¡¾ Abstract ¡¿ [Objective] To improve the cleaning and sterilization quality of precision and expensive endoscopic instruments, reduce unnecessary damage and ensure medical safety. [Methods] The supply room adopted the management mode of special person in charge of collecting, cleaning, packing and delivering precision and valuable instruments. Results: the service life of the precision and expensive equipment was prolonged, the loss of medical equipment was reduced to the minimum, and the integrity and use efficiency of the precision and expensive equipment were also ensured. [Conclusion] The economic and social benefits of the hospital can be improved by increasing the utilization rate and perfect rate of precision and valuable instruments.

¡¾ Key words ¡¿ Disinfection supply; Precision expensive cavity mirror instrument; management

With the development and transformation of biomedicine, medicine and sociology, minimally invasive surgery has become more popular and all kinds of endoscopic surgery have developed rapidly [1]. Surgical instrument is an important tool for surgeons to perform surgical treatment for patients, the performance of the instrument directly affects the operation and even the success of the operation. Our hospital is a comprehensive tertiary hospital. In recent years, with the continuous development of the hospital, more and more sophisticated and expensive instruments have been applied to surgery. Therefore, in order to improve the utilization rate and integrity rate of precision and expensive instruments, the traditional decentralized management mode has been changed since February 2009, and the precision endoscopic instruments of the whole hospital have been returned to the supply room for management, which has achieved good results. It is described as follows.

1. Materials and methods

1.1 General information

From January 2020 to December 2020, our hospital received precision and valuable instruments in the operating room, including 4 sets of laparoscopic instruments, 2 sets of hysteroscopic instruments, 3 sets of vaporized electrotomy instruments, 1 set of holmium laser instruments, 3 sets of cystoscope instruments, 1 set of percutaneous nephroscope instruments, and 1 set of knee arthroscopy instruments. They were used 250 times, 350 times, 132 times, 117 times, 322 times, 58 times and 26 times respectively.

1.2 methods

Two senior nurses with careful work, strong sense of responsibility, standardized operation and quick action (with more than 5 years of working experience in disinfection supply room) were selected.

1.3 Personnel Training

I learned the methods and precautions of using, disassembling, installing, cleaning, drying, oiling, packaging and sterilization of each precision endoscopic instrument from the original endoscopic management department, and organized the observation of such operations, with the purpose of understanding the use methods of endoscopic instruments as soon as possible. At the same time, the engineer of the endoscope of the factory was invited to explain the basic structure, installation, working principle, technical performance, use range and operation procedure of the endoscope instrument, to understand the correct disinfection method, as well as the matters needing attention in the process of use and maintenance.

1.4 Assessment Criteria

The on-site physical operation meets the technical requirements, the operation process is correct, and passes the training and examination.

2. Organization and system

Set up a management group headed by the chief nurse to undertake the special management of the equipment. Establishes the handover registration system, the training examination and verification system, the special person responsibility system, the regular inspection and maintenance system, the damage compensation system and other related systems.

3 handover method

By using the department after the instrument used to call disinfection supply center, disinfection supply room personnel with airtight locker next, with the use of department personnel to the number of transfer equipment, sound level (especially the definition of the mirror), accessories can activity, and presence of doing an initial rinse, timely detection instrument with and without damage, completes the registration. If there is damage, to use the department of nurses face to face and make a good record, so as not to affect the next use, reduce or put an end to the two "wrangle" phenomenon.

4 Cleaning method

Cleaning personnel should first protect themselves according to the standard prevention requirements, wear special work clothes, anti-penetration apron, round hat, mask, gloves, protective glasses and rubber shoes. Cleaning before all the instruments should be down to the smallest unit (don't have to remove some small screw), the casing shall be pulled up inner core, mirror and instruments placed separately, with a piece of gauze widget, prevent loss, all precision instrument is separated from ordinary equipment cleaning, especially the mirror stem to separate cleaning, should take put down gently, and placed in the safe place; Mirror wipe mirror paper repeatedly to avoid scratching the mirror. The usual cleaning procedure is cleaning, disinfecting and drying. The operation method is as follows: the instrument is immersed in the multi-enzyme solution for 10 min(for the instrument that needs ultrasonic cleaning, the time is not more than 5 min), and the mirror rod is gently placed into the enzyme solution at last and separated from other instruments to avoid collision and damage to the mirror. Each component of a flow water thoroughly clean endoscopic instrument shaft section of department, the bend, pipe cavity thoroughly scrub with a soft brush, scrub with care to avoid scratches, lumen, rinse thoroughly with water cannon, resistance to high temperature instruments in a drying oven drying, dry or not resistant to high temperature instruments with gauze auxiliary drying with 95% ethanol, tube cavity with air gun to blow dry. Non-immersion devices such as light guide fibers should be wiped to clean the surface of the object. After cleaning, count the number of equipment, especially small parts, to prevent loss. After the mirror is cleaned, its clarity is checked jointly by two people, without crack, scratch. Clean thoroughly with a cleaning brush and disinfect at least 1 times a day.

5 packaging

According to the instrument card, check the name, quantity, cleanliness, dryness, whether the function is intact, and whether the insulation layer is damaged. The protective cap should be put on sharp instruments such as puncture apparatus in time to avoid damage to the instrument. Choose instrument trays of different specifications according to the type of instrument, and mark "do not press the valuable instrument" on the outside of the instrument package to the sterilizer and ask it to be placed in a safe place. Low-temperature plasma paper plastic bag is used to seal the equipment that cannot withstand high temperature.

6 the sterilization

Before sterilization, the cleaning must be sufficient to completely remove all tissue fragments, while removing other organic matter to ensure the sterilization effect; High temperature resistant endoscopic instruments can be autoclaved by high pressure steam. The instruments that are not resistant to high temperature shall be sterilized by low temperature plasma or soaked with chemical disinfectant.

7 send

Precise and valuable instruments should be placed in a closed storage box when they are sent down. During transportation, attention should be paid to the safety of the instruments to avoid pressure and collision. After delivery to the department, make a careful handover and registration with the nurses of the department, and sign with both parties.

8 the experience

Precise and expensive instruments should be cleaned by special person, maintained carefully, packed skillfully and sterilized clearly. To achieve the purpose of quality, safety and instrument integrity. The implementation of the special person responsibility system, can find problems in time, and investigate the responsibility of the relevant personnel, to ensure the integrity of precision and expensive equipment, improve the utilization rate. Through our management measures, the rate of precision and expensive equipment is more than 99%, which reduces the medical cost and improves the economic and social benefits of the hospital.