Evaluation of the Impact of Refined Quality Control Management Model on the Qualified Rate of Disinfection and Sterilization of Surgical Instruments in the Sterilization Supply Center

Objective:To evaluate the application value of a refined quality control management model for a sterilization supply center.Methods:A retrospective analysis was conducted on the work situation of the sterilization supply center from January 2021 to January 2023.The work situation before January 31,2022,was classified as the control group;a routine quality control management model was implemented,and the work situation after January 31,2022,was classified as the observation group.The quality of medical device management and department satisfaction between the two groups were compared.Results:The timely recovery and supply rate,classification and cleaning pass rate,disinfection pass rate,packaging pass rate,sterilization pass rate,and department satisfaction score in the observation group were all higher than those of the control group(P<0.05).Conclusion:Implementing a refined quality control management model in the sterilization supply center can improve the quality management level of medical devices and department satisfaction and is worthy of promotion.

Effects of Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children: A Group Randomized Trial in China

Objective To assess the effectiveness of multiple cleaning and disinfection interventions in the homes and kindergartens, in reducing gastrointestinal and respiratory illnesses of children. Methods From October 2010 to September 2011, we performed a prospective, controlled study in China. 408 children under 5 years old were recruited and group randomized into intervention and control groups. Families and kindergartens in the intervention group were provided with antibacterial products for hand hygiene and surface cleaning or disinfection for one year. Each child＇s illness symptoms and sick leave were recorded every day. Results A total of 393 children completed the study, with similar baseline demographics in each of the 2 groups. Except for abdominal pain, the odds of symptoms （fever, cough and expectoration, runny nose and nasal congestion, diarrhea）, illness （acute respiratory illness and gastrointestinal illness）, and sick leave per person each month were significantly reduced by interventions. The rates of fever, diarrhea, acute respiratory illness, gastrointestinal illness and sick leave per person per year were significantly decreased as well. Conclusion Not only the acute respiratory children were significantly reduced by multiple and gastrointestinal illness but the sick leave rate in interventions.

Improve the Center Supply Room to Ensure the Quality System for Disinfection and Sterilization

The disinfection supply room is a very important department of the hospital.Its main job is to provide sterile equipment and dressings for various activities in the hospital.It is an important department in the hospital infection management process.Doing a good job in the control and management of the disinfection supply room is the main link to ensure the prevention and control of hospital infections.The quality of management directly affects modern clinical medical work.Therefore,the hospital supply room should be strengthened and improved to ensure that all items can be safely used in the work process,which can effectively avoid the occurrence of cross-infection incidents in the hospital.

Observational study of enzyme in instrument cleaning for sterile reprocessing and factors impacting enzyme activity

Objective To evaluate the application of enzyme in instrument cleaning for hospital sterile reprocessing and different factors that impact the enzyme activity.Methods Standard soil objects for instrument cleaning quality evaluation,as testing coupons,were identified and used to evaluate different cleaning processes designed with varied conditions.Between testing groups using enzymatic detergent versus non-enzymatic detergent,the amount of residual protein on the testing coupons were quantified and compared at different soaking time(10min,20min,30min,45min and 60min).Then,within the enzymatic detergent group,different testing conditions were further explored by adjusting factors,in⁃cluding the soaking temperature(25°C,30°C and 45°C),use solution pH(7.0,8.0),and enzyme dosing(1/80,1/40,1/20,3/40,1/10 and 3/20 in v/v).Then,through an observational comparative study for each testing condition,the time needed to achieve a complete soil removal through visual inspection of the testing coupons was documented for analyses.Results In the test of enzymatic detergent versus non-enzymatic detergent,the non-enzymatic group did not show an obvious decline in the residual protein amount(1069μg at 10 min vs.1042μg at 60 min),whereas the enzymatic group showed significant decrease in residual protein quantity(947μg at 10 min vs.620μg at 60 min).Meanwhile,the amounts of the residual protein at different time points in the enzyme group(947μg at 10 min,864μg at 20 min,812μg at 30 min,691μg at 45 min,and 620μg at 60 min)were consistently lower than those at the same time schedule in the non-enzyme group(1069μg at 10 min,1069μg at 20 min,1067μg at 30 min,1059μg at 45 min,and 1042μg at 60 min).Furthermore,within the enzymatic group,the soaking temperature,use solution pH and enzyme dosing factors all appear to impact the enzyme activity and significantly contribute to the cleaning outcomes.Specifi⁃cally,the higher soaking temperature,higher use solution pH and higher enzyme dosing showed 58.4%,20.0%and 34.4%time reduction to completely remove the soil on the testing coupons,respectively.Conclusion Enzyme seems to play a significant role in the instrument cleaning process for hospital sterile reprocessing.The soaking temperature,cleaning use solution pH,and enzyme dosing all appear to be critical factors impacting the enzyme activity and thus the overall cleaning outcomes.In practice,cleaning process verification should be considered to ensure the optimal use conditions for enzyme cleaning performance are well-understood and consistently achieved at the facility level.

