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Objective:To analyze the impact of multi-color non-woven packaging in surgical instrument management on surgical turnover efficiency,surgical instrument preparation,and satisfaction of surgical medical staff and patients.Methods:31,589 surgical instruments from Beijing Friendship Hospital Capital Medical University from March 2016 to December 2021 were Selected.According to different management methods,71,007 surgical patients and corresponding 16,224 surgical instruments from March 2016 to January 2019 were included in the control group,which adopted traditional gauze-cotton bag packaging surgical instrument management method;62,548 surgical patients and the corresponding 15,365 surgical instruments from February 2019 to December 2021 were included in the observation group,which adopted multi-color non-woven packaging surgical instrument management method.The surgical turnover efficiency,surgical instrument preparation and satisfaction of surgical staff and patients were compared between the two groups.Results:The room entry time,room entry to skin incision time,the following surgery room entry to skin incision time,and surgical delay rate of surgeries of patients in the observation group were lower than those in the control group,the difference was statistically significant(t=52.681,37.167,72.524,x2=9.605,P<0.05).Compared with the control group,the number of outgoing deliveries,assembly errors and loss of instruments decreased significantly,the number of intact devices was increased significantly,the difference was statistically significant(x2=107.345,11.782,8.727,66.223,P<0.05.The satisfaction of patients and medical staff in the observation group was significantly higher than that in the control group,the difference was statistically significant(t=100.723,6.756,P<0.05).Conclusion:The application of multi-color non-woven packaging in the management of surgical instruments can help to improve surgical turnover rates,improve the efficiency of the central sterile supply department by reducing the number of outgoing deliveries,assembly errors and instrument losses,and improve the satisfaction of surgical medical staff and patients with multi-color non-woven packaging of surgical instruments.
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Background: Odontogenic maxillary sinusitis caused by a foreign body presents diagnostic and therapeutic challenges due to its infrequent occurrence and unique characteristics compared to sinusitis originating from other sources. CaseReport:Illustrating such fact, this report presents the clinical case of a 37-year-old woman referred complaining of pain in the same region where she had extracted her upper right first molar five days before. The intraoral examination revealed the presence of an orifice in the region, suggesting oroantral communication. Imaging exams revealed opacification of the right maxillary sinus and the unexpected presence of a highly radiodense object. With the diagnosis of maxillary sinusitis due to a foreign body established, the surgical approach initially consisted of administering preoperative medication, preceded by access to the maxillary antrum using the Caldwell-Luc technique. The object was found and removed, consisting of a surgical drill. At follow-up there was complete absence of symptoms and complete closure of communication. Conclusion: Cases of odontogenic maxillary sinusitis caused by drill detachment after tooth extraction are fairly uncommon. A thorough clinical evaluation proved to be essential and the Caldwell-Luc access was effective, safe and with good postoperative results, even with the absence of standardized diagnostic and management methods(AU)
Contexto: A sinusite maxilar odontogênica causada por corpo estranho apresenta desafios diagnósticos e terapêuticos devido à sua ocorrência infrequente e características únicas em comparação com sinusites originadas de outras fontes. Relato do Caso: Ilustrando tal fato, este relato apresenta o caso clínico de uma mulher de 37 anos de idade encaminhada com queixa de dor em mesma região que havia extraído o primeiro molar superior direito cinco dias antes. Ao exame intraoral verificou-se a presença de um orifício na região, sugerindo comunicação oroantral. Os exames de imagem revelaram opacificação do SM direito e a inesperada presença de um objeto altamente radiodenso. Com o diagnóstico de sinusite maxilar por corpo estranho estabelecido, a abordagem cirúrgica consistiu inicialmente na administração de medicação pré-operatória, precedida pelo acesso ao antro maxilar através da técnica de Caldwell-Luc. O objeto foi encontrado e removido, consistindo em uma broca cirúrgica. Ao acompanhamento houve ausência completa dos sintomas e total fechamento da comunicação. Conclusão: Casos de sinusite maxilar odontogênica causada por descolamento da broca após extração dentária são bastante incomuns. Uma avaliação clínica minuciosa mostrou-se primordial e o acesso de Caldwell-Luc eficaz, seguro e com bons resultados pós-operatórios, mesmo com as ausências de métodos de diagnóstico e manejo padronizados.(AU)
