灭菌包敷料黄染的原因及对策分析

Causes and countermeasures analysis of yellowing of sterilization package dressing

目的探讨运用根本原因分析法(RCA)在压力蒸汽灭菌包质量改进中的应用,为其提供参考依据。方法分析2014年10月-2015年4月供应室处理的灭菌包中出现敷料黄染的情况,应用RCA方法找出灭菌后敷料不合格的原因,与2015年6月-12月制定相应的改进措施后的压力蒸汽灭菌包进行比较。结果改进后,灭菌包敷料黄染的发生数由70例下降到11例,差异有统计学意义(P<0.05)。结论使用RCA科学方法能够解决灭菌包质量问题,提高消毒供应中心灭菌工作质量,确保医疗安全。

OBJECTIVE To explore the application of root cause analysis （RCA） method in the quality improvement of pressure steam sterilization packages, so as to provide references. METHODS The cases of yellowing of sterilization package dressing of supply room from Oct. 2014 to Apr. 2015 were analyzed, the RCA method was used to find out the causes of failure, and then compared with the pressure steam sterilization packages with the corresponding improvement measures from Jun. 2015 to Dec. 2015. RESULTS After improvement measures, the number of yellowing of sterilization package dressing were significantly decreased from 70 cases to 11 cases （P〈 0.05）. CONCLUSION Using the RCA method can solve the quality problems of sterilization packages, improve the sterilization quality of sterilization supply center, and ensures medical safety.