The Application of Standard Operation Procedures in Laparoscopic Instruments Reprocessing for Quality Improvement
Wu Keping, The Fifth Affiliated Hospital of Sun Yat-sen UniversityCui Zhidan
Layout of CSSD in the Fifth Floor of Medical Tech Building
SOP of Processing Optical System, Instruments and Lumens
Flushing
Washing
Rinsing
Disinfection
Final Rinsing
Lubrication
Drying
CSSD Introduction
CSSD1 CSSD2p
Reusablemedical devices
from clinical departments
Reusablemedical devices from operating
rooms
There are 30 people in our CSSD, including 1 associate chief nurse, 1 supervising nurse, 6 nurses and 22 technicians.
Our CSSD is the training base in Guangdong. We’ve hosted 13 sessions since the foundation in Dec. 2009. The trainees come from 76 hospitals in Guangdong, Guangxi, Hainan and Sichuan. We provide education on collecting ,cleaning, inspection, packaging, sterilization and distribution and we also have trainings in the management of equipment and medical devices and team building. We’ve been promoting the implementation of three national standards and regulations and policies, which has been beneficial for the development of CSSD in Guangdong.
Research Method
Control group: the instruments are processed according to Technical
Standard for Cleaning and Disinfection of Endoscopes (2004).
Test group: the instruments are processed according to WS310.2,
Guidance to the Cleaning, Disinfection and Sterilization of Rigid
Endoscopes, manufacturers’ instructions for use and AAMI ST79 and
the Standard Operation Procedures of Laparoscopic Instruments (SOP).
20 sets of laparoscopic instruments (289 in total) that function properly are
randomly assigned to the test group and control group. Each group has 10 sets of
instruments. The control group has 141 instruments and test group has 148
instruments.
Conclusion The importance of cleaning quality of laparoscopic instruments
Compared with the common instruments, the laparoscopic instruments are delicate, made of various materials, and complex. The long lumens, dead ends, grooves and crevices are easy to harbor blood and other organic contaminants but difficult to clean. Debris are often found in these places which eventually form hard-to-clean biofilm. It will affect the sterilization[4] andcause hospital acquired infections, which threaten the risks of operation and patients’ lives.
The application of SOP in promoting the quality improvement of laparoscopic instruments cleaning
• SOP can improve the cleaning quality
• SOP can prevent the damages to instruments functions
• SOP needs continuous improvements.
Hospital IntroductionThe Fifth Affiliated Hospital of Sun Yat-sen University, a Tertiary A
hospital, is the largest one in Zhuhai with adequate equipments and
a strong technical force. It’s located not far from beautiful mountains
and rivers. The European style buildings are Outpatient Building,
Inpatient Building, Medical Tech Building and Center of Treatment
and Prevention of Tumor. There are more than 1600 healthcare
providers and 1300 bed counts. The Department of General Surgery
is the key discipline at provincial level in Guangdong. The Tumor
Department and Respiratory Medicine are the key disciplines at
municipal level in Zhuhai.
It’s a teaching hospital for high level of medical talents for Sun Yat-
Sen University. It’s responsible for educating the doctors and
postgraduates and undergraduates. Meanwhile, it has been
embarking on multiple technical programs at national and provincial
and municipal levels. The Zhuhai Medical Tech Research Center
has developed over 200 new technologies ever since its
establishment in 2003.
BackgroundAs the minimally invasive technology advances, laparoscopic instrumentss are widely
used in diagnosis and treatment. The laparoscopic instrumentss are delicate and
expensive with complex structures and big challenges to cleaning. The simplified
processing procedures and improper use of cleaning tools are making the situation
worse[1], directly affecting the cleaning effects. The standard operating procedure (SOP)
is to describe the step-to-step information on how to execute one thing and lay down the
optimized processes. Its purpose is to achieve consistency by following the same
procedures. By having the SOP for laparoscopic instruments processing, we will improve
the cleaning quality.
Results
Group Totalnumber
Optical system Light guide andcamera
Cable Instruments
Cracks Badimaging
Damage Greyshadow
Cracks Missingparts
Closure Blades Perfectness ratio
Testgroup
148 0 0 0 0 0 0 0 0 100%
Controlgroup
141 0 0 0 0 1 1 0 0 98.6%
2.1 Functionality Comparison (see Table 1)Table 1: Functionality Comparison of Instruments in Both Groups
Group Optical system Light guide and cable Trocars Instruments Total passrate
Pass Passrate
Pass Pass rate Pass Passrate
Pass Pass rate
Testgroup
10/10 100% 16/20 80% 20/20 100% 87/98 88.8% 89.9%
Controlgroup
4/10 40% 0/20 0 16/20 80% 36/91 39.6% 39.7%
2.2 Cleaning Effects Comparison (see Table 2)Table 2: Cleaning Effects Comparison of Instruments in Both Groups
Layout of CSSD in the First Floor of Medical Tech Building
敷料间
Manual Cleaning of Rigid Endoscopes and Quality Standards
Receiving:CSSD professionals
Tools
Counting the instruments, the name, specification, quantity and
functionality
Sorting and disassembly
Cleaning separately based on the materials
SOP of Processing Cameras, Light Guides and Cable
Wiping with tap water
Wiping with or soaking in enzymatic detergent
Wiping with tap water
Wiping with purified water
Disinfection
Drying
About the authors
Wu KepingAssociate chief nurse, 31 years of experience in nursing. Head nurse of CSSD of the Fifth Affiliated Hospital of Sun Yat-sen University, chairman of committee of Zhuhai Nursing Association, member of standing committee of Guangdong Nursing Association, deputy supervisor of Guangdong Nursing Education Center in CSSD