It is even related to the life safety of patients. Because most surgical patients have poor health and low resistance, surgical instruments and articles directly contact the incision of patients. If you don't do a good job of strict disinfection and sterilization and infection control, it will be easy.
Causing cross-infection between patients. The main routes of cross-infection are air, surgical materials such as surgical dressings and instruments, operators' hands and various disinfectants. In order to effectively prevent and control cross-infection in operating room, I
Scientists have taken the following measures.
1 Establish two-level infection management organizations in hospitals and departments, and improve various management systems.
Our hospital has set up a leading group for hospital infection management, headed by the dean in charge and composed of directors of various departments and head nurses. At the same time, in order to ensure the safety of surgical patients and reduce the occurrence of cross-infection, the operating room set up a hospital acquisition quality control group with the head nurse as the team leader and two quality control nurses as members.
In view of the causes of cross infection, specific rules and regulations have been formulated and improved. Such as cleaning and hygiene management system, disposable supplies management system, disinfection isolation, disinfection monitoring system, aseptic operation system and operating room sewage management system.
2. Strengthen the training and learning of hospital infection knowledge.
Regularly organize medical staff to learn operating room rules and regulations, hospital infection management norms and disinfection technical norms, improve the awareness of surgical staff to prevent hospital infection, establish knowledge of department infection prevention, and urge each other to avoid surgical infection.
3. Strengthen the management of indoor and outdoor environment and air in operation.
3. 1 Strengthening Health Management All cleaning work in the operating room must be carried out by wet cleaning. The surfaces and floors of operating rooms, shadowless lamps, operating beds, equipment carts and closets should be wiped with clean water and disinfectant before and after operation every day, and the slippers of operators should be cleaned and disinfected once a day. Every week, the walls and ground surgical supplies of each operating room should be strictly disinfected.
3.2 strictly control the personnel in and out of the operating room.
Persons with upper respiratory tract infection or suppurative infection are strictly prohibited from entering the operating room. The operator enters the operating room according to the list on the "Operation Notice". Doctors (including advanced students and interns) must be in the "operation" if they want to come to the undergraduate surgery.
The notice indicates the name of the visitor, and foreign visitors should contact the medical department in advance and fill in the "application form for visiting surgery". Special infection surgery refuses to visit.
3.3 Strict dress management requires personnel entering the operating room to wear clothes, pants, shoes, hats, masks, etc. The operating room is prepared according to the regulations and placed in the designated position when leaving. All surgical patients will be transported by exchange car, put on clean sick clothes, put on isolation caps, and pedestrians will change shoes.
3.4 Strengthen the rational layout management of the operating room
The dressing room, washroom, instrument cleaning room, sterile instrument room and dressing room of operating room should be placed in a reasonable operating line to meet the requirements of contaminated area, clean area and sterile area. Strict implementation of clean sewage diversion, medical personnel
Staff, patients and cleaning items are clean streamline; Postoperative instruments, dressings, dirt, etc. As a streamline of dirt, it is strictly distinguished to ensure the cleanliness of the air in the operating room and the needs of the operation process.
3.5 Strengthen the management of air disinfection in operating room
In addition to daily routine disinfection with air ozone sterilizer, the operating room must be cleaned and disinfected after operation and every day, and fresh air should be ventilated regularly every day.
In addition to H, we also used lactic acid fumigation for double disinfection, running continuously for 30 min ~ 1 h to improve the air disinfection effect. Do a good job in monitoring air disinfection before and after operation.
3.6 Reasonable arrangements should be made to separate aseptic surgery from bacterial surgery and clean surgery from contaminated surgery.
4. Strengthen the management of surgical items, and strictly monitor aseptic technology and disinfection and sterilization isolation.
Among many factors that cause hospital infection, medical devices are frequently reported [1]. The key measures to control hospital infection are "cleaning, disinfection, sterilization and aseptic technology". In view of this, we have adopted the following methods for the management of surgical instruments and materials.
4. 1 The process of cleaning instruments requires that surgical instruments should be thoroughly cleaned within 10 min after operation, and the surfaces, occlusal surfaces, tooth spaces, joints and gaps of all instruments should be cleaned with a toothbrush as far as possible, and there should be no residual blood and stains. At the same time, check the performance of the equipment in the cleaning process, and eliminate the equipment that has been used for too long and is not easy to clean.