Disinfection Water Wells and Sterilization

Disinfection is an important step in ensuring that water is safe to drink. Well disinfection is used to inactivate or control bacteria populations in a well and the distribution system. Disinfection is the inactivation or destruction of pathogenic organisms through the disruption of the organisms’ normal life processes. The objective of this work is to clean and/or disinfect entire borehole to prepare wells for pump installation. The last water sample was collected after the well disinfec-tion on that time. The results of water chemical analysis are presented in Tables 2-4, and there was nothing found against the specification requirements. After a reaction time of approximately 12 h, the well was cleaned from the sterilization solution by airlifting until chlorine concentration in the water reached 0 mg/l. Then through analyzing the test for samples of water after disinfection and sterilization the wells showed the Iron Bacteria were not seen and the Bacteria Species/Anaerobic Bacteria were absent.

Smell reduction and disinfection of textile materials by dielectric barrier discharges

In this paper we present investigations of textile cleaning of cotton fabrics with respect to both, the smell reduction and the disinfection of textile materials. Normal pressure plasma sources on the base of dielectric barrier discharge (DBD) were used for the purification and disinfection of textiles. For gaseous odour components which stick to clothing the results have shown that one can reach an uncritical odour threshold. In the case of disinfection a significant reduction of microorganism population in some of the samples could be noted. In particular a high reactivity is reached, while in parallel with a radiation by ultraviolet light ozone is activated.

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic:Case series

BACKGROUND Misuse of disinfectants during the coronavirus disease 2019 pandemic has led to several poisoning incidents.However,there are few clinical case reports on poisoning caused by improper mixing of household disinfectants.AIM To summarize the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents.METHODS We retrospectively analyzed baseline and clinical data,clinical symptoms,and treatment methods of seven patients with chlorine poisoning who were admitted to the National Army Poisoning Treatment Center.RESULTS Among the seven patients,the average poisoning time(exposure to admission)was 57 h(4-240 h).All patients were involved in cleaning bathrooms.Chest computed tomography scans revealed bilateral lung effusions or inflammatory changes in five patients.The partial pressure of oxygen decreased in six patients,and respiratory failure occurred in one.Five patients had different degrees of increase in white blood cell count.Humidified oxygen therapy,non-invasive mechanical ventilation,anti-inflammatory corticosteroids,antioxidants,and antibiotics were administered for treatment.The average length of hospital stay was 7 d(4-9 d).All seven patients recovered and were discharged.CONCLUSION Improper mixing of household disinfectants may cause damage to the respiratory system due to chlorine poisoning.Corticosteroids may improve lung exudation in severe cases,and symptomatic supportive treatment should be performed early.

Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope's controhead to this forceps elevator, then this channel's com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized.

