°í ÀÖÀ¸¸ç °£È£»çµéµµ ´ëÇк´¿ø ³»½Ã°æ½Ç ±Ù¹«°æ·ÂÀÌ »ï³â ÀÌ»ó µÈ Àü¹®ÀηµéÀÔ´Ï´Ù. ¸Å³â ±¹¸³¾Ï¼¾ÅÍ ¼Òµ¶±³À°µµ °¡°í ÀÖ½À´Ï´Ù.

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±³¼ö´Ô ³»½Ã°æ culture °ü·Ã Áö½ÄÀÌ ¸¹Áö ¾ÊÀ¸³ª ÀϹÝÀûÀÎ °üÁ¡¿¡¼­ Àǰߵ帳´Ï´Ù. ^^ Glucose nonfermenter GNB ´Â ´ÙÀ½°ú °°°í ÀÓ»óÀûÀ¸·Î Acinetobacter, Burkholderia, Pseudomonas, Stenotrophomonas µîÀº ±¤¹üÀ§ÇÑ Ç×»ýÁ¦¸¦ ó¹æ¹ÞÀº ȯÀڵ鿡¼­ ¿ø³» °¨¿°À» ÀÏÀ¸Å°´Â ¿øÀαÕÀ¸·Î µÇ¾î ÀÖ½À´Ï´Ù. (ƯÈ÷ ÀÇ·á±â±¸°ü·Ã)

CDC¿¡¼­´Â ³»½Ã°æ ¹è¾ç¿¡¼­ ºÐ¸®µÈ ±ÕÀ» high-concern organisms (i.e., organisms more often associated with disease)°ú low-concern organisms (i.e.,organism less often associated with disease and potentially a result of contamination of cultures during collection)À¸·Î ±¸ºÐÇÏ°í ÀÖ½À´Ï´Ù.

Âü°í·Î Á¦°¡ ãÀº ³í¹®(Chiu. BMC Gastroenterol 2012)¿¡¼­´Â biospy method ¸¦ ºñ±³ÇÑ ³í¹®À̱â´Â Çϳª GNGN (glucose nonfermenter gram negative) ÀÌ °¡Àå ÈçÈ÷ ºÐ¸®µÇ´Â ±ÕÀ¸·Î µÇ¾î ÀÖ½À´Ï´Ù. DiscussionÀ» º¸¸é GNGN Àǹ̿¡ ´ëÇؼ­ ³ª¿Í ÀÖ½À´Ï´Ù. ÀÌ ³í¹® ³»¿ëÀ» º¸¸é non-fermenter GNB ¿¡ ´ëÇØ µ¿Á¤À» ÀϹÝÀûÀ¸·Î ÇÏÁö ¾Ê¾Ò´Ù°í µÇ¾î Àִµ¥ »ç¶÷ÀÇ °Ëü°¡ ¾Æ´Ï¾î¼­ ÀϹÝÀûÀ¸·Î ºÐ¸® µ¿Á¤À» ÇØÁÖÁö ¾ÊÀº °Í °°½À´Ï´Ù. ¹®ÀÇÇϽŠ¼±»ý´ÔÀÌ ÀÇ·ÚÇϽŠ¾÷ü¿¡¼­µµ °°Àº ÀÌÀ¯·Î µ¿Á¤À» ÇØÁÖÁö ¾ÊÀº °Í °°½À´Ï´Ù. ´Ù¸¸ À§ÀÇ ºÐ·ù´ë·Î ±¸ºÐÇÑ´Ù¸é nonfermenter GNB ´Â high concern organism À¸·Î ºÐ·ùÇÒ ¼ö ÀÖ°Ú°í, ¸é¿ªÀúÇÏÀÚ, ±¤¹üÀ§ Ç×»ýÁ¦ ó¹æÀ» ¹Þ¾Ò´ø ȯÀڵ鿡¼­´Â °¨¿°À» ÀÏÀ¸Å³ ¼ö ÀÖ´Â ±ÕÀ¸·Î ÆľÇÇÏ½Ã¸é µÇÁö ¾ÊÀ»±î ½Í½À´Ï´Ù.