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Humans , Female , Adult , Surgery, Oral , Maxillary Sinusitis , Oroantral FistulaABSTRACT
Objective:To establish and effect evaluate of management process of Da Vinci robotic surgical instrument based on bar code, and evaluate its application effect.Methods:This study was a randomized controlled trial using convenient sampling method. A total of 172 Da Vinci robotic surgeries from Jiangsu Cancer Hospital from September to November 2020 were selected as the control group, and 118 Da Vinci robotic surgeries from September to November 2021 were selected as the observation group. The control group adopted the traditional Da Vinci surgical instrument management mode, while the observation group adopted the management mode of Da Vinci surgical instrument based on bar code. The incidence of management problems related to Da Vinci surgical instruments, the number of reported adverse events of instruments rate and the impact of staff work effect were compared between two groups.Results:The incidence rates of non-traceable information, counting error, usage charge and bar code irregularity were 9.3% (11/118), 0, 0.8% (1/118) and 2.5% (3/118), respectively, which were lower than 26.7% (46/172), 17.4% (30/172), 12.2% (21/172) and 16.9% (29/172) of the control group. The differences were statistically significant ( χ2 values were 12.89-24.68, all P<0.01). The reporting rate of device adverse events in the control group was 0, and the observation group was 4.2% (5/118), and the difference between the two groups was statistically significant ( χ2=7.42, P<0.05). The number of sterilization package turnover sets in the observation group was 2(2, 3), which was lower than 2(2, 4) of the control group, and the difference was statistically significant ( Z=-2.50, P<0.05). The average amount of pre-purchased surgical instruments per surgical instrument in the observation group was 7 858.0 (6 712.1, 14 119.9), which was lower than that of the control group of 7 858.0 (7 858.0, 2 0385.0), and the difference was statistically significant ( Z=-2.97, P<0.05). Conclusions:The management process of Da Vinci Xi robotic surgical instrument based on bar code can reduce the incidence of related management problems, increase the reporting rate of adverse events, improve the work efficiency of the management of mechanical arm to optimize hospital of reusable medical equipment management level, thus further ensure medical safety and improve medical quality.
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The retained of a foreign body during a surgical procedure is defined by the forgetting of a material, left by inattention in the body of the patient during this act. It is a rare event but is responsible for high morbidity and mortality. Authors report a retained foreign body incidentally discovered during a caesarean section. The patient had performed an illegal abortion by endo-uterine instrument which was complicated by uterine perforation five years previously. She was pregnant at 37 weeks and presented to the emergency department for bleeding and diagnosed as placenta previa. The antecedent of abortion had not been informed because it is an illegal act in Madagascar. The plastic instrument was in the broad ligament in contact with the ureter and the uterine artery. Caesarean section, the removal of the catheter and postoperative recovery was uneventful. Foreign body retention remains a malpractice and the diagnosis must be made in the face of chronic pain in patients who have undergone surgery.
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Objective To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems,so as to lay a foundation for further development of relevant standards.Methods In January 2019,549 hospitals of different grades in 33 provinces,autonomous regions and municipalities were surveyed by a convenience sampling.The survey covered the basic information,the cognition of the management personnel on instrument maintenance,and the status quo of surgical instrument maintenances of the hospitals.Descriptive analysis was carried out on the data,and the number and percentage of counting data were described.Results 368 (59.74％) hospitals were manned with special post for cleaning precision surgical instruments,426 (69.16％) were manned with special post for cleaning quality inspection,and 382 (62.01％) were manned with special post for assembly and packaging.347 (56.33％) for manufacturers training,299 (48.53％) for self-study manufacturers instruction,420 (68.18％) by department internal training;116 (18.83％) for manual cleaning,413 (67.05 ％)for manual and ultrasonic cleaning,87 (14.12％) for mechanical cleaning;High pressure steam sterilization was used in 518 (84.10％),hydrogen peroxide plasma sterilization was used in 398 (64.61％),and ethylene oxide sterilization was used in 222 (36.04％) hospitals.Conclusions The maintenance of surgical instruments should be carried out by professional personnel,relevant training should be carried out,management personnel should strengthen the inspection,and relevant standards and norms should be formulated to unify the management of surgical instruments.
