手術器械清潔再處理流程之改善專案

The Project to Improve Reprocess in Surgical Instrument Cleaning

林麗華(Li-Hua Lin)；楊雅如(Ya-Ju Yang)

手術器械 ； 清潔作業再處理 ； 手術部位感染 ； Surgical instruments ； Cleaning reprocess ； Surgical site infection

嘉基護理

20卷1期（2020 / 06 / 01）

13 - 23

繁體中文

本專案目的乃提升手術器械之清潔作業再處理完整率，降低清潔不當的包盤供應，以提升手術作業品質。由於外科技術不斷提升，連帶使器械種類更為多樣及精密，導致清洗作業困難度增加。因器械髒污後續引發手術部位感染疑慮，進而提報病安異常事件，故引發專案改善動機。透過實地稽查、問卷、訪談等方式，確立主要問題：一、清潔工具不足；二、人力不足；三、對器械構造不熟悉；四、缺乏正確作業規範；五、清洗機維護不當。經由增購清洗工具、擴編人力、教育訓練、修訂作業標準、定期保養等，器械清潔完整率從改善前79%提升到95%，清潔異常發生率由0.04%下降為0.016%，不僅提升清潔品質並改善人員工作負擔。

The project aims to improve the completion rate of cleaning in reprocessing surgical instruments, as well reduced the supplies of inadequate cleaning during surgical procedures. Since the continuous improvement of surgical techniques, the varieties of instruments are more diverse and delicate, which also increases difficulty in cleaning process. According to Patient Safety Reporting System revealed episodes of surgical instrument contamination, subsequently, it might be suspected the issue of surgical site infection. Therefore, a project was developed to improve cleaning reprocess. We conducted a serial investigations including observation of cleaning process, questionnaire, and staff interview. After analysis to determine this as to be a result of lack relevant cleaning tools, not configured with appropriate manpower, insufficient education with instrument training for staff, incorrect cleaning process, as well as improper maintenance of washer. We proposed the following measures: 1) purchasing relevant cleaning tools, 2) increasing a expanding manpower in decontamination area, 3) job training for instrument cleaning. 4) revising the operating procedures, 5) regularly maintain equipments. Following those approaches, the completion rate of instrument cleaning from 79% increased to 95%, occurrence rate of unclean surgical instruments decreased from 0.04% to 0.016%, not only enhanced the quality of cleaning , but also reduced work loads of employees.

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