Âü°í·Î º»¿øÀº °¨¿°°ü¸®½Ç¿¡ ¼ÓÇØ ÀÖ´Â ÀÓ»ó º´¸®»ç ¼±»ý´ÔÀÌ °Ë»ç¸¦ Çϴµ¥ º»¿øÀÇ °æ¿ì flushing channel ÅëÇؼ­ ±Õ °Ë»çÇÏ´Â °æ¿ì ±ÕÀÌ ºÐ¸®µÈ °æ¿ì´Â °ÅÀÇ ¾ø¾ú½À´Ï´Ù. ÀÏÀü¿¡ ERCP ¿ë ³»½Ã°æÀ̳ª ±â°üÁö ³»½Ã°æ¿¡¼­ non-fermenter GNB°¡ ³ª¿Â ÀûÀº ÀÖ½À´Ï´Ù. ÀÌ·± ±ÕµéÀÌ ÀÇ·á±â±¸³ª ȯ°æ¿¡ ¿À·¡ »ýÁ¸ÇÒ ¼ö ÀÖ½À´Ï´Ù.

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EndoTODAY surveillance´Â ÇÊ¿äÇÑ°¡¿¡¼­ ¼³¸íµå¸° ¹Ù¿Í °°ÀÌ ³»½Ã°æ ¹è¾çÀÇ Àǹ̴ ¾ÆÁ÷ ºÒ¸íÈ®ÇÕ´Ï´Ù. ¾ÕÀÇ °¨¿°³»°ú ¼±»ý´Ô²²¼­´Â ÃÖ´ëÇÑ Á¶½ÉÇÑ´Ù´Â ÀÔÀå¿¡¼­ ´äº¯À» ÇϼÌÁö¸¸ Àú´Â a few bacilli ¶§¹®¿¡ ¿ì·ÁÇÒ Á¤µµ´Â ¾Æ´Ò °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ´Ù½Ã Çѹø ¼Òµ¶ÇÑ ÈÄ ¹è¾çÇØ º¸½Ç °ÍÀ» ±ÇÇÕ´Ï´Ù. ±×·¯¸é ´ëºÎºÐ ´õ ÀÌ»ó ±ÕÀÌ ³ª¿ÀÁö ¾ÊÀ» °ÍÀÔ´Ï´Ù.


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[2018-11-1. ¾Öµ¶ÀÚ Áú¹®]

1) Á¦°¡ »õ·Î ±Ù¹«ÇÏ°Ô µÈ º´¿ø °ËÁø¼¾ÅÍ ¿¡¼­´Â HBsAg(+) ¼ö°ËÀÚÀÇ °æ¿ì ³»½Ã°æ ÈÄ Àü¼¼Ã´À» ´Ù¸¥ Åë¿¡ ´ã°í, ³»½Ã°æ°ú ¿¬°áµÈ Suction Lineµµ ±³Ã¼Çϴµ¥... ÀÌ·¸°Ô ÇÏ´Â°Ô ¸Â´Â°ÇÁö ±Ã±ÝÇÕ´Ï´Ù. ¼ÖÁ÷È÷ HBs Ag(+)¼ö°ËÀÚ ÇÑ¸í °Ë»çÈÄ ³Ê¹« ÇØ¾ß ÇÒ ÀÏÀÌ ³Ê¹« ¸¹Àº °Í °°½À´Ï´Ù.

2) ³»½Ã°æ Á¶Á÷°Ë»ç ÈÄ Á¡»óÃâÇ÷ÀÌ °è¼ÓµÉ ¶§ º¸½º¹Î¾×À» ¾²´øµ¥... ÀÌ ¿ë¾×À» ÁöÇ÷¿ëÀ¸·Î »Ñ¸®´Â°Ô ¸Â´Â°ÇÁö?? ¾µ ¼ö ÀÖ´Ù¸é ¾î¶»°Ô Èñ¼®Çؼ­ ½á¾ß ÇÏ´ÂÁöµµ ±Ã±ÝÇÕ´Ï´Ù...