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In this paper,the author introduced the evolution of instruments related to gynecological singlesite laparoscopic surgery,from the perspective of historical development,focusing on the advantages and disadvantages of related instruments and the reasons for their improvement,as well as the impact on the development of gynecological single-site laparoscopic surgery.It is helpful for readers to better choose the appropriate instruments on the basis of understanding the relevant history.
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Objective@#To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems, so as to lay a foundation for further development of relevant standards.@*Methods@#In January 2019, 549 hospitals of different grades in 33 provinces, autonomous regions and municipalities were surveyed by a convenience sampling. The survey covered the basic information, the cognition of the management personnel on instrument maintenance, and the status quo of surgical instrument maintenances of the hospitals. Descriptive analysis was carried out on the data, and the number and percentage of counting data were described.@*Results@#368(59.74%)hospitals were manned with special post for cleaning precision surgical instruments, 426(69.16%) were manned with special post for cleaning quality inspection, and 382(62.01%) were manned with special post for assembly and packaging. 347(56.33%)for manufacturers training, 299(48.53%)for self-study manufacturers instruction, 420(68.18%)by department internal training; 116(18.83%)for manual cleaning, 413(67.05%)for manual and ultrasonic cleaning, 87(14.12%)for mechanical cleaning; High pressure steam sterilization was used in 518(84.10%), hydrogen peroxide plasma sterilization was used in 398(64.61%), and ethylene oxide sterilization was used in 222(36.04%) hospitals.@*Conclusions@#The maintenance of surgical instruments should be carried out by professional personnel, relevant training should be carried out, management personnel should strengthen the inspection, and relevant standards and norms should be formulated to unify the management of surgical instruments.
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Development and current problems of fetal surgery were introduced. Application and research frontiers of new minimally-invasive techniques were elaborated from the aspects of intraoperative imaging diagnosis and navigation, new-type minimally-invasive instrument,energy therapy and robot technique for diagnosis and treatment.Current bottlenecks and future outlooks of new minimally-invasive techniques in fetal surgery were analyzed. Great clinical potential of new minimally-invasive techniques in fetal surgery was stated.It's pointed out that how to integrate diagnosis and therapy and apply them to real clinical treatment would be the focus of future research.
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Objective To develop a pulling device using magnetic positioning to optimize the procedures of repairment of donor liver from organ donation . Methods The pig liver specimens were used to measure the pull force of repairment of donor liver, magnetic spiderman was developed based on the measurement results. The magnetic spiderman was applied to simulate the repairment of donor liver from organ donation on the pig liver specimens. The effectiveness of magnetic spiderman was also evaluated. Results The pulling force was required all less than 2 N during the repairment of donor liver. The magnetic spiderman was successfully manufactured. The magnets of magnetic spiderman could generate 3 N magnetic forces with paramagnetic basin of hepatic repairment. The self-retraction pull wire of the magnetic spiderman could provide 2.5 N pulling forces. The magnetic spiderman was successfully applied to the simulated experiment of repairment of donor liver from organ donation in 6 cases. The operation time was (54±5) min. No clip slippage,displacement and slippage of the base occurred during the operation. With the cooperation of multiple magnetic spidermen,the remaining surgical procedures were performed by one single surgeon except for the vascular ligation. Conclusions The magnetic spiderman has small volume and implements flexible positioning, can perform pulling operation and nottake up operational space. It can effectively optimize the procedures of repairment of donor liver from organ donation and reduce the quantity of surgeons.
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Objective To explore the application of Wagner sterilization case to packaging of special surgical instruments.Methods Totally 108 sets of special surgical instruments were randomly divided into a group with Wagner sterilization case (abbreviated as Wagner group) and a group with double-layer cotton cloth (abbreviated as cotton group).Statistical analyses were executed on packaging,qualification rate for sterilization,efficiency-cost ratio.Results The two groups had the qualification rates of pressuresteam sterilization being 100％,and 156 surgeons and operating nurses had the satisfaction degrees over double-layer cotton cloth and Wagner sterilization case being 70.51％ and 94.87％ respectively.Wagner sterilization case gained advantages over the cotton cloth in user satisfaction and cost,and the difference between the costs was significant (P＜0.05).Conclusion Wagner sterilization case can decrease the risks for hospital infection effectively.
