手术室与供应室一体化管理初探

目的 探索洁净手术室与供应室一体化管理模式。方法 将手术室和供应室进行一体化设计、建设，手术室用过的器械通过外走廊、污梯直接送往供应室消毒灭菌后。再通过专用清洁电梯送至手术室备用。结果 正式运行近1年。节省了手术室护士大量时间(人均1．0h／d)；手术由过去的每日平均71．0台增至82．0台；手术器械包数目、夹带等错误发生数由过去的平均每月9项减少到0。并杜绝了器械丢失现象。结论 手术室与供应室实行各自独立而又密切相关的一体化管理模式。可提高工作效率，使手术室更加洁净。     

眼科手术室显微器械的优化管理

目的 探讨眼科手术室显微器械的有效管理方法.方法 对精密度高、结构复杂、价格昂贵、清洗难度大的眼科显微器械由手术室护士负责清洗和包装、供应室负责灭菌、手术室专人管理的传统管理模式,转向为手术室与供应室一体化、人人参与管理的全程质量控制管理模式,并对两种模式的管理质量进行比较.结果 优化管理后,显微器械的清洁度、器械完好率显著优于优化管理前(均P<0.01).结论 对眼科手术室显微器械管理运用手术室与供应室一体化、人人参与的全程质量控制管理模式,既保证了显微器械灭菌质量,又大幅度提高了显微器械的完好率,延长了显微器械的使用寿命,同时也提高了手术室护理质量,和谐了医护关系与护患关系.     

整形外科手术室与供应室清洗器械一体化管理体会

长期以来,我院整形外科手术后的器械清洗、保养、打包均由手术室护士完成,一方面增加了手术室护士的劳动强度,另一方面由于手术室护士未参加过供应室专业培训,器械清洗的质量难以达到供应室专业化水平。随着医学模式的     

医疗器械集中式管理的体会

自河南省卫生厅《供应室验收标准》下发后，我院医疗器械的管理由原来的分散式管理模式逐步走向集巾式管理模式，先后规范了病区、门诊内、外、妇、产、儿、五官科等15个科室的医疗器械管理工作，最后制止手术室器械的回收：就其在器械回收的过程及工作运行中所感体会，总结如下：     

温馨提示在手术室与供应室一体化管理中的应用

随着外科手术的迅猛发展,在无菌方面对手术环境提出了更高要求,创建更加洁净的手术室是外科手术发展的必然需要。为了适应其发展．我院自2004年起实行了手术室与供应室一体化管理新模式。运行过程中发现在手术毕手术室与供应室交接手术器械过程中常出现一些问题,如交接手术器械包的数目与实际数目不一致、夹带等。鉴此,我科推出温馨提示牌,使交接工作更加有效、完善,显著减少了交接错误的发生,提高了双方的合作满意度,介绍如下。     

温馨提示在手术室与供应室一体化管理中的应用

随着外科手术的迅猛发展,在无菌方面对手术环境提出了更高要求,创建更加洁净的手术室是外科手术发展的必然需要.为了适应其发展,我院自2004年起实行了手术室与供应室一体化管理新模式,运行过程中发现在手术毕手术室与供应室交接手术器械过程中常出现一些问题,如交接手术器械包的数目与实际数目不一致、夹带等.鉴此,我科推出温馨提示牌,使交接工作更加有效、完善,显著减少了交接错误的发生,提高了双方的合作满意度,介绍如下.     

综合管理模式在手术室外来器械管理中的应用效果

目的探讨综合管理模式在手术室外来器械管理中的应用效果。方法比较实施综合管理模式前后的器械遗失损耗和更换频次、无菌检验一次合格率、锐器损伤发生率、物品包装合格率及器械有效验收率。结果管理后手术室外来器械的更换频次、遗失损耗率及锐器损伤发生率明显少于管理前,无菌一次检验合格率、微生物限度一次检验合格率、物品包装合格率及器械有效验收率均明显高于管理前,差异均有统计学意义(P0.05)。结论消毒供应室综合管理模式可以有效提高清洗和灭菌效果,同时提高器械使用频率。     

洁净手术部建设中应注意的问题

保证洁净手术室内部建设的规范性和可行性,着重探讨洁净手术部在建设过程中应注意的问题,手术室护士长应发挥的作用.前者包括平面布局应符合快捷方便的工作流程,手术部的位置应满足与供应室一体化要求,手术部应与血库、病理科相邻,每个手术部应设置具有"正、负压"切换功能的手术室,手术部内部的供电、供水应设两路供应线路,医用气体终端设置应在吊塔和墙面各安装一组插口,对讲呼叫系统设置,手术室内的监控摄像机安装位置,洁净手术部建成后应确保各技术参数符合国家标准;后者包括把好无菌管理关、把好流程合理关、把好工程质量关.     

