利用根因分析法持续改进复用医疗器械清洗质量

Root cause analysis in continuous improvement of cleaning quality of reusable medical instruments

目的利用根因分析法持续改进复用器械清洗质量,以降低医院感染及器械耗损。方法利用因果分析鱼骨图对影响器械清洗质量的要因进行分析并验证,针对5个末端因素进行持续质量改进,比较实施持续质量改进前后器械的生锈率、污渍率、返洗率、报损率与临床科室满意度。结果器械清洗合格率由实施前的94.24%上升至实施后的97.60%,器械的生锈率、污渍率、返洗率、报损率分别由实施前的3.39%、2.37%、5.76%和2.08%,下降至实施后的1.55%、0.85%、2.40%和0.48%,各组比较,差异均有统计学意义(均P<0.001);实施前临床科室对消毒供应中心的满意度为(93.87±3.87)分,实施后为(98.08±0.59)分,经比较差异有统计学意义(t=6.80,P<0.001)。结论利用根因分析法对复用医疗器械进行持续质量改进,有利于提高器械清洗质量,降低医院感染和器械损耗,节约医疗成本。

Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection（HAI）and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,continuous quality improvement was carried out based on5 terminal factors,the rate of rusting,stain,repeated cleaning,damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from94.24% before implementing measures to97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from3.39%,2.37%,5.76%,and 2.08%to 1.55%,0.85%,2.40%,and 0.48%respectively,there were significant difference among different groups（all P0.001）;the score of satisfaction rate to central sterile supply department elevated from（93.87±3.87）before implementing measures to（98.08±0.59）after implementing measures（t=6.80,P0.001）.Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continuously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.