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Objective To develop a series of surgical instruments to improve surgical treatment in field conditions with considerations on the characteristics of medical shelter and the requirements of surgical treatment in field conditions.Methods A series of surgical instruments was developed with considerations on the characteristics and requirements of surgical treatment in field conditions.Results The mask strap behaved well in structure,operation and fixation,and prevented the mask from unplanned extubation,dropping off and displacement.The sterilizing rack had high stability and safety and 150 kg bearing capability,and eliminated the needs for additional workload for patient carrying and traction during preoperative sterilization.The prone-position cushion exposed the operative field sufficiently and enhanced the success rate of surgical treatment.Conclusion The series of surgical instruments gains advantages in structure,operation,mobility,cleaning,sterilization,carrying,storage,loading and transport,and thus is applicable for field emergency rescue.
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Objective To explore the application of Wagner sterilization case to packaging of special surgical instruments.Methods Totally 108 sets of special surgical instruments were randomly divided into a group with Wagner sterilization case (abbreviated as Wagner group) and a group with double-layer cotton cloth (abbreviated as cotton group).Statistical analyses were executed on packaging,qualification rate for sterilization,efficiency-cost ratio.Results The two groups had the qualification rates of pressuresteam sterilization being 100％,and 156 surgeons and operating nurses had the satisfaction degrees over double-layer cotton cloth and Wagner sterilization case being 70.51％ and 94.87％ respectively.Wagner sterilization case gained advantages over the cotton cloth in user satisfaction and cost,and the difference between the costs was significant (P＜0.05).Conclusion Wagner sterilization case can decrease the risks for hospital infection effectively.
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Objective To develop a series of surgical instruments to improve surgical treatment in field conditions with considerations on the characteristics of medical shelter and the requirements of surgical treatment in field conditions.Methods A series of surgical instruments was developed with considerations on the characteristics and requirements of surgical treatment in field conditions.Results The mask strap behaved well in structure,operation and fixation,and prevented the mask from unplanned extubation,dropping off and displacement.The sterilizing rack had high stability and safety and 150 kg bearing capability,and eliminated the needs for additional workload for patient carrying and traction during preoperative sterilization.The prone-position cushion exposed the operative field sufficiently and enhanced the success rate of surgical treatment.Conclusion The series of surgical instruments gains advantages in structure,operation,mobility,cleaning,sterilization,carrying,storage,loading and transport,and thus is applicable for field emergency rescue.
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Objective To apply six sigma management method to optimizing flow,enhancing treatment quality,prolonging service life and decreasing purchase cost of the non-coated surgical instrument.Methods The treatment flow of the noncoated surgical instrument was optimized through five steps of six sigma method including defining,measuring,analyzing,improving and controlling.The treatment results before and after flow optimization were compared,analyzed and evaluated.Results The rates for corrosion and rejection were both decreased significantly after flow optimization,while the quality was increased obviously (P＜0.05).Conclusion Six sigma management method involved in the treatment of the non-coated surgical instrument saves purchase cost,enhances the efficiency of disinfection supply room and facilitates effective supervision and monitoring.
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Objective To investigate the status of treating precision surgical instruments in disinfection supply center,and to provide fundamental data for standardizing treatment procedure.Methods We chose 616 disinfection supply centers in hospitals from 30 provinces,autonomous regions,and municipalities,and sent investigation forms (digital) on treatment of precision surgical instruments,asking head nurses of disinfection supply centers to fill the forms according to real situation.Results Among 616 hospitals receiving treatment of precision surgical instruments,59.74％ had specific cleaning post,69.16％ had specific post for cleaning quality inspection,62.01％ had specific post for assembly and packaging,only 56.33％ had training from manufacturers,48.53％ self-studied instructions provided by manufacturers;18.83％ performed manual cleaning,67.05％ performed manual cleaning followed by ultrasonic cleaning,only 14.12％ performed mechanical cleaning;for method of sterilization,84.10％ used high pressure steam sterilizer,64.61％ used hydrogen peroxide low-temperature plasma sterilization,36.04％ used ethylene oxide sterilization.Conclusion There was a lack of specific posts for precision surgical instruments,especially for cleaning;training for specific posts should be enhanced;cleaning methods were mainly manual and ultrasonic,high pressure steam sterilization was the main method for sterilization.Standardized regulations for cleaning and sterilization are recommended to be made according to different precision surgical instruments.
