包装器具对手术器械包灭菌质量的影响

目的 探讨合适的手术器械包装器具,提高手术器械灭菌质量.方法 将选定的手术器械包1 000个随机分成两组,对照组(500个)和实验组(500个).对照组用传统的有孔打包盘作为包装器具包装灭菌,实验组用打包篮筐作为包装器具包装灭菌,观察两组手术器械包灭菌质量.结果 生物监测和包外化学指示标签全部合格,对照组手术器械包湿包率为8%、包内化学指示卡变色合格率96%,实验组手术器械包湿包率为0.04%、化学指示卡变色合格率100%,两者比较具有显著性差异(P＜0.01).结论 打包篮筐包装手术器械包的灭菌质量比打包盘包装手术器械包的灭菌质量好.

Abstract：

Objective To Explore suitable packaging equipment of operation instrument to improve sterilization quality of operation instrument Methods A total of 1 000 packages operation instruments were randomly divided into two groups,traditional packaging tray with holes was used to package and sterilize in control group,packaged basket was used to package and sterilize in experimental group.The sterilization qualities of the two groups'operation instruments were observed.Results Biology monitoring and chemical indicators labeling were all qualified,the packet rate of operation instrument was 8%, the passing rate of discoloration of the chemical indicator card was 96% in control group,the wet packet rate of operation instrument was 0.04%, the passing rate of discoloration of the chemical indicator card was 100% in experimental group,there was significant difference between the two groups (P<0.01).Conclusions Sterilization quality of packaged baskets as packaging equipment is better than that of packaging tray as packaging equipment.     

包装器具对手术器械包灭菌质量的影响

目的 探讨合适的手术器械包装器具,提高手术器械灭菌质量.方法 将选定的手术器械包1 000个随机分成两组,对照组(500个)和实验组(500个).对照组用传统的有孔打包盘作为包装器具包装灭菌,实验组用打包篮筐作为包装器具包装灭菌,观察两组手术器械包灭菌质量.结果 生物监测和包外化学指示标签全部合格,对照组手术器械包湿包率为8%、包内化学指示卡变色合格率96%,实验组手术器械包湿包率为0.04%、化学指示卡变色合格率100%,两者比较具有显著性差异(P＜0.01).结论 打包篮筐包装手术器械包的灭菌质量比打包盘包装手术器械包的灭菌质量好.     

手术器械包的优化包装流程

目的合理利用人力资源,优化包装流程,提高手术器械包集中供应后的工作效率和包装准确度。方法根据每个岗位的工作特点,赋予相应的岗位职责,对手术器械包的包装流程进行内容细分,科学分组,流水作业,责任到人。结果优化手术器械包包装流程后,装配差错率较流程优化前显著降低(χ2=39.9704,P0.001)。结论手术器械包集中供应后,通过对包装流程的细分化、科学分组和人员职责分工,使消毒供应中心在有限的人力资源条件下,提高了工作效率与质量,值得推广。     

自制不锈钢支器架包装手术器械的应用

压力蒸汽灭菌的器物每一部位必须接触饱和蒸汽,否则灭菌失败。以前包装器械要求扣一个齿,导致器械齿纹轴节充分打开;现在包装器械要求不扣齿,一般诊疗穿刺包内器械少齿纹轴节能充分打开,但手术器械包如轴节打开不穿在一起造成零乱,包装、手术时取拿分辨费时。但穿在一起,齿纹轴还是不能充分打开,包装、手术时易使器械手把孔互相套叠,分开麻烦,针对出现的问题,我们自行设计制作一批不锈钢支器架,用于包装时穿手术器械,经实际应用,效果良好。现介绍如下。支器架制作采用一根直径3 mm,长50 cm不锈钢条,沿钢条两端向中心20 cm处折成高10 cm,双边…     

环节质量控制对外来手术器械湿包的控制效果

摘要 目的了解加强环节控制后外来手术器械的湿包情况。方法 将进行压力蒸汽灭菌的外来手术器械包分对照组和试验组,每组900个。试验组加强环节质量控制,比较两组的湿包发生情况。结果 对照组发生湿包15个,湿包率1.67％;试验组发生湿包5个,湿包率0.56％,两组差异有统计学意义(P<0.01)。结论 加强环节控制能有效减少压力蒸汽灭菌后外来手术器械湿包发生。     

过氧化氢等离子低温灭菌对手术器械灭菌的效果

目的 探讨过氧化氢等离子低温灭菌器在手术器械消毒灭菌中的应用效果.方法 将手术室不耐高温器械分别采用过氧化氢等离子低温灭菌器灭菌和戊二醛熏蒸灭菌,比较两种灭菌方法的效果、器械损耗率、手术感染率和医护满意度.结果 两种灭菌方法的生物监测合格率方面均为100％.与熏蒸法比较,低温灭菌法的灭菌时间短（P＜0.05）,灭菌后有效时间较长（P＜0.05）,毒性反应的发生率较小（P＜0.05）,手术感染率低（P＜0.05）,器械损耗率较低（P＜0.05）.结论 过氧化氢等离子低温灭菌器灭菌均有快速、安全、质量好等特点,对器械损伤小,可作为不耐高温手术器械消毒的首选方法.     

