根本原因分析法在过氧化氢等离子灭菌循环终止原因中的应用

Application of root cause analysis in the analysis of the causes of termination of hydrogen peroxide plasma sterilization cycle

目的探讨应用根本原因分析法(RCA)在过氧化氢等离子灭菌循环终止原因分析中的应用,提高消毒、灭菌质量,以便更好地为临床服务。方法应用根本原因分析法分析厦门市妇幼保健院供应室过氧化氢等离子灭菌循环终止的原因,制订相关措施,并进行考核整改,对整改前后的规章管理制度、消毒灭菌知识、机器设备工作原理和日常维护、无菌技术规范操作进行考核。并采用简单随机抽样法抽取整改前后180件和90件清洗、灭菌及包装后的医疗器械进行细菌培养,比较其清洗、灭菌及包装的合格率。并将整改前(2018年6月至2019年6月)及整改后(2019年7月至2020年12月)的资料进行比较分析,比较整改前后规章管理制度、消毒灭菌知识、机器设备工作原理和日常维护、无菌技术规范操作的考核结果,比较医疗器械清洗、灭菌及包装的合格率,过氧化氢等离子灭菌循环终止的次数,以及造成灭菌循环终止原因的次数。结果整改后科室工作人员规章管理制度(85.60±4.55)分、消毒灭菌知识(91.20±3.30)分、机器设备工作原理和日常维护(87.67±3.48)分、无菌技术规范操作(87.40±3.50)分,均高于整改前,医疗器械清洗、灭菌及包装合格率分别为96.67%、98.89%、98.89%,均高于整改前,差异均有统计学意义(P<0.05)。整改前后过氧化氢等离子消毒、灭菌895及765舱次,灭菌循环终止53次及15次,取消率为5.92%及1.96%,整改后降压期压力检查失败、过氧化氢浓度低、低等离子功率发生次数分别为7、4、3次,均低于整改前,差异有统计学意义(P<0.05)。而操作者误操作、设备故障发生0、1次,低于整改前,差异无统计学意义(P>0.05)。结论将根本原因分析法引入供应室消毒、灭菌的管理过程,能有效提高科室工作人员整体业务水平,减少过氧化氢等离子灭菌循环取消次数,及其造成的原因次数,提高消毒、灭菌成功率,进而减少院内感染率,提高医院的整体医疗质量。

Objective To explore the application of root cause analysis(RCA)in the analysis of the causes of termination of hydrogen peroxide plasma sterilization cycle,so as to improve the quality of sterilization and disinfection and better serve the clinic.Methods The RCA was applied to analyze the causes for the termination of hydrogen peroxide plasma sterilization cycle in the supply room of Xiamen Maternal and Child Health Hospital,develop relevant measures,and carry out an assessment for regulations and management system,sterilization and disinfection knowledge,working principle and daily maintenance operation of machines and equipment,and standardized operation of sterile technique before and after the rectification.A simple random sampling method was used to take 180 pieces and 90 pieces of clean,sterilized and packaged medical devices before and after rectification for bacterial culture to compare their cleaning,sterilization and packaging qualification rates.The information before rectification(from June 2018 to June 2019)was analytically compared to that after rectification(from July 2019 to December 2020)in terms of the assessment results of regulations and management system,sterilization and disinfection knowledge,working principle and daily maintenance of machines and equipment,standardized operation of sterile technique,medical device cleaning,sterilization and packaging qualification rates,as well as the number of terminated hydrogen peroxide plasma sterilization cycles,and the number of causes of terminated sterilization cycles.Results After the rectification,the rules and management system of the staff in the department(85.60±4.55)points,the knowledge of disinfection and sterilization(91.20±3.30)points,the working principle and daily maintenance of machinery and equipment(87.67±3.48)points,and the aseptic technical standard operation(87.40±3.50)points,both higher than before rectification,and the qualified rates of medical device cleaning,sterilization and packaging were 96.67%,98.89%,and 98.89%,respectively,which were higher than those before rectification,and the differences were statistically significant(P<0.05).Before and after the rectification,895 and 765 cabins were sterilized and sterilized by hydrogen peroxide plasma,the sterilization cycle was terminated for 53 and 15 times,and the cancellation rate was 5.92%and 1.96%.The occurrence times of low plasma power were 7,4,and 3 times,which were lower than those before rectification,and the differences were statistically significant(P<0.05).The operator's misoperation and equipment failure occurred 0 and 1 time,which was lower than that before the rectification,and the differences were not statistically significant(P>0.05).Conclusion Introducing the RCA into the management process of disinfection and sterilization in the supply room can effectively improve the overall business level of the department staff,reduce the number of hydrogen peroxide plasma sterilization cycle cancellations and the number of causes for such cancellations,improve the success rate of disinfection and sterilization,and thus reduce the rate of nosocomial infection and improve the overall medical quality of the hospital.