洁净手术部建设中应注意的问题

保证洁净手术室内部建设的规范性和可行性,着重探讨洁净手术部在建设过程中应注意的问题,手术室护士长应发挥的作用。前者包括平面布局应符合快捷方便的工作流程,手术部的位置应满足与供应室一体化要求,手术部应与血库、病理科相邻,每个手术部应设置具有“正、负压”切换功能的手术室,手术部内部的供电、供水应设两路供应线路,医用气体终端设置应在吊塔和墙面各安装一组插口,对讲呼叫系统设置,手术室内的监控摄像机安装位置。洁净手术部建成后应确保各技术参数符合国家标准;后者包括把好无茵管理关、把好流程合理关、把好工程质量关。     

膝关节置换术手术室器械护士培训方法探讨

目的探讨针对膝关节置换手术,使手术室器械护士熟练掌握外来器械操作的培训方法。方法采取厂家提供器械模拟训练、集中培训理论知识、相对固定器械护士的方法,使器械护士逐步取代跟台人员,单独完成手术配合。结果器械护士单独配合率由32.04%上升到88.39%,跟台率由67.96%下降到11.61%,器械安装熟练程度由8.82%上升37.50%,平均手术时间缩短(10±2.2)min,医生满意度由62.14%提高至92.86%。结论手术室器械护士能熟练进行厂家器械操作,掌握配合关健环节,手术配合质量明显提高。     

Building towards equitable access to safe surgery for every child

Kids Operating Room (KidsOR) is a global health charity focused entirely on helping transform surgical care for children around the world. KidsOR corroborates and puts into practice the argument of the Lancet Commission on Global Surgery that surgical care is a valuable investment and should be incorporated as an essential component of a functioning health care system. Moreover, by investing in local capacities, we distance ourselves from the status quo of international health aid, more specifically short-term medical missions and specific disease interventions. Our focus is to integrate the capabilities inherent to the country in the development of human resources that fosters greater local empowerment. As a result, despite the challenges of the time, we have shipped a pristine Operating Room to a partner hospital on average once every 12 days. Our strategy also includes a funding programme that supports the development and training of local surgeons and anaesthetists. By 2030 we have committed to open 120 new Operating Rooms in Africa, and we expect to achieve 1.2 million years averted of Disability Adjusted Life Years (DALYs) for every year of full activity in our Operating Rooms as well as to strengthen the economies across sub-Saharan Africa economies by a combined total of 2.5 billion US dollars a year. We also look to the future and advocate for a new aid model for the 21st century in consonance with the principles encouraged by the 1978 Alma Ata Declaration and aiming to make health for all more than a slogan.Level of evidence: IV     

General principles for the clinical organization and management of a surgical unit

Because health-care costs and demand for services are both rising, appropriate management of resources is yet another essential consideration in efficient clinical practice. Surgical units, with their special features, are a particular focus of attention. Although it is possible to study the circumstances of each hospital individually, in fact surgical units often share the same management concerns. Currently, surgical units are often reorganized and provided with an Operating Room Committee, a Medical director or coordinator and operational protocols, such that the unit is considered a system rather than a sum of its individual parts. Work is goal-oriented, with starting and ending points, flexibility in use of surgical theaters, reserve capacity for unscheduled surgery, low cancellation rates and good output; the use of time indicators is considered essential. Other factors to bear in mind when managing a surgical unit are the universalization of information, which should be accurate and up to date, the involvement of teams such as that of anesthesia and recovery, scheduling that is realistic and tight, the appropriate design and use of circuits, and the use of techniques for continuous improvement and problem solving. Some programs, such as that of major outpatient surgery, orthopedic surgery and others may have special needs.     