棉布包装灭菌包有效保存时间分析

目的:探讨棉布包装灭菌包的有效保存时间。方法:将脉动预真空压力蒸汽灭菌的灭菌包作为研究对象,在不同时间内进行物品表面采样,送细菌室培养做活菌计数。结果:2层、4层包装的灭菌包在18 d内无细菌生长;保存21 d、28 d的灭菌包不同季节采样样本阳性率比较差异无统计学意义(P>0.05)。结论:在医院治疗室的环境条件下,不同季节内的不同棉布层数包装的灭菌包在18 d内均无细菌生长。     

手术器械包装质量现状调查及分析

目的:通过对手术器械包装质量现状的调查,找出存在的问题,提高手术器械包装质量。方法:按卫生部WS310.2-2009《医院消毒供应中心第2部分:清洗消毒及灭菌技术操作规范》对包装的要求,自制调查表对珠江三角洲两市10家医院(含一级、二级和三级)手术器械包装质量进行现场调查,对所得数据进行分析统计。结果:密封式包装一、二、三级医院合格率分别为80%、93%、100%;闭合式包装一、二、三级医院合格率分别为76%、89%、94%;一、二、三级医院包装操作者对包装质量标准掌握合格率分别为50%、60%和80%。结论:建立包装过程质量标准,完善、细化包装操作规程,加强工作人员培训十分必要。     

二维条形码在手术器械灭菌过程中的质量追溯

目的 目的 探讨二维条形码对手术器械的质量追踪.方法 消毒供应中心各区于手术器械包上使用二维条形码,包外标注品名、包装者、消毒者、灭菌日期、失效期、锅号、锅次等信息.结果 有效地实现了手术器械包的质量追踪.结论 二维条形码使用快捷、信息化程度高,能提高工作效率及灭菌质量,确保手术病人安全,是现代化医院建设的必然趋势.     

压力蒸汽灭菌隐性湿包的影响因素及控制措施

目的研究压力蒸汽灭菌隐性湿包的影响因素及控制措施,确保无菌物品的质量。方法采用目测和触摸方法,对不同组合包装器械包和改变冷却时间等措施影响湿包的结果进行观察。结果压力蒸汽灭菌医疗器械采用棉布包装干燥速度较慢,将棉布包装器械包置于器械盘内会降低干燥速度,医用皱纹纸包装方法干燥速度最快。灭菌后延长干燥时间,包内干燥速度没有变化。结论压力蒸汽灭菌器内棉布包装的器械包不易干燥,皱纹纸包装干燥速度最快,延长灭菌器干燥时间不是最好的方法,因此器械包干燥速度与包装材料直接相关。     

二维条形码信息管理在手术灭菌器械质量追溯管理中的应用

目的探讨应用二维条形码信息管理对手术灭菌器械进行质量追溯的效果。方法将16857件手术灭菌器械分为实验组8356件和对照组8501件,模拟实验组有276件和对照组有288件灭菌器械不合格,实验组使用二维条形码信息管理,对照组采用传统方法对手术灭菌不合格器械质量进行追溯。比较两组器械质量追溯花费时间的差异。结果实验组质量追溯时间短于对照组,两组比较,t=-244.09,t=P<0.001,差异具有统计学意义。结论使用二维条形码信息管理对手术灭菌器械进行质量追溯,不仅能提高工作效率,同时保证手术病人的安全。     

不同消毒方法对手术器械清洗质量的影响

目的:探讨机械热力消毒法与含氯消毒剂浸泡消毒法在手术器械清洗中的应用效果。方法:将100件非特殊感染手术器械分为A组和B组各50件,A组采用机械热力消毒,B组采用含氯消毒剂浸泡消毒。比较两组清洗质量。结果:两组手术器械合格率目测法比较差异无统计学意义(P>0.05),细菌培养法比较A组合格率明显高于B组(P<0.05)。结论:采用机械热力消毒法处理手术器械可提高清洗质量,值得推广。     

生化分析仪的灭菌操作规范及灭菌过程中问题的处理

目的探讨使用生化分析仪等仪器设备前的灭菌操作规范及灭菌过程中问题的处理方法。方法选取2015年8~9月该院800次生化分析仪等仪器设备使用过程中的相关资料进行分析,分析生化分析仪等仪器设备使用前的灭菌规范及灭菌过程中问题的处理方法及处理效果。结果规范后仪器设备服务达标率为90.00%,灭菌达标率为92.50%,仪器设备管理达标率为90.00%,显著高于规范前的62.50%、67.50%、72.50%,差异均有统计学意义(P0.05);规范化消毒供应中心对仪器设备灭菌满意率为95.00%,显著高于规范前85.00%,差异有统计学意义(P0.05)。结论生化分析仪等仪器设备使用前灭菌过程中存在的问题较多,应该严格按照灭菌操作规范进行处理,提高仪器设备的灭菌效果。     