Medical errors, infection-control breaches and the use of adulterated and misbranded medical devices

Several well-publicized cases of improper cleaning,disinfection or sterilization of contaminated reusable medical equipment that posed an increased risk of patientto-patient disease transmission were reported within the past few years,resulting in the notification of approximately 20 000 patients.These medical errors,the specific infection-control standards they breached,and assessments of the risk of infection associated with each are discussed.Other topics discussed include the Food and Drug Administration’s(FDA)regulation of medical devices and infection-control products;the use of adulterated,misbranded,and investigational devices;consent decrees and associated Certificates of Medical Necessity;and informed patient consent.Focus is placed on liquid chemical sterilization,its history,and the FDA’s recent censure and discontinuation of a medical device labeled with this claim,namely,the STERIS System 1 processor.Recommendations are provided for healthcare facilities,regulatory agencies,manufacturers of reusable medical devices,and professional healthcare organizations and administrations to improve public health and prevent healthcareassociated infections.

Study on a New Ultraviolet Sterilizer to the Surface Disinfection of the Ultrasound Probe

We studied the disinfection effect of a new ultraviolet （UV） sterilizer and its utilization on ultrasound probe surfaces. Carrier quantitative germicidal tests, simulated on-the-spot trials, and organic substance influence tests were used to carry out experimental observation. Artificially infected probes were disinfected using the sterilizer or a germicidal lamp for comparison. The total number and types of bacteria were determined and identified. Our results demonstrated the sterilizer had the best disinfection effect among three different disinfection methods in hospital. The sterilizer has been used in a hospital setting for 2 years with no notable damage to the ultrasound probe instrument. It has the advantages of fast disinfection, high disinfection effect, and good compatibility with the ultrasound instrument, worthy of being a promoted application in medical institutions.

Overview of chemical steam sterilization indicators

1 Introduction Infection control involves lots of information about consumables,so an overview of chemical steam sterilization indicators is provided to help healthcare staffs know recent developments of chemical steam sterilization indicators.The main method for sterilization of medical devices is steam sterilization,and the sterilization mechanism is destroying the protein strings by coagulation[1-2].Without the complete protein strings,the organisms

Ozone Disinfection Test in Chicken House

[Objective] The paper was to verify the disinfeelion effect of ozone on livesioek and poultry houses. [Method] The empty chicken house was disinfected by ozone with the help of ozone disinfector. [Result] As the ozone disinfeelor was worked for 60 min, the average sterilizing rate of air was 85.33%; Ihe average sterilizing rale on the surface of chicken coop was 86.77%; and the average sterilizing rate of wall was 89.13%. The disinfection effect was obvious. [Conclusion] The results will providc references for promotion and application of ozone disinfector in breeding in- dustry.

信息化质量追溯系统在消毒供应中心医疗器械管理中的应用效果

目的:探讨信息化质量追溯系统在消毒供应中心(CSSD)医疗器械管理中的应用效果。方法:选取郑州儿童医院CSSD采取常规管理期间(2020年6月至2021年6月)接收的1018件器械为对照组,选取应用信息化质量追溯系统管理后(2021年7月至2022年7月)接收的1018件器械为观察组。比较两组医疗器械管理质量(清洗、灭菌、包装不合格率)及各科室医护人员对CSSD的满意度。结果:观察组医疗器械清洗、包装、灭菌不合格率均低于对照组,差异有统计学意义(P<0.05);各科室医护人员对观察组服务态度、技术水平、器械供应及时性、器械结构功能、器械无菌性等方面的满意度均高于对照组,差异有统计学意义(P<0.05)。结论:信息化质量追溯系统用于CSSD医疗器械管理可提高管理质量,降低医疗器械清洗、包装、灭菌不合格率,提高各科室医护人员满意度,有效保障医疗安全。

