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(Central Sterile Supply Department, Fu Wai Hospital of Cardiovascular Disease of Yunnan Province, Kunming, Yunnan, 650031)

Introduction

The loaner instruments mainly refers to the surgical instruments loaned to the hospital by equipment suppliers, which can be repeatedly used for implants associated operation[1]. These complex instruments are very specific and high in value[2], thus required specific handling skills. Since January 2015, our hospital has collected 2 418 packages for the purpose of promoting the implementation of the standardization management procedures of loaner instruments and achieved a significant improvement in service quality and efficiency by, actively coordination, clear defined responsibilities, and strict examination produces.

Data and methods

Generalinformation

Our hospital is a three grade general hospital. During the period between January 2013 and December 2014, 2 639 items of loaner instruments were collected as the control group, while another 2 418 items were also collected as the observation group from January 2015 to December 2016. The general situation of the two sets of instruments were not statistically significant (P>0.05).

Methods

The control group was handled by routine management procedures. The resistance points of observation group were analyzed. Leading by hospital director, all departments involved in this seamless management process worked and coordinated together, inclduing all clinical departments, CSSD, Operation room and Administrative departments. Optimize SOP of every single step covering entire procedure, receiving, issuing, monitoring and training[3]. Supporting by knowledge sharing and IT technology, the implementation of standardized management of loaner instruments had been steadily moving ahead lead by CSSD.

Reviewandarchiveoftheloanerinstruments: We reviewed the qualification of loaner instrument suppliers, only IFU with clear information on reprocessing and disposal procedures were accepted and archived in our hospital system.

TheCSSDconductsspeciallecturesbeforeintroductionofloanerinstruments: It takes time from watching, to accept, then understand, finally actively engage into the process. We expanded the communication channels and provided the regular staff training on medical device reprocessing with active participation[4]. The preferable timing of training was set normally at start-up phase of the project. With the proper training, staff members’ knowledge of management standardization and skills on handling loaner instruments had been improved .

Standardizetheflowofloanerinstrumentsinthehospital: For the loaner instruments used in scheduled surgery procedures, the requesting departments must submit the request through information system 12 hours prior to the operation. The loaner instruments should be delivered and handed over to CSSD by MD supplier by 3:00 PM. If requesting for early release for emergency surgery, the requesting department is suposed to clearly state requirement with approval by authorized physician in their own department. The CSSD is responsible for reprocessing. If the request is for an implant, the biological evaluation result should be notified to the department in time by the CSSD.

Establishstandardprocedureforequipmenthandoverandutilization: The type and quantity of loaner instruments shall be verified according to specification by CSSD specialist and MD supplier at point of receiving and picking up. Status of in-plant shall be additionally specified clearly on the handover list. The handover list should be signed and archived.

Preparationbeforescheduledsurgery: CSSD should send the loaner instruments and an operation notice to the operating room one hour before the scheduled surgery time. Operation room and users of the loaner instrument should check information of six key categories. The unique identifier on the loaner instrument. We also included the name of the patient and his unique code to avoid confusions caused by multiple operations on same day with same procedure.

Monitortheprocessexecution: Department of infection should get the hospital staffs involved and listen to the inputs and suggestions during the implementation process. They should monitor the execution and result of process, and optimize in necessary. If deviation of procedures is found during inspection, a warning will be given and the correction shall be taken as early as possible to allow continuous improvement and enhance staffs' responsibility[5].

Evaluationmethods

A comprehensive statistical analysis was performed on the rates of resistance decline before and after the implementation of standardized management. A comparison was made among the key indicators including entry procedure, supplement on schedule, early release criteria, information accuracy and postoperative treatment. The data were analyzed by software SPSS 19.0.

Results

Rateofresistancedecline

There were significant differences in rate of resistance decline in the aspects communication, technical training, process execution and configuration standardization between the observation group and the control group(P<0.01), as shown in table 1.

Table 1. Comparison of rate of resistance (%)

Generalrateofqualification

The general rate of qualification were showed in table 2. The difference between the observation group and control group was statistically significant (P<0.01).

Table 2. General qualification rate comparison (%)

Passrateofprocessindicators

Among of all process indicators, the increase of qualification rate of entry procedure and postoperative treatment are higher than others, as showed in table 3. The observation group was compared with the control group in the five categories of entry procedure, supply on schedule, early release criteria, information accuracy and postoperative treatment. The differences were statistically significant(P<0.01).

Table 3. Comparison of the pass rate of process indicators (%)

Discussion

Loaner instruments are frequently utilized in Chinese hospitals. Effective and standardized management of them is still a hot issue[6].Potential safety risks presenting in all aspects of management processes especially like entry procedure, supply on schedule, early release criteria, information accuracy and postoperative treatment cannot be ignored. It is imperative to implement the standardized management procedures for the loaner instruments in all steps from receipt through issuing[7].

According to the analysis on potential obstructions during introducing loaner instrument, management procedure linking all departments who involved in the whole cycle is required. It is necessary to take the challenges as breakthrough points, motivate all departments to participate the changing actively. Furthermore, CSSD managers should enhance the safe use of loaner instruments by providing both theoretical and practical training, additionally emphasizing the quality supervision.

[1] PEOPLE'S REPUBLIC OF CHINA NATIONAL HEALTH AND FAMILY PLANNING COMMISSION. WS310-2016 Hospital CSSD, Part 1: Management Standard [S]. 2016-12-27.

[2] GUO L S , YE F M, YAN Y C. Rules of Admittance, Punctuality, Process, professionalization and standrization in CSSD management of loaner instruments and its efficacy [J]. Chinese General Pract Nurs, 2015, 13 (30): 3067-3069.

[3] LIU Y , LIANG X H, WEI F P, et al. Application of seamless nursing management model in operation room management [J]. Chinese J Modern Nurs, 2014, 20 (3): 347-349.

[4] LIU W, FENG L L . The application of standardized training in the management of loaner instruments in CSSD [J]. Int J Nurs, 2015, 34 (23): 3284-3285.

[5] YANG F, ZHAO Z Y, YANG J S, et al. Standardized treatment of loaner instruments[J]. Chinese J Nosocomiol. 2015, 25 (15): 3583-3585.

[6] ZHANG Y, FENG X L, REN W, et al. The implementation of three criteria in the hospital CSSD [J]. Chinese J Infection control, 2014, 13 (4): 193-197.

[7] YU X, YUAN X J, LI X H. Integrated management of surgical instruments CSSD [J]. J Qilu Nurs, 2011, 33 (17): 103.