[2018-11-2. ÀÌÁØÇà ´äº¯]

1) ³»½Ã°æ ¼¼Ã´,¼Òµ¶Àº universal precautionÀÇ ¿øÄ¢¿¡ µû¸£´Â °ÍÀÔ´Ï´Ù. ¹°·Ð ³»½Ã°æ ½Ã¼úµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù. ¸ðµç ȯÀÚ°¡ °¨¿°¼º ÁúȯÀ» °¡Áö°í ÀÖ´Â °ÍÀ¸·Î °¡Á¤ÇÏ´Â °ÍÀÌÁö¿ä. ¸ðµç ȯÀÚ°¡ HBsAg (+) ÀÌ°í ¸ðµç ȯÀÚ°¡ HIV (+) ÀÎ °ÍÀ» °¡Á¤ÇÏ°í ¼¼Ã´°ú ¼Òµ¶À» ÇÏ°Ô µÇ¾î ÀÖ½À´Ï´Ù. ±×·¡¼­ ¼Òµ¶°ú ¼¼Ã´ °¡À̵å¶óÀÎÀ» º¸¸é °¨¿° ¿©ºÎ¿¡ µû¸¥ Â÷ÀÌ´Â ÀüÇô ¾ð±ÞµÇ¾î ÀÖÁö ¾Ê½À´Ï´Ù. ½ÇÁ¦·Î °Ë»ç¿Í ¼¼Ã´,¼Òµ¶ °úÁ¤ÀÌ °¡À̵å¶óÀο¡ µû¶ó Ãæ½ÇÇÏ°Ô ÁøÇàµÇ°í ÀÖ´Ù¸é HBsAg (+)À̶ó´Â ÀÌÀ¯·Î Ưº°ÀÌ ´õ ÇÒ °ÍÀº ¾ø½À´Ï´Ù. °úÇÐÀû ±Ù°Å¿¡ ÀÇÇÑ °ÍÀº ¾Æ´ÏÁö¸¸, Àΰ£ÀÇ º¸ÆíÀû Á¤¼­ (ȤÀº °ÆÁ¤)¿¡ ÀÇÇØ HIV (+), °áÇÙ (+) ȯÀÚÀÇ °æ¿ì ¸Ç µÚ¿¡ °Ë»çÇÏ°í Ưº°È÷ ÁÖÀÇÇÏ´Â °æ¿ì(µÎ¼¼¹ø ¼Òµ¶ÇѴٰųª ÇÏ´Â µî)´Â ÁÖº¯¿¡¼­ ¸¹ÀÌ º¸°í ÀÖ½À´Ï´Ù¸¸...

2) Á¶Á÷°Ë»ç ÈÄ oozing¿¡¼­ º¸½º¹Î spray°¡ µµ¿òµÈ´Ù´Â ±Ù°Å´Â ¾ø½À´Ï´Ù. ÀúÈñ´Â »ç¿ëÇÏÁö ¾Ê´Â ¹æ¹ýÀÔ´Ï´Ù. ±×³É ¼ö ºÐ °æ°ú°üÂû ÇÏ´Ù°¡ ¿µ °ÆÁ¤µÇ¸é clipÀ» 1-2°³ ÀåÂøÇϽñ⠹ٶø´Ï´Ù.


[2019-2-8. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô. EndoTODAY¸¦ ÅëÇØ °øºÎÇÏ°í ÀÖ´Â °³¿ø³»°ú ÀÇ»çÀÔ´Ï´Ù.

³»½Ã°æ ÀÚµ¿¼¼Ã´±â »ç¿ëÁßÀ̸ç, ¼Òµ¶¾×Àº ¿ÀÇǵ¦½º¾× »ç¿ëÁßÀÔ´Ï´Ù (Orthophthaldehyde). Æó°áÇÙÀ¸·Î °áÇÙ¾à º¹¿ëÁßÀΠȯÀÚ (ƯÈ÷ º¹¿ë½ÃÀÛÇÑÁö ¾ó¸¶ ¾ÈµÈ ȯÀÚ), ¶Ç´Â, ºñ°áÇÙ¼º Ç×»ê±Õ (NTM) À¸·Î °áÇÙ¾à º¹¿ëÁßÀΠȯÀÚ°¡ À§³»½Ã°æÀ» ÇÏ·¯ ¿Â´Ù¸é, ÀϹÝÀûÀÎ ¼Òµ¶¹æ¹ýÀ¸·Î °áÇÙ±Õ ¶Ç´Â ºñ°áÇÙ¼ºÇ×»ê±Õµµ ÃæºÐÈ÷ »ì±ÕÀÌ µÇ´ÂÁö¿ä? °áÇÙ±Õ ¶Ç´Â ºñ°áÇÙ¼ºÇ×»ê±Õ Ä¡·áÁßÀΠȯÀÚÀÇ ³»½Ã°æ ¼Òµ¶Àº ¾î¶»°Ô ÇØ¾ß ÇÏ´ÂÁö¿ä?