From the operating room of the present to the operating room of the future. Human-factors lessons learned from the minimally invasive surgery revolution

The minimally invasive surgical revolution has changed the way surgery is practiced. It has also helped surgical innovators to break the tethers that anchored the practice of surgery in an early 20th century operating room environment. To some in surgery, the Operating Room of the Future will be seen as a revolution but to others, an inevitable evolution of the changes ushered in by the adoption of minimally invasive surgery. Although minimally invasive surgery has conferred considerable advantages on the patient, it has imposed significant difficulties on the surgeon, which in turn, have impacted outcomes. These difficulties were primarily human factor in nature and were poorly understood by critical groups such as device manufacturers, surgeons, and surgery educators and trainers. This article details what these human factors were, how they related to the practice of minimally invasive surgery, and how they will impact on the practice of surgery in the Operating Room of the Future. Much of the technology for the Operating Room of the Future currently exists (eg, surgical robotics, virtual reality, and telemedicine). However, for it to function optimally it must be integrated in a fashion that takes on board the human factor strengths and limitations of the surgeon. These advanced technologies should then be harnessed to optimize surgical practice. In some cases, this will involve rethinking existing technologies (ie, three-dimensional camera systems), applying technologies that currently exist in a manner that is more systematic and better managed (ie, surgical robots and virtual reality), and a reconsideration of who should be applying these technologies for the practice of surgery in the 21st century. In all cases, there will be education and training implications for the practitioner. Lastly, there must be unequivocal demonstration that these changes bring about positive benefits for patients in terms of better outcomes and for surgeons in terms of ability and ease of doing their job. After the experiences of the last decade with minimally invasive surgery, the Operating Room of the Future should be seen as a well-grounded evolution, not a revolution.     

The operating room of the future: a view from Europe

The Operating Room of the Future will be characterized by meticulous preoperative planning, full integration of the operating room into the general flow of information, more comprehensive intraoperative diagnostic imaging procedures, and the use of sophisticated visualization processes including augmented reality. Mechatronic support (partially autonomous robots) enhances safety and allows reduction of staff. Integrated operating room systems will allow the wide spectrum of new devices and functionalities to be easily controlled by the operating team. The Operating Room of the Future will no longer be isolated from the rest of the clinical endeavor. Intraoperative teleconsultation and telepresence will help to promote and teach safer evidence-based endoscopic therapeutic surgery. Traditional surgical intervention will expand its definitions by procedures via an interdisciplinary, cooperative approach that will replace the sequential therapeutic process of today.     

Flammable surgical drapes--a patient and personnel hazard

After a surgical drape fire, the New York State Society of Anesthesiologists, Operating Room Safety Committee, investigated the factors contributing to it. Subsequently, eight detailed cases were collected. It found that no voluntary standards or government regulations exist to oversee the flammability of surgical drapes; no agency or bureau collects reports of operating room fires; most professionals are not aware of the hazard because no labelling requirements regarding flammability exist and because most episodes are minor in nature or settled out of court and thus not reported. This relatively new hazard has developed with the more frequent use of high-energy devices designed to provide better therapeutic results.     

Three years of institutionalized paediatric day case surgery: organization — indications — frequency — complications

In the last seven years, the number of surgical procedures which are performed as day case surgery for infants and children has increased dramatically. Day case surgery should be able to be conducted effectively, with few complications, while saving time and money but also providing a pleasant atmosphere for the children and their parents. Since 1990, we have been practising day case surgery in the Department of Paediatric Surgery at the University of Tübingen twice a week. We have a special unit for this purpose with a team of day care personnel, paediatric nurses, anaesthesiologists and paediatric surgeons. The total number of operations performed in our department from 1990 to 1992 was 5330. Of these, 2111 (39.6%) were conducted as day case surgery for children of the ages six weeks to 20 years. The series includes 44 umbilical hernias, 385 phimoses, nine cervical cysts, 399 inguinal testes, 857 inguinal hernias, 90 hydroceles/funiculoceles, 19 haemangiomas, 43 meatotomies, 95 endoscopies and 170 other operations. Postoperative complications were defined as secondary haemorrhage, fever, obvious vomiting and urine retention. In a total of 35 (1.66%) children, the complications necessitated a stay in the hospital of up to eight (average 2.17) days, despite day case planning of the surgical procedure. Our experience shows that a large number of paediatric surgical procedures can be performed as day case surgery. Nevertheless, even with an expanded spectrum of possible operations there must always be ward capacities available in order to monitor and treat complications adequately.     

