摘要
目的查找内镜清洗消毒过程中存在的问题,制定有效的策略,持续提高内镜消毒质量。方法应用FOCUS-PDCA程序,查找影响内镜消毒失败的各个环节,进行分析整改、培训考核。改进前(2014年11月-2015年3月)检测内镜24件,改进中(2015年4月-2016年4月)检测内镜120件,改进后(2016年5月-2017年6月)检测内镜350件;应用倾注培养加滤膜接种的方法检测内镜消毒后菌落总数,比较不同阶段内镜消毒合格率以及护士、清洗工人知识掌握情况。结果内镜菌落总数的合格率由改进前的75.0%、改进中的86.7%,提高到改进后的98.6%(χ~2=36.673,P<0.01),呈线性趋势;胃镜、肠镜和支气管镜的检测合格率均升高(χ~2=7.250,P=0.019;χ~2=11.012,P=0.003;P<0.01);机器清洗的胃镜菌落总数合格率由改进前的66.7%提高到100.0%(χ~2=7.030,P=0.048);手工清洗的肠镜合格率由50.0%提高到100.0%(χ~2=18.096,P<0.01);手工清洗的支气管镜合格率由77.3%提高到99.4%(P<0.01);护士与工人的知识技能评分也由91.2分提高到96分(t=8.232,P=0.001)。结论利用FOCUS-PDCA模式可对软式内镜清洗、消毒各环节及时进行管理和改进,规范了内镜洗消流程,持续提高了内镜消毒质量。
OBJECTIVE To explore the problems existing in the disinfection of flexible endoscopes,develop the effective strategy and improve the effectiveness of disinfection.METHODS FOCUS-PDCA model was carried out to find out the aspects influencing the disinfection quality,and the rectification,analysis and training were implemented.Totally 24,120 and 350 endoscopes were tested before implementation period（from Nov.2014 to Mar.2015）,during implementation period（from Apr.2015 to Apr.2016）and after implementation period（from May 2016 to Jun.2017）.The total number of colonies was counted after pouring culture and film inoculating.The qualified rates of endoscopes and skill scores of nurses and workers during different periods were compared.RESULTS The qualified rate was improved from 75.0% to 86.7% and 98.6% ,which showed a linear trend（χ^2=36.673,P0.01）.The qualified rates of gastroscopy,colonoscopy and bronchoscopy were all increased（χ^2=7.250,P=0.019;χ^2=11.012,P=0.003;P0.01）.The qualified rates of total number of colonies of gastroscopy washed by machine,colonoscopy and bronchoscopy by manual were improved from 66.7% to 100% （χ^2=7.030,P=0.048）,from50% to 100% （χ^218.096,P0.01）and from 77.3% to 99.4% （P〈0.01）.Skill scores of nurses and workers increased from 91.2 to 96（t=8.232,P=0.001）.CONCLUSIONFOCUS-PDCA model is useful for management and improvement of washing and disinfection of flexible endoscopies on time.It may contribute to standardize the washing and disinfection process and improve the quality of disinfection.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第18期4252-4254,4302,共4页
Chinese Journal of Nosocomiology