[2019-2-8. ÀÌÁØÇà ´äº¯]

Ç¥ÁØ ³»½Ã°æ ¼Òµ¶ ÇÁ·ÎÅäÄÝÀº °áÇ٠ȯÀÚ¸¦ °¡Á¤ÇÏ°í ¸¸µé¾îÁø ÇÁ·ÎÅäÄÝÀÔ´Ï´Ù. Ç¥ÁØ ¼Òµ¶ ÁöħÀ» µû¸£¸é ±×¸¸ÀÌ°í ´õ Ãß°¡ÇÒ °ÍÀº ¾ø½À´Ï´Ù.

³»½Ã°æ ¼Òµ¶¿¡´Â ÁÖ·Î liquid chemical germicide (LCG)°¡ ÀÌ¿ëµË´Ï´Ù. ¼Òµ¶ÀÇ °­µµ´Â high-level disinfection, intermediate-level disinfection, low level disinfectionÀ¸·Î ³ª´©¾îÁý´Ï´Ù. ³»½Ã°æ ¼Òµ¶ÀÇ ¸ñÇ¥´Â ³ôÀº ¼öÁØÀÇ ¼Òµ¶(high-level disinfection)ÀÔ´Ï´Ù. ¸ê±ÕÀÌ ¾Æ´Õ´Ï´Ù. ´Ù·®ÀÇ bacterial spore¸¦ Á¦¿ÜÇÑ ¸ðµç ¹Ì»ý¹°À» Á¦°ÅÇÏ´Â °ÍÀÔ´Ï´Ù. ½ÇÁ¦ÀûÀÎ ÆÇ´Ü ±âÁØÀº °áÇÙ±ÕÀÇ ¼Ò¸ê¿©ºÎÀÔ´Ï´Ù.

High level disinfectionÀÌ °¡´ÉÇϵµ·Ï ¸¸µé¾îÁø ³»½Ã°æ ¼Òµ¶ ÇÁ·ÎÅäÄÝÀ» Ãæ½ÇÈ÷ µû¸£¸é °áÇÙȯÀÚ »ç¿ë ³»½Ã°æ¿¡µµ ¹®Á¦°¡ ¾ø½À´Ï´Ù.

[2019-3-22]

´ëÇÑÀ§´ëÀå³»½Ã°æÇÐȸ¿¡¼­ ¹æ¼ö ÀçÁú·Î ¸¸µç °Ë»ç¿ë °¡¿îÀÌ ³ª¿Ô´Ù°í ÇÏ¿© Çѹø ÀԾ¾Ò½À´Ï´Ù.


[2019-4-17. ¾Öµ¶ÀÚ Áú¹®] (¿ä¾à)

À§´ëÀå³»½Ã°æÇÐȸ¿¡¼­ ³ª¿Â ÀÚ·á¿¡µµ º¸¸é ±¹³» º´ÀÇ¿øÀÇ Àý¹ÝÁ¤µµ°¡ OPA°è¿­À» ¾²°í ÀÖ°í ÀúÈñµµ ½ÎÀ̵¦½º OPA ¿À¸®Áö³Î Á¦Ç°À» »ç¿ëÇØ¿Ô½À´Ï´Ù. ºÐ±âº°·Î ¼Òµ¶ ÈÄ scope¶û ¼¼Ã´±â ±Õ¹è¾ç °Ë»ç¿¡¼­ ¼ö³â°£ Çѹøµµ ±ÕÀÌ ¹è¾çµÈ ÀûÀÌ ¾ø¾ú½À´Ï´Ù. ±¤ÁÖÁö¿ª¿¡¼­ ³»½Ã°æ ¼Òµ¶Á¦(OPA°è¿­) Æó±â¹° ¹èÃâ °ü·ÃÇÏ¿© ¸ð º´¿øÀÌ °üÇÒ Áö¹æÀÚÄ¡´Üü¿¡¼­ °æ°í(?)¸¦ ¹Þ¾Ò´Ù°í ÇÏ¿© ³»½Ã°æ ¼Òµ¶Á¦¸¦ °úÃÊ»ê°è¿­·Î ¹Ù²Ù·Á°í ÁøÇà Áß¿¡ ÀÖ½À´Ï´Ù.

