In recent years, the centralized management of surgical instruments has attracted more and more attention from many infection experts. Centralized management can effectively control iatrogenic cross infection, ensure the safety of operation and save manpower and material resources. Since June 5438+ 10, 2009, our hospital has centralized management of surgical instruments by disinfection supply center, and gained some experience. Introduction is as follows:
1 There is a problem.
1. 1 Inadequate preparation and communication. When accepting surgical instruments, I didn't communicate with the competent leader in detail, so the plan was simple and anxious. Problems arise, the two sides argue and shirk their responsibilities, and the problems cannot be solved in time.
The workflow of 1.2 is unreasonable, and there are many problems in actual operation. Improper selection of recycling methods, unclear handover between the two parties, resulting in lack of equipment; Some department instruments were not washed in place for the first time, with obvious blood and dirt; Every time a large number of instruments are recovered, no protective measures are taken. Instruments are damaged and lose their functions during recovery and transportation (especially sharp, lumen instruments and fine instruments are more common).
1.3 The instruments, appliances and articles contaminated by infectious pathogens are not handled properly, and the occupational protection is not in place.
1.4 The equipment and manpower are insufficient, and the number of cleaning instruments is large, so the quality cannot be guaranteed.
1.5 The packaging of the instrument is not standardized. Did not carefully check and maintain the equipment before packaging; Some surgical instrument sets and dressing sets are not packaged separately; The types and quantities of some surgical instruments do not meet the requirements of doctors; The professional instruments in the professional surgical instrument set are not professional and cannot meet the surgical requirements; The lack of surgical instrument sets and the untimely cleaning and disinfection affect the operation use.
1.6 aseptic storage. The storage conditions do not meet the requirements, and the storage quantity does not match the actual quantity. After sterilization, the wet bag is not reprocessed; The monitoring and management of aseptic storage is not in place, and there are expired packages and damaged packages.
1.7 Problems in monitoring sterilization effect. After sterilization, the label of surgical instrument set is incomplete or lost, and wet package appears after sterilization; Sterilization effect monitoring is not standardized or not up to standard.
1.8 problems in transportation. Unclean means of transport, pollution of loading and unloading materials, wrong transport registration, unclear signatures of both parties; Handling should not be handled with care, resulting in different degrees of damage to the contents of the surgical instrument set.
2 Cause analysis
2. 1 Organization and management are not in place, and leaders at all levels pay insufficient attention and guidance is not deep enough.
2.2 Without systematic on-the-job training, employees cannot master professional knowledge, operating norms and skills.
2.3 communication is not in place, and preparation is not sufficient.
2.4 Insufficient personnel and equipment, heavy workload, high intensity and unqualified personnel structure.
2.5 There are many new recruits, low academic level, poor basic quality and lack of professional knowledge and practical experience.
3 countermeasures
3. 1 Strengthen communication with superior leaders and scientifically and reasonably allocate personnel and related equipment.
3.2 In-depth research, preparation and training for acceptance of surgical instruments, and formulation of practical acceptance scheme. Disinfection supply center personnel went deep into the operating room to observe the use of surgical instruments on the spot; Or ask the head nurse in the operating room to talk about the demand, application and supply point of surgical instruments; Communicate with superior leaders and transfer 1-2 operating room personnel to the disinfection supply center to be responsible for the supply of surgical instruments; The operating room and the disinfection supply center each choose a responsible staff member to take charge of surgical instruments and coordinate the problems in daily work at any time; Conduct pre-job training for relevant personnel, improve the level of theory and skills, and take up their posts as soon as possible.
3.3 Establish and improve relevant management systems and formulate reasonable and standardized operating procedures for surgical instruments.
Establish surgical instrument handover system, surgical instrument loss reporting system, instrument damage supplement system, etc. , to avoid passing the buck in actual work operation, and to solve problems in time. The handover of surgical instruments should be equipped with a list of surgical instruments signed by the operators of two departments, which is convenient for acceptance and counting; From the recovery of instruments to aseptic supply, a set of feasible operation schemes and processes have been formulated to facilitate the supply of surgical instruments with good quality and quantity.
3.4 According to the configuration of surgical instruments in the hospital, make a surgical instrument configuration sheet (atlas) with pictures and words.
According to the precise, expensive, specialized, microscopic and special characteristics of surgical instruments, the surgical instruments are summarized, classified and sorted, and color pictures are taken and made into books to organize operators to know, be familiar with and master them, so as to facilitate the independent and correct supply of surgical instruments.
3.5 Strictly follow industry standards and standardize the packaging of instruments and dressings.
Before the instrument is packaged, the inspection and maintenance, cleanliness inspection and function test of the instrument should be done carefully to ensure that the instrument that can no longer be used is picked out, and at the same time, the unclean instrument should be picked out in time for backwashing to ensure safe operation; Strictly follow the industry standards, surgical instruments should be packaged in baskets or perforated plates, and instrument sets and dressing sets should be packaged separately [1].
3.6 Standardize the monitoring of aseptic packaging to ensure the quality of sterilized items.
3.7 Strengthen information construction and do a good job in the distribution and supply of surgical instruments.
Reserve microcomputer, provide package supply or one-time combined supply according to operation requirements; Sterile instruments are directly transported by sterile vehicles or net racks, and sterile instruments are transported by special channels. Vehicles are cleaned and dried regularly, and cleaned and disinfected immediately when they are suspected of being polluted [2]; When packaging and unloading equipment, handle it with care, do not squeeze it, and push it smoothly; The record is complete, signed by both parties, and can be consulted and traced.