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Objective:To regulate operation requirement for electric instrument using in surgery and eliminate hidden danger so as to ensure their safety in using.Methods: Through discussed the regulation of operative process for electric instrument using in surgery to develop a insulation detector which can adapt the particular case of hospital, and then to carry out relevant management for this kind of electric instrument.Results: The simplest insulation monitoring method got best reliable data, and it provide accuracy basis for clinical electric instrument. Therefore, it ensured the safety of clinical application of electric instrument.Conclusion: The special insulation monitor detects electric instrument in surgery has series of merits including low investment, fast detection and reliable performance, it not only can ensure the safety of surgery but also can provide traceable basis for preventing relevant medical dispute.
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Many hospitals experience one or more retained surgical instrument events with risk of patient morbidity and medicolegal problems. Identification of retained surgical instrument is important. The radiologists should be familiar with imaging finding of retained surgical instrument. In a 62-year-old female with a retained plastic tube, localized peritoneal infiltration around air-containing tubular structure mimicked acute appendicitis on abdomen computed tomography (CT), one year after laparoscopic cholecystectomy. We reported CT findings of foreign body reaction related to retained Endoloop ligature plastic tube mimicking acute appendicitis.
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Female , Humans , Middle Aged , Abdomen , Appendicitis , Cholecystectomy, Laparoscopic , Foreign Bodies , Foreign-Body Reaction , Ligation , Peritonitis , PlasticsABSTRACT
Objective To investigate the management status of loaner surgical instruments,and evaluate the effect of plan-do-check-act cycle (PDCA)quality control on loaner surgical instrument management.Methods From July 2011 to June 2012,8 965 pieces of loaner surgical instruments before adopting PDCA quality control management was as control group;from July 2012 to June 2013,8 564 pieces of loaner surgical instruments adopting PDCA quality control was as ob-servation group.The defects of loaner surgical instruments during application process and effect of PDCA quality control on loaner surgical instrument management were analyzed.Results There were many problems in checking-tracking,cleaning quality and company personnel of loaner surgical instruments.The qualified rate of observation group was higher than that of control group(99.36% vs 96.27%)(χ2 =194.74,P <0.01).The main causes for unqualification of observation group were unqualified cleaning (n=21 ,38.18%)and incomplete function of instruments(n=8,14.55%);while the main causes for unqualification of control group were the loss of instruments(n=81,24.25%),lack of monitor and record (n=71, 21.26%),unqualified cleaning(n=55,16.47%)and the soaking of package(n=54,16.17%).Conclusion PDCA quality control is an effective method for loaner surgical instruments management,it is helpful for building long-term effective quali-ty control system for loaner surgical instruments,and make loaner surgical instrument management more scientific,system-atic,and standard.
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Objective To develop a newly transparent sheath and explore the application value of the sheath in neuroendoscopic intra-axial surgery Methods Sixty-eight patients,admitted to our hospital from August 2010 to February 2013,underwent endoscopic surgery with the help of new sheath.Pre-operated CT or MRI were performed to locate the puncture direction;the transparent sheath was used to provide a trajectory in the brain parenchyma,and offer the clear vision surround the sheath tube and the puncture direction.Results Forty-eight patients adopted lateral ventricle anterior horn approach and 46 (95.83％) achieved lesions in the first puncture.Three patients with septum pellucidum cyst and one with Monro obstruction were successfully received the cystic wall fenestration or recanalization with the sheath directly.After the entry point were determined with CT in 10 intracerebral hematoma,the sheath was inserted into the hemorrhage cavity simply and easily;and a smash-suction tube was inserted to evacuate the hematoma safely.Conclusion The transparent sheath can be inserted into lateral ventricle,hemorrhage cavity or cyst efficiently,and provide perfect surgical vision around the sheath and the puncture direction to estimate the brain parenchyma,hemorrhage cavity or the hemorrhage remains;therefore,this transparent sheath,as a safely neuroendoscopic intra-axial surgical instrument,is deserved to be spread.
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Rarely, surgical clips can migrate into the biliary tract after laparoscopic cholecystectomy and work as a nidus for biliary stone formation. We report a case of the development of a common bile duct (CBD) stone induced by surgical clip in a 57-year-old man who underwent laparoscopic cholecystectomy 10 years ago. On computed tomography, a CBD stone with a metallic material was found, and endoscopic retrograde cholangiopancreatography (ERCP) revealed a CBD stone including a metallic clip. The stone was removed completely by ERCP, and the surgical clip was found along with the stone.