ÃÖ±Ù °úÃÊ»ê °è¿­ÀÎ XX¶ó´Â °úź»ê³ªÆ®·ý ¼ººÐÀÇ ºÐ¸»·Î µÈ ³»½Ã°æ ¼Òµ¶Á¦¸¦ µ¥¸ð·Î »ç¿ëÇϸ鼭 ±Õ¹è¾ç °Ë»ç µî Å×½ºÆ®¸¦ Çغ¸¾Ò´Âµ¥¿ä.. (³¯¸¶´Ù ºÐ¸»À» ÀÏÁ¤ºñÀ²·Î ¹°¿¡ Èñ¼®Çؼ­ ¼¼Ã´¾×À» Á¶Á¦ÇÏ¿© »ç¿ëÇÕ´Ï´Ù.) ÀÌ Á¦Ç°À» »ç¿ëÇÏ¿© ¼¼Ã´ ÈÄ À§ scope¿¡¼­ Pseudomonas areuginosa°¡ °ËÃâµÇ¾ú°í ¼¼Ã´±â¿¡¼­´Â Acinetobacter lwoffii. (Gram negative)±ÕÁÖ°¡ ¹è¾çµÇ¾ú½À´Ï´Ù. ¹°·Ð ÃæºÐÇÑ ³óµµ ÀÌ»óÀÇ ¼Òµ¶¾×À» Á¶Á¦ÇÑ »óÅ¿¡¼­ ¼Òµ¶ÀÌ ÀÌ·ç¾îÁ³½À´Ï´Ù.

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ÀÌ ¹®Á¦¿¡ ´ëÇØ ¾÷ü ´ã´çÀÚ¿¡°Ô ¹®ÀǸ¦ ÇÏ´Ï ÇÑ´Ù´Â ¾ê±â°¡ Pseudomonas´Â ¼öµµ¹°°°Àºµ¥¼­µµ ½±°Ô °ËÃâµÇ´Â ¼¼±ÕÀÌ°í ¾Æ¸¶µµ °úÃÊ»ê °è¿­ÀÌ Çó±À¼ºÀÌ ÁÁ´Ùº¸´Ï ±Ý¹æ Çó±ÅÁ®¼­ scope¿¡ ¾à°£ ³²¾ÆÀÖ´ø Çó±À½Ã »ç¿ëÇÑ ¼öµ¾¹°¿¡ ÀÖ´ø ¼¼±ÕÀÌ °ËÃâµÈ°Í °°´Ù°í Çϳ׿ä. ±×·¡¼­ ±×ÂÊ¿¡¼­ ÁØ ÀڷḦ º¸´Ï ÀÌ·± ±ÕÁÖ°¡ ³ª¿À¸é ¹®Á¦ÇØ°á¹æ¹ýÀ¸·Î Çó±À°úÁ¤ °ËÅä, Çó±À¿ë ¼öÁú °ËÅä, ¼¼Ã´±â¿Í Á¤¼ö½Ã½ºÅÛ¿¡ ´ëÇÑ °ËÅä µîÀÌ ³ª¿ÍÀÖ½À´Ï´Ù.