新型冠状病毒疫情期间骨科患者手术器械消毒灭菌与管理的流程与策略

2019年12月以来,新型冠状病毒肺炎(COVID-19)已在世界多地暴发。虽然疫情在我国得到控制,随着复工复产的逐步深入,部分COVID-19患者治愈后"复阳",特别是近1个月以来,境外输入病例逐渐增多,因此疫情防控形势仍然严峻,医疗机构在未来一段时间内仍面临巨大压力。基于2016版《医院消毒供应中心清洗消毒及灭菌技术操作规范》、2012版《医疗机构消毒技术规范》、《新型冠状病毒肺炎防控方案(第五版)》及《新型冠状病毒肺炎诊疗方案(试行第六版)》等相关标准,河北医科大学第三医院消毒供应中心制定本科室"新型冠状病毒(2019-nCoV)感染复用器械处理流程、2019-nCoV感染器械回收流程、2019-nCoV感染器械转运车处理流程"等应急预案。为疫情防控期间消毒供应中心(CSSD)各项防控管理措施提供参考。     

Small changes in operative time can yield discrete increases in operating room throughput

BACKGROUND AND PURPOSE: Operating room throughput is influenced by the efficiency of the perioperative process (for nonoperative time) and by the surgeon (for operative time). Operative time is thought not to be easily amenable to deliberate reductions. We tested the hypothesis that gradual improvements in operative time had allowed one surgeon to perform additional cases during scheduled hours. MATERIALS AND METHODS: The surgeon had been working in both a high-throughput and a conventional operating room for more than 1 year prior to the study. During the studied interval, we applied statistical process control analysis to time data for the surgeon performing full days of complex laparoscopic operations. Separate analyses were conducted for the conventional and high-throughput operating rooms. The average operative time for each day and the number of cases per day were plotted against sequential days for each environment. RESULTS: Midway through the studied interval, there was a discrete 17-minute drop in operative time in both the high-throughput and the conventional environment. Throughput increased from two cases per day to three per day in the high-throughput environment. The average end time for the three-case days was 17:15 (range 16:04-18:32). Longer average operative and nonoperative times in the conventional rooms precluded performing three complex cases during regular work hours. CONCLUSION: There was a sudden, rather than a gradual, reduction of operative time leading to extra cases being performed. This coincided with (1) the surgeon being assigned a new fellow and (2) administrative commitment to finish three cases per day. Our original hypothesis was negated, but other controllable causes for changes in surgical throughput were identified.     

Perforation of the small intestine

BACKGROUND: Small bowel perforation is a major problem in abdominal typhi disease, but is seldom observed in Italy, as Salmonella typhi infections are rare in this Nation. The cause of perforation varies greatly. The reported mortality is high and varies from 23 up to 42%. A retrospective study has been performed in order to find how to improve the outcome. METHODS: A series spanning 10 years is reviewed, from January 1, 1987 to December 31, 1997, comprising 60 patients with small bowel perforation, operated in a urgency setting in the Operating Room of the Emergency Department of the Molinette Hospital in Torino. Resection and primary anastomosis were utilized in 33 patients, 27 underwent oversewing. In 3 patients a colostomy was felt necessary because of a concomitant damage of the colon. RESULTS: No leakages occurred. Hospital stay varies from 1 day to 76 days (24 days mean). Mortality is consistent with literature: 20 patients (33%) but the cause is related to the primary diseases of the patients. Delay in diagnosis did not affect the patient's outcome. CONCLUSIONS: In conclusion, it is confirmed the one-time surgery as the choice treatment in small bowel perforations from causes other then S. typhi infection. Mortality is not directly related to the consequences of surgical repair.     

Bedeutung der Materiallogistik im Schnittstellenmanagement der Operationsabteilungen

The implementation of diagnosis-related groups (DRGs) sharply increased economic pressure on hospitals. Hence, process optimization was focussed on cost-intensive areas, namely the operation room (OR) departments. Work-flow in the OR is characterized by a mandatory interlocking of the job functions of many different occupational groups and the availability of a variety of different materials. Alternatives for staff assignment optimization have been published in numerous publications dealing with the importance of OR management. In this connection the issue of material logistics in the context of OR management has not been frequently addressed. In order to perform a surgical procedure according to plan, one depends on personnel and on timely availability of the materials needed. Supply of sterilized materials is of utmost importance, because in most hospitals sterilized surgical devices constitute a critical resource. In order to coordinate the OR process with the production flow of sterilized materials, an organizational connection to the OR management makes sense. Hence, in a German university hospital the Department of Hospital Sterile Supplies was integrated into the OR management of the Department of Anesthesiology. This led to a close coordination of work-flow processes, and concomitantly a significant reduction of production costs of sterile supplies could be achieved by direct interaction with the OR. Thus, hospital sterile supplies can reasonably be integrated into an OR management representing a new interesting business area for OR organization.