4.2 After equipment maintenance and cleaning, dry it with sterile gauze or dry it with a warm air blower, oil it immediately, pack it, and autoclave it within 2 hours after packaging. Control the amount of oil in the process of refueling, so as to avoid too much oil affecting the sterilization effect.
4.3 Strengthen the management of intraoperative instruments. Cover the instruments not used in the operation with sterile towels to prevent blood pollution, add them according to the operation situation, and clean the instruments in use as much as possible to avoid congestion and increase the difficulty of cleaning during the operation. During the operation, the operating room staff should strictly implement and supervise the aseptic operation of the operator to prevent infection.
4.4 Operating room instruments, medicines, dressings, etc. There should be a fixed position, depending on the class.
According to different kinds of articles in the operating room, different disinfection and sterilization methods are adopted. Used for high-risk items, such as endoscopes and straws. , disinfection and sterilization after purchase and use must be strictly controlled. All surgical instruments entering the body cavity are used for medical treatment.
Articles must be disinfected before each use. Pressure steam sterilization is the first choice, which has many advantages such as high efficiency, rapidity, convenience, economy and safety. Chemical indicator cards should be placed in various aseptic packages, and the products should be observed after a sterilization cycle.
Compare the color change with the standard color to determine whether the sterilization effect is achieved. The chemical indicator tape (3M) is attached to the outside of the package, and whether it is sterilized or not can be judged according to its color change characteristics when heated at a certain high temperature and high pressure. And indicate the responsibility.
Personnel and deadline. Try to avoid using chemical disinfectants to soak and disinfect. If articles that cannot withstand temperature and humidity must be soaked and disinfected with chemical disinfectants, the disinfection principles and methods should be strictly mastered, the disinfection time should be paid attention to, and disinfectants should be prepared.
Bacterial monitoring. Note that the articles after soaking and disinfection must be washed repeatedly with sterile distilled water or physiological saline for three times before use.
4.5 Staff hand disinfection management operators should strictly abide by the rules of hand brushing to ensure the quality of hands. If the gloves are damaged or violate the principle of aseptic operation during the operation, they should be replaced immediately. Do a good job of hand protection and monitor the effect of hand brushing. It is forbidden to change dressing before operation to prevent cross infection.
4.6 Surgical wound management
Before the operation, the patient is required to take a bath, change clothes and clean and disinfect the skin in the operation area. The visiting nurse should check the skin preparation, notify the operator if there are lesions and skin injuries, and do a good job of isolation and disinfection. Carefully disinfect and smear the skin before operation.
Single, dressing change, wearing sterile gloves and other aseptic operations. Surgical incision and surrounding tissues should be protected and isolated. Strictly abide by the principle of aseptic technique operation, medical staff supervise each other and cooperate closely to shorten the operation time.
Ensure the quality of surgery. Rational use of antibiotics to prevent surgical infection.
4.7 Disposal of postoperative contaminated articles 10 should be disinfected with 0.5% "84" solution in time.
Cleaning after minutes, and then autoclaving. The dressing is sealed in a yellow plastic bag and sent to the laundry for treatment. Surgical items with special infection should be disinfected by special infection, and disposable goods should be destroyed immediately after use. Our hospital is based on medical waste.
"Management Regulations" has formulated a strict recycling management system, and strengthening post-use treatment is the key to prevent recycling, and disfigurement treatment after use is an effective measure [2].
4.8 Strengthen the monitoring and evaluation of disinfection and sterilization, regularly detect the radiation intensity of the air ozone sterilizer, conduct bacterial culture on the air, surface and hands of the operating room every month, and conduct disinfection and isolation quality control work once a week by the hospital infection team, solve problems in time when found, and regularly check key links, strengthen inspection and supervision, and understand the implementation of disinfection and isolation.
The management level of hospital infection in operating room is the embodiment of the quality of operating room work, and the possibility of infection in a very small link is often ignored. Through the establishment of biphasic infection management organization, improve the management system, improve the management level of medical staff.
Regular training and study of hospital infection knowledge, strengthening the management of indoor and outdoor environment of operation, monitoring the disinfection and sterilization of surgical items and strict aseptic technology management have achieved completely different results. To this end, we must control
As a head nurse in the operating room, we should be bold and strict in management and have a high sense of responsibility. The most important thing is to establish and improve a set of quality control system and management countermeasures, rectify the weak links, and make the operating room every link.
Scientific and standardized management can effectively prevent cross-infection and ensure the safety of operation.