ÀϹÝÀûÀ¸·Î °úÃÊ»ê Á¦Á¦´Â ±Ý¼Ó ºÎ½Ä µîÀÇ ¹®Á¦°¡ ¹ß»ýÇÒ¼ö À־ ½ºÄß ¼Õ»ó¿ì·Á°¡ ÀÖ´Ù°í ¼Òµ¶Á¦ Á¤¸®ÇصРÀ§´ëÀå³»½Ã°æÇÐȸ¿¡¼­ ¹ßÇàÇÑ Ã¥¿¡¼­ ºÃ½À´Ï´Ù. ÀúÈñ°¡ ÃÖ±Ù µµÀÔÀ» °í·ÁÇß´ø XX´Â ºÐ¸»»óÅ¿¡¼­ ¾ÈÁ¤µÇ¾î ÀÖ°í, ±×ÂÊ¿¡¼­ ¾ê±âÇϱæ ph°¡ ´Ù¸¥ °úÃÊ»êÁ¦Á¦¿¡ ºñÇØ »ó´ëÀûÀ¸·Î ³ô¾Æ¼­ ±Ý¼ÓºÎ½Ä ¿ì·Á°¡ ¾ø´Ù´Â ¾ê±â¸¦ Çϳ׿ä... ¿ØÁö ÀÌ·±°Í ¶§¹®¿¡ ¼Òµ¶·ÂÀÌ ¾à°£ ¾àÇÑ°Ô ¾Æ´Ñ°¡ ½ÍÀº ÀDZ¸½ÉÀÌ µé±âµµ Çϱ¸¿ä.. ¾Æ¹«Æ° ±¹³» Á¾ÇÕº´¿ø±Þ°ú ÀϺΠ´ëÇк´¿ø¿¡¼­µµ XX¸¦ »ç¿ëÁßÀ̶ó Çϴµ¥ ±×·¡µµ °°Àº °úÃÊ»ê Á¦Á¦ÀÎ ACECIDE¸¦ »ç¿ëÁßÀÎ SMC³»½Ã°æ½Ç¿¡¼­µµ Pseudomonas°°Àº ±ÕÁÖ°¡ ¼Òµ¶ ÈÄ¿¡µµ ¹è¾çµÈ ÀûÀÌ ÀÖ´ÂÁö¶û ÀÌ·± ¼¼±ÕµéÀÌ ¼Òµ¶ÈÄ¿¡ ³ª¿ÔÀ»¶§ ÀÓ»óÀûÀÎ Àǹ̰¡ Àִ°ÇÁö È®ÀÎÇغ¸°í ³ª¼­ ÀúÈñµµ µµÀÔÀ» °ËÅäÇؾßÇÒ°Í °°¾Æ¼­ ³»½Ã°æ ÃʽÉÀÚ°¡ ¸¹Àº ½ÃÁðÀ̶ó À¯µ¶ ´õ ¹Ù»Ú°í Á¤½Å¾øÀ¸½Ç ±³¼ö´Ô²², ±×¸®°í ³»½Ã°æ½ÇÀåÀ» ¸Ã°í °è½Ã±â ¶§¹®¿¡ ±×µ¿¾È ÀÌ·± À¯»çÇÑ ¹®Á¦¿¡ À־ °ü½É°®°í °è½Ç °Í °°¾Æ¼­ ¿°Ä¡ºÒ±¸ÇÏ°í ¹®ÀÇ µå·Áº¾´Ï´Ù..

[2019-4-18. ÀÌÁØÇà ´äº¯]

±¹°¡¿¡¼­ °øÀÎÇÏ¿´°í ³»½Ã°æÇÐȸ¿¡¼­µµ Á¤½ÄÀ¸·Î ÀÎÁ¤ÇÑ ¼Òµ¶Á¦ÀÇ ¼Òµ¶·ÂÀº ¹Ï°í ÀÖ½À´Ï´Ù. »ç¿ë¹ý°ú °ü¸®»óÀÇ À̽´´Â ´Ã °¡´ÉÇÕ´Ï´Ù.

Áö±Ý±îÁö »ç¿ëÇÏ´ø ¼Òµ¶Á¦¿¡¼­ ¹®Á¦°¡ ¾ø´Âµ¥ ¹Ù²Ü °ÍÀ» °í·ÁÇÏ´Â ¼Òµ¶Á¦¿¡¼­ ÀÇÀÇ´Â ºÒ¸íÈ®ÇÏ´õ¶óµµ ¹º°¡ ¹®Á¦°¡ ÀÖÀ¸¸é ±×³É ÇöÀçÀÇ ¼Òµ¶Á¦¸¦ »ç¿ëÇÏ´Â °ÍÀÌ ¾ÈÀüÇÒ °Í °°½À´Ï´Ù. ÀÌ·± À̽´´Â Àý´ë·Î ¼­µÎ¸¦ ÀÏÀÌ ¾Æ´Ï±â ¶§¹®ÀÔ´Ï´Ù.

°ú°Å¿¡´Â surveillance culture¿¡¼­ ºñº´¿ø¼º ¼¼±ÕÀÌ ¾ÆÁÖ µå¹°°Ô °ËÃâµÇ¾ú´ø °Í °°±â´Â ÇÕ´Ï´Ù¸¸ ÃÖ±Ù¿¡´Â ÀüÇô °ËÃâµÈ ¹Ù°¡ ¾ø¾î¼­ ÀúÈñ´Â ±â¾ï³ª´Â À̽´´Â ¾ø½À´Ï´Ù.


