In recent years, the centralized management of surgical instruments has gained more and more attention from many infection experts. Centralized management can effectively control cross-infection of medical origin, guarantee the safety in surgery, and also save the cost of manpower and materials. Since January 2009, our hospital started to centralize the management of surgical instruments by the disinfection and supply center, and we have gained some experience. It is introduced as follows:
1 Problems
1.1 Inadequate preparation and communication. Acceptance of surgical instruments did not communicate in detail with the leadership in charge, the program is simple, acceptance of hasty; the occurrence of problems, the two sides argue, mutual shifting of responsibility, the problem can not be resolved in a timely manner.
1.2 The workflow is unreasonable, and there are many problems in actual operation. Recovery method selection is not appropriate, the two sides of the handover is not clear, resulting in missing instruments; part of the use of the department of the initial rinsing of instruments is not in place, there is obvious blood and dirt; each time the recovery of a large amount of instruments, did not use protective measures, instruments in the recovery of the transportation of the damage occurred, the loss of function (especially sharp, tubular lumen instruments, fine instruments are more common).
1.3 Infectious pathogens contaminated instruments, appliances, items of the initial treatment is not appropriate, occupational protection is not in place.
1.4 Inadequate equipment and manpower, large amount of cleaning instruments, quality is not guaranteed.
1.5 The packaging of instruments is not standardized. Instrument packaging before the inspection and maintenance; part of the surgical instrument packages, dressing packages are not separated for packaging; part of the surgical instrument packages packaging content varieties and quantities do not meet the needs of the doctor's surgery; specialty surgical instrument packages in the specialty instruments are not specialized, can not meet the needs of surgery; surgical instrument packages spare less, cleaning and sterilization is not timely, affecting the use of surgery.
1.6 Problems in sterile storage. Storage conditions do not meet the requirements, the storage volume does not match the actual number. After sterilization, wet packages are not reprocessed; aseptic storage monitoring and management is not in place, there are expired packages and broken packages.
1.7 Problems in the sterilization effect monitoring. Sterilization of surgical instrument packages, incomplete or lost labels, wet packages after sterilization; sterilization effect monitoring is not standardized or substandard.
1.8 Problems in the delivery process. Transportation tools are not clean, the loading and unloading of contaminated materials, transportation registration errors, the two sides signed unclear, untimely; loading and unloading can not be gently held and placed, resulting in different degrees of damage to the contents of the bag of surgical instruments.
2 Analysis of the causes
2.1 organization and management is not in place, leadership at all levels of attention, in-depth guidance is not enough.
2.2 Not systematic job training, employees can not master the specialized knowledge, operating norms and skills.
2.3 Communication is not in place, the preliminary preparation is not sufficient.
2.4 Shortage of personnel and equipment, high workload, high intensity, staff structure does not meet the requirements.
2.5 Existing personnel newcomers, low level of education, poor basic quality, specialty knowledge and lack of practical experience.
3 Countermeasures
3.1 Strengthen communication with the higher leadership, scientific and reasonable staffing and related equipment.
3.2 In-depth research to do a good job in the acceptance of surgical equipment and training, to develop a practical acceptance of the program. Sterilization supply center personnel in-depth operating room, on-site observation of the use of surgical instruments; or ask the operating room head nurse to talk about the demand for surgical instruments, the application of the situation and the supply of surgical instruments and other key points; with the higher leadership to communicate, the transfer of 1-2 operating room personnel to work in the sterilized supply center, specifically responsible for the supply of surgical instruments; the operating room and the sterilized supply center elected a The operating room and sterilization supply center each elected a strong sense of responsibility ` staff in charge of the work of surgical instruments, at any time to coordinate the day-to-day work of the problems that arise; pre-service training for the relevant personnel, to enhance the level of theory and skills, as soon as possible to carry out their work.
3.3 Establish and improve the relevant management system, and develop a reasonable and standardized surgical instrument handling procedures.
The establishment of the surgical instruments handover system, surgical equipment loss reporting system, equipment damage replacement system, etc., in the actual operation of the work to avoid both sides of the responsibility of each other, the problem was resolved in a timely manner. The handover of surgical instruments should be equipped with a list of surgical instruments signed by the operators of the two departments to facilitate the acceptance and inventory; from the recovery of instruments to each link in the aseptic supply, to develop a set of practical operational programs and processes, to facilitate the completion of the supply of surgical instruments of quality and quantity.
3.4 According to the status of the hospital's surgical instrument configuration, create a surgical instrument configuration list (atlas) with images and text.
The surgical instruments will be summarized, classified, sorted, according to the precision, valuable, specialized, microscopic and special surgical instruments and other characteristics, photographed in color and formulated into a booklet, the organization of operators cognitive, familiar with, master, easy to independently and correctly complete the work of supplying surgical instruments.
3.5 Strictly follow the industry standards, standardize the packaging of instruments and dressings.
Instruments before packaging carefully do a good job of inspection and maintenance of instruments, cleanliness check and function test, to ensure that instruments that can no longer be used are picked out, but also can be picked out in time to wash unclean instruments for backwashing, to protect the safety of the operation; strict adherence to industry standards, surgical instruments should be placed in the basket or a perforated tray for matching packaging, instrument packages, dressing packages are separated from each other for packaging [1].
3.6 Standardize the monitoring work of the sterile packages to ensure the quality of sterilized items.
3.7 Strengthen the construction of information technology, and do a good job of transporting and supplying surgical instruments.
The use of microcomputer to make appointments, according to the surgical needs of the package supply or a one-time combination of supply; sterilized instruments using sterilized trolley or net frame direct transfer, through a special channel to transport sterile instruments, the transport tool is cleaned and dried at regular intervals, and immediately cleaned and disinfected when contamination is suspected [2]; instrument packages loaded and unloaded gently, not extruded, and pushed and delivered smoothly; the record is perfect, signed by both sides, the It is accessible and traceable.