品管圈活动在降低手术器械管理不良事件中的作用

目的探讨品管圈(quality control circle,QCC)活动在降低手术器械管理不良事件中的作用效果。方法成立QCC小组,进行QCC知识培训,选定活动主题,进行现状调查,分析手术器械管理不良事件发生的原因,制订对策并实施持续质量改进。结果手术器械管理不良事件由QCC活动前的69件降至活动后的24件,活动前后比较,χ2=33.694,P0.01,差异有统计学意义。结论开展QCC活动对消毒供应中心手术器械质量进行持续改进,可有效降低器械管理不良事件的发生,从而提高手术安全性。     

起搏器患者生存质量量表的编制及信效度分析

目的编制与考评起搏器患者生存质量量表的信度和效度。方法采用选题小组和专题小组的程序化决策方式编制起搏器患者生存质量测定量表并通过随机抽取200例起搏器患者的生存质量测定资料对量表进行信度和效度的考评。结果躯体、心理、社会、一般认识4大领域和量表总分的重测相关系数分别为0.875,0.856,0.816,0.910和0.815,分半信度为0.873,4大领域的克朗巴赫系数(Cronbachαcoefficients)分别为0.866,0.893,0.879和0.823。量表的结构与设计时的概念相吻合,以SF-36量表为效标进行评估,其效标为0.812。结论起博器患者生存质量的量表具有较好的信度和效度,可作为我国起搏器患者生存质量的测评工具。     

Development of a patient-orientated instrument to measure service quality in outpatient departments

AIMS OF THE STUDY: To describe three stages in the development of an instrument to measure service quality from the patients' perspective in hospital outpatient departments. RATIONALE: A reliable and valid service quality instrument is a valuable tool for collecting feedback from patients when improving outpatient services. DESIGN: A multiphase process with several versions of the questionnaire testing its validity and reliability. The first version of the questionnaire was constructed from information collected in a previous interview study of patients' service experiences. Using this version (47 questions) information was collected in 15 outpatient departments (314 patients) and the second version of the questionnaire was developed. At this stage, a survey of employees (n=111) was included in the development process. This second version of the questionnaire (43 questions) was used to collect more data in three outpatient departments of a university hospital and in two outpatient departments of two regional hospitals on three different occasions (1416, 369 and 124 patients) within a period of 2 years. The reliability of the instrument was tested in terms of stability by using three repeated measurements, and using the Cronbach's alpha coefficient as an indicator of internal consistency. Content validity was assessed by means of percentage agreement between staff and patients. Logistic regression analysis was performed to assess construct validity. RESULTS: The final version of the questionnaire contained 12 items. Agreement between patient and staff ratings was found to be acceptable for most questions (content validity). Two measurements on different occasions yielded a similar structure (construct validity). Internal consistency was acceptable (Cronbach's alpha = 0.67-0.93 in the first and 0.71-0.94 in the second survey). The variance of the alpha coefficients was small in the retest (stability). CONCLUSIONS: The instrument developed is general to the extent that it is suitable for assessing service quality improvement needs in individual units and for making cross-departmental comparisons.     

低温等离子灭菌法在手术室精密器械中的应用

目的探讨低温等离子灭菌法在手术室精密器械中的应用。方法应用LK/MJG—100过氧化氢低温等离子灭菌方法及传统环氧乙烷灭菌法对不耐热、不耐湿的腹腔镜、胸腔镜、关节镜、耳鼻喉科电刨、电钻等精密器械进行低温灭菌。比较两种灭菌方法的灭菌效果、灭菌周期、残留毒物等方面情况。结果两种灭菌方法均能达到灭菌效果,但过氧化氢低温等离子灭菌法灭菌周期短,无废气排放。结论过氧化氢低温等离子灭菌法安全可靠,较传统环氧乙烷灭菌法具有灭菌周期短、无化学药物残留、环保等方面的优势,是目前手术室转台手术精密手术器械灭菌的首选方法之一。     

Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management

AIM OF THE STUDY: To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management. BACKGROUND: Strategic and clinical quality indicators in postoperative pain management were previously developed from a tentative model of important aspects of surgical nursing care and assessed to have content validity, that is to be essential for the quality of care, realistic to carry out and possible for nurses to use to influence management. METHODS: The quality indicators were converted to items suitable for a patient questionnaire and were scored on a 5-point scale, with higher scores indicating higher quality of care. Inpatients from five surgical wards took part in this study on their second postoperative day. The response rate was 96% and the average ages of the female (n=120) and the male (n=78) respondents were 62 and 63 years, respectively. RESULTS: Items in the total scale had an average inter-item correlation >0.20 and an item-total correlation >0.30. Cronbach's coefficient alpha was 0.84 for the total scale. Four factors entitled 'communication', 'action', 'trust' and 'environment' emerged from an orthogonal factor analysis, with a cumulative variance of 61.4%. Patients who received epidural analgesia had higher scores on the total scale compared with those who did not receive epidural analgesia. Patients who reported more pain than expected had lower scores on the total scale compared with those who did not report more pain than expected. Correlation between the total scale and an overall pain relief satisfaction question was 0.53. CONCLUSION: The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.