[2019-4-18]

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"ÃÖ±Ù ÀÌÁ÷ÇÑ º´¿ø¿¡¼­ ³»½Ã°æ º¸°üÀåÀ» º¯°æÇÏ°Ô µÇ¾î ¾Ë¾Æº¸´Ï, ŸÁö¿ª º´¿ø¿¡ ÀÏÇϴ ģ±¸ ¸»ÀÌ °ø´Ü½Ç»ç¿¡¼­ °ÇÁ¶±â´ÉÀÌ ÀÖ´Â ³»½Ã°æº¸°üÀåÀ¸·Î º¯°æÀ» ±ÇÀ¯ÇÏ¿´´Ù°í ÇÕ´Ï´Ù. ³»½Ã°æ º¸°üÀå¿¡ air circulation ±â´ÉÀÌ ²À ÀÖ¾î¾ßÇÏ´Â Áö Çʼö Á¶°ÇÀÎÁö ¹®Àǵ帳´Ï´Ù.^^;; ±¹³» ¾÷üµµ °ÇÁ¶±â´ÉÀÌ ÀÖ´Â ¼ö³³ÀåÀ» ¸¸µé°í´Â ÀÖ¾ú½À´Ï´Ù. Àú´Â ¿Ã¸²Çª½º Á¦Ç°À» ã¾Æº¸¾Ò½À´Ï´Ù (īŸ·Î±×). ÀÌ·± ½ÇÁúÀûÀÎ Áú¹®À» µå¸± °÷ÀÌ ¾ø¾î ÀÌ·¸°Ô ¿¬¶ôµå¸³´Ï´Ù.^^;; "

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¿À´Ã ´ëÇÑ ¼ÒÈ­±â³»½Ã°æÇÐȸ·Î ºÎÅÍ ÀÌ·± ¸ÞÀÏÀ» ¹Þ¾Ò½À´Ï´Ù.

"Air circulationÀÌ Àǹ« Á¶Ç×Àº ¾Æ´Õ´Ï´Ù. ¿À¿°µÈ ¿ÜºÎ ȯ°æ°ú û°áÇÑ ³»½Ã°æ ½ºÄßÀÌ Á¢ÃËÇÏ´Â °ÍÀ» Â÷´ÜÇÑ´Ù´Â ÀǹÌÀÔ´Ï´Ù. ½ºÄß ¼±´ÜÀÌ ¹Ù´Ú¿¡ ´êÁö ¾Ê´Â º¸°üÀåÀÇ ±¸ºñ°¡ Çʼö Á¶°ÇÀ̸ç, air circulationÀº Àǹ« Á¶°ÇÀÌ ¾Æ´Õ´Ï´Ù."

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[2019-7-16] ³»½Ã°æ channelÀ» ¾Ä´Â ballÀÌ ³ª¿Ô½À´Ï´Ù. °³´ç 800¿øÀ̶ó°í ÇÕ´Ï´Ù.


[2020-3-23] COVID-19¿Í ³»½Ã°æ (´ëÇѳ»½Ã°æÇÐȸ ÀÚ·á)


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Äڷγª°¡ ½ÃÀ۵Ǹ鼭 À§³»½Ã°æÀü ÀüóġÁ¦ÀÎ ¸®µµÄ«ÀÎ ½ºÇÁ·¹ÀÌ ³ëÁñ·Î °³¿ø ³»°úÀÇ»çµéµµ ¸¹Àº °í¹ÎÀ» Çß¾ú½À´Ï´Ù. ¾î¶² ¿øÀå´ÔÀº Ä«Æä¿¡¼­ »ç¿ëÇÏ´Â ±½Àº 1ȸ¿ë »¡´ë¸¦ ²È¾Æ¼­ Çغ¸½Å ºÐµµ ÀÖ¾ú½À´Ï´Ù.

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[2021-1-28] ¿Ã¸²Çª½º ¾Ç¼¼¼­¸® Áß ÀϺΰ¡ ¸®ÄÝ recallµÇ¾ú½À´Ï´Ù.