两种方法清洗消毒达芬奇机器人手术臂的效果比较

目的探讨达芬奇机器人手术臂有效的清洗消毒方法。方法回顾性分析2022年1月至2023年4月江西省人民医院手术室使用后的达芬奇机器人手术臂200件达芬奇机器人手术臂作为研究对象,按照不同的操作流程将其分为观察组(100件)与对照组(100件)。观察组采用流动水冲洗+腹腔镜酶剂浸泡+超声波清洗机超声+蒸汽清洗机清洗手术臂操作端+高压水枪纯水漂洗+全自动清洗机清洗消毒。对照组清洗消毒流程为流动水冲洗+腹腔镜酶剂浸泡+超声波清洗机超声+刷洗手术臂操作端+高压水枪纯水漂洗+全自动清洗机清洗消毒。采用目测检查法(四倍带光源放大镜)、腺苷三磷酸(ATP)生物荧光快速检测法进行检测,计算清洗质量不合格的返洗率,比较两组的清洗消毒操作平均耗时。结果观察组的目测检查法返洗率低于对照组,观察组的ATP生物荧光检测返洗率低于对照组,差异有统计学意义(P<0.05)。观察组清洗消毒平均耗时短于对照组,差异有统计学意义(P<0.05)。结论蒸汽清洗机清洗消毒达芬奇机器人手术臂效果比手工刷洗清洗消毒效果更为理想,可节约大量清洗消毒时间,有效节约稀有医疗资源。

眼科超声乳化手柄清洗质量管理的最佳证据总结

目的检索、评价并整合国内外眼科超声乳化手柄清洗质量管理的相关证据,为临床实践提供指导。方法计算机检索国际指南协作网、美国国立指南网、BMJ Best Practice、PubMed、万方数据库、中国知网等网站或数据库中关于眼科超声乳化手柄清洗质量管理的所有证据,包括指南、专家共识、系统评价及证据总结,检索时限为从建库至2023年2月15日。结果共纳入10篇文献,其中实践指南4篇,专家共识4篇,系统评价1篇,证据总结1篇。总结了管理要求、环境要求、设备设施与耗材要求、人员要求、操作要求、现场预处理、回收转运、清洗及清洗质量评价9个方面共38条证据。结论该研究总结了眼科超声乳化手柄清洗质量管理的最佳证据,为规范超声乳化手柄的清洗质量管理提供了循证依据,可为提高眼科器械清洗质量水平、预防与控制医院感染发生提供参考。

失效模式与效应分析提升手术室软式内镜清洗消毒质量的效果

目的探讨失效模式与效应分析(FMEA)在提升手术室软式内镜清洗流程风险管理中的应用效果。方法选择上海交通大学医学院附属瑞金医院2021年1月1日至12月1日自动内镜清洗消毒机(AER)清洗消毒后的内镜共827镜次设为FMEA实施前组,2022年1月1日至12月1日AER清洗消毒后的内镜共844镜次设为FMEA实施后组。运用FMEA对手术室软式内镜清洗操作程序中的各个环节进行分析,通过计算风险优先指数(RPN)查找每个环节中的高危因素,针对RPN>125的关键环节制订改进方案并予以实施。比较FMEA实施前后的失效模式RPN值、内镜消毒合格率、内镜故障维修率、手术患者等待时间、手术室护士AER操作熟练度以及医生满意度。结果FMEA实施后,经过筛选并整改的5个项目的RPN值均下降至<125分;总体的RPN值由1247.24分下降至475.05分,RPN值下降率为61.91%;FMEA实施前后内镜消毒合格率及内镜故障维修率差异均无统计学意义(P>0.05);FMEA实施后手术患者等待时间短于实施前[(10.35±1.57)min vs(12.38±1.91)min],手术室护士AER操作得分及医生满意度高于实施前[(92.50±3.92)分vs(80.49±5.64)分,(93.87±2.16)分vs(83.07±3.10)分],差异均有统计学意义(P<0.05)。结论通过应用FMEA针对性优化相关操作流程,使手术室护士对软式内镜的清洗操作更加熟练,有助于提高清洗效率与质量、减少手术患者的等待时间、提升医生满意度。