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MSDS °ü·ÃÀä... CidezymeÀÇ ¹°Áú¾ÈÀüº¸°ÇÀÚ·á¿¡ "À¯ÇØ,À§Çè¹®±¸ H360 ÅÂ¾Æ ¶Ç´Â »ý½Ä´É·Â¿¡ ¼Õ»óÀ» ÀÏÀ¸Å³ ¼ö ÀÖÀ½" ºÎºÐÀÌ Ãß°¡µÈ °Í °°½À´Ï´Ù. ¾ÆÁ÷±îÁö ÆÄ¾ÇµÈ ¹®Á¦´Â ÀüÇô ¾ø¾úÁö¸¸ MSDS´Â ¸Å¿ì Áß¿äÇÑ À̽´À̹ǷΠÀþÀº Á÷¿øÀÌ ¸¹Àº º´¿ø ȯ°æ¿¡¼­ ±Øµµ·Î ÁÖÀÇ°¡ ÇÊ¿äÇÑ ºÎºÐÀ¸·Î ÆǴܵ˴ϴÙ. Á¶¼ÓÈ÷ ´ëüǰÀ» ã¾Æº¼ ¿¹Á¤ÀÔ´Ï´Ù.


[2021-3-5] Äڷγª ½Ã´ë¿¡ °¨¿°Áõ ȯÀÚÀÇ ³»½Ã°æ °Ë»ç ÈÄ Àåºñ ¼Òµ¶ÀÌ °ÆÁ¤ÀÔ´Ï´Ù. ³»½Ã°æ ¹ëºê´Â ¼Òµ¶ÀÌ ¾î·Á¿î ºÎºÐÀä... 1ȸ¿ë ¸ê±Õ ¹ëºê°¡ ³ª¿Í ¼Ò°³ÇÕ´Ï´Ù. ¸î °³ ÁغñÇØ µÎ¾ú´Ù°¡ ²À ÇÊ¿äÇÒ ¶§ »ç¿ëÇϸé ÁÁÀ» °Í °°½À´Ï´Ù. Cantel »ç Á¦Ç°Àε¥ ¿¬°£ 9¹é¸¸°³ÀÇ ¹ëºê¸¦ ¸¸µé°í ÀÖ´Ù°í ÇÕ´Ï´Ù.^^

±¹³» ¼öÀÔó´Â M.I.TechÀÔ´Ï´Ù (mitech@mitech.co.kr).


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[References]

1) 1997³â 3¿ù 13ÀÏ Áß¾ÓÀϺ¸ (°­³²Åë½Å)¿¡ ½Ç¸° Ȳ¼¼Èñ ±âÀÚÀÇ ±â»ç.

À§¾ÏÄ¡·áÀÇ 1µî°ø½ÅÀº ¿ª½Ã À§(êÖ)³»½Ã°æ°Ë»ç´Ù.À§¾ÏÀ» Á¶±âÁø´ÜÇÒ °æ¿ì Ä¡·áÀ²À» 95%±îÁö ²ø¾î¿Ã¸± ¼ö Àֱ⠶§¹®. µû¶ó¼­ ±¹³» »ç¸Á·ü 1À§ÀÎ À§¾ÏÀ» ÁÙÀ̱â À§ÇØ 40´ë ÀÌÈÄ ¼ºÀο¡°Ô´Â ¸Å³â À§³»½Ã°æ °Ë»ç°¡ ±ÇÀåµÇ°í ÀÖ´Ù. ±×·¯³ª À§³»½Ã°æ °Ë»ç°¡ º¸ÆíÈ­µÇ¸é¼­ °Ë»ç·Î ÀÎÇÑ °¨¿°ÀÇ À§Ç輺ÀÌ Á¦±âµÇ°í ÀÖ¾î ÁÖ¸ñµÈ´Ù.´Ù¸¥ »ç¶÷ÀÇ ºÐºñ¹°À̳ª Ç÷¾×µîÀÌ ¼Òµ¶µÇÁö ¾ÊÀº ³»½Ã°æ¿¡ ¹¯¾î ÀÖ´Ù °¨¿°ÀÇ ¸Å°³¿øÀÌ µÇ´Â °ÍÀÌ´Ù.°£¿°.¸Åµ¶.¿¡ÀÌÁî.°áÇÙ.Ç︮ÄÚ¹ÚÅ͵îÀÌ °¨¿°µÉ ¼ö ÀÖ´Â ´ëÇ¥ÀûÀÎ Áúº´µé.ƯÈ÷ À§³»½Ã°æ °Ë»ç¶§ ½Ç½ÃÇÏ´Â Á¶Á÷°Ë»ç´Â À̵é ÁúȯÀÇ Àü¿°°¡´É¼ºÀ» ³ôÀÌ°í ÀÖ´Ù.

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