专业化清洗、消毒流程对手术器械清洗质量的影响

目的:探讨专业化清洗、消毒流程对手术器械清洗质量的影响。方法:以我院2020年11月—2021年10月需要灭菌的手术器械984件为对照组,2021年11月—2022年10月需要灭菌的手术器械1026件为观察组;对照组采用常规流程,观察组采用专业化清洗、消毒流程;比较两组器械外观、清洗合格率、质量控制评分。结果:两组器械目测外观血渍、污垢、锈斑、外观光亮、清洗合格率及器械拆装、清洗质量、消毒质量、包装质量、环境管理评分比较,差异均有统计学意义(P<0.001)。结论:专业化清洗、消毒流程可提高器械清洗合格率及器械质量控制水平。

床旁脉冲预处理对流产吸引管清洗质量的影响

目的通过对流产吸引管预处理方法进行改进,探索预处理时机与方法对管腔器械清洗质量的影响。方法选取2020年7月至2022年7月梧州市红十字会医院使用的600件流产吸引管为研究对象,按照抽签分组法分为A组(n=200)、B1组(n=200)和B2组(n=200)。A组预处理采用在流产吸引管使用后马上床旁使用负压吸引恒温多酶清洗剂进行脉冲冲洗管腔内壁方式进行处理;B1组和B2组预处理采用在流产吸引管使用后马上采用流动水下冲洗管腔内壁进行处理。经预处理的器械均放置3 h后集中回收到供应室进行进一步处理,A组直接放入超声波清洗机超声清洗5 min;B1组在常温多酶洗剂内浸泡20 min后再放入超声波清洗机超声清洗5 min;B2组在常温多酶清洗剂内浸泡15 min后用毛刷在液面下贯通管腔来回刷洗5次后再放入超声波清洗机超声清洗5 min。比较三组器械清洗质量。结果A组残留蛋白检测合格率、隐血试验合格率、白色通条检查合格率、带光源放大镜检查合格率均高于B1组和B2组,差异有统计学意义(P<0.001)。结论改进预处理方法将器械有效预处理的地点前移至使用科室,预处理时间前移至术后即时,既践行行业标准,又改进预处理方法,抓住污染管腔器械最佳处理时间以及酶洗剂最强效果,利用脉冲原理使污物从管腔内壁剥离达到理想的预处理效果,进而提高器械清洗质量。

北京市51所三级医院内镜超声微探头清洗消毒现状调查

目的了解北京市三级医院内镜超声微探头清洗消毒现状。方法采用便利抽样法抽取北京市51所三级医院,对内镜中心护士长进行问卷调查,调查内容包括内镜超声微探头预处理、清洗、消毒、灭菌、生物学检测、消毒追溯、储存维修等情况。结果51所三级医院中甲等医院33所,乙等医院18所。76.47%(39所)的医院对使用后的超声微探头进行床旁预清洗,内镜超声微探头床旁预处理方式主要包括酶液湿巾擦拭(38.47%,15/39)和乙醇湿巾擦拭(30.77%,12/39);96.08%(49所)的医院对超声微探头进行手工清洗,手工清洗方法以“酶洗-擦洗-擦干”为主(58.82%,30所)。96.08%(49所)的医院对使用后的微探头进行消毒,以化学消毒剂浸泡消毒为主要方法(65.31%,32所);43.14%(22所)的医院对微探头进行灭菌,灭菌方法主要为0.2%~0.35%过氧乙酸浸泡10~15 min(77.27%,17/22);41.18%(21所)的医院定期对微探头进行生物学监测;37.25%(19所)的医院对微探头的清洗消毒流程进行追溯;88.24%(45所)的医院定期对微探头进行检查、保养、维修。结论北京市51所三级医院对内镜超声微探头的预处理、清洗、消毒、灭菌及生物学监测情况存在较大差异,建议尽快制定相关专家共识或指南,从而规范内镜超声微探头的清洗消毒工作。