Analysis of Wet Pack Incidence in Steam Sterilization: A Study in a Chinese Medical Center.

BACKGROUND Central sterile supply departments (CSSDs) play a vital role in hospital infection control. We investigate the factors associated with wet pack occurrence after steam sterilization. MATERIAL AND METHODS We designed a log sheet to record information concerning sterilized packs. The data included the type of sterilized pack; outside weather (sunny, overcast, or rainy); the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been laid flat, upright, or leaning at an acute angle; which sterilizer was used for sterilization of the pack; whether the pack had been placed on the top or bottom shelf inside the sterilizer chamber; whether the pack had been loaded in compliance with guidelines; the drying time following sterilization; and cooling time after sterilization. The sterilized packs in our study were selected from all of the packs that were sterilized in the CSSD of the authors' institution during June to December 2021. RESULTS Factors associated with wet pack occurrence after steam sterilization include: outside weather on the day of sterilization; the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been placed on the top or bottom shelf; and cooling time after sterilization. Statistically significant differences (P<0.05) in wet pack incidence were identified for all of these factors. CONCLUSIONS Various factors are associated with wet pack occurrence after steam sterilization. Recommendations for reducing the risk of wet packs include regular maintenance of the steam pipeline, regular replacement of thermal insulation materials for the steam pipeline, and extension of the drying time.

Status of Professional Identity, Self-Directed Learning Competence, and Self-Efficacy Among Central Sterile Supply Department Nurses.

BACKGROUND Previous studies on professional identity, self-directed learning competence, and self-efficacy among central sterile supply department (CSSD) nurses are rare. We investigated the status of these 3 characteristics among CSSD nurses and offered suggestions, to provide a reference for CSSD talent development. MATERIAL AND METHODS CSSD nurses working in 45 hospitals in southwest China were invited to participate in a questionnaire survey in August 2021. The survey comprised a general information questionnaire, a self-directed learning competence rating scale, a professional identity scale, and a general self-efficacy scale. RESULTS The CSSD nurses' scores for professional identity, self-directed learning competence, and self-efficacy were 109.92±17.161, 125.77±21.316, and 26.92±6.633, respectively. For professional identity, statistically significant differences were identified (P≤0.05) for 3 factors: monthly income, reason for studying nursing, and reason for working in the CSSD. For self-directed learning competence, statistically significant differences (P≤0.05) were identified for 5 factors: age, hospital grade, type of employee, monthly income, and reason for working in the CSSD. For self-efficacy, statistically significant differences were identified (P≤0.05) for 3 factors: age, reason for studying nursing and working in the CSSD, and whether the CSSD nurses wished their children to become nurses. CONCLUSIONS The professional identity, self-directed learning competence, and self-efficacy of the CSSD nurses in this study were at the medium level. More attention should be paid to career planning of young nurses and improvement of their professional identity and self-directed learning competence.

Factors associated with damages and repair costs of reusable flexible bronchoscopes in pediatrics in China.

BACKGROUND: Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures. METHODS: This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes. RESULTS: The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%. CONCLUSION: The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs.

Improvement and implementation of central sterile supply department training program based on action research.

BACKGROUND: This study aimed to improve and implement the central sterile supply department (CSSD) training program through action research and to evaluate its effect. MATERIALS AND METHODS: The project was underpinned by action research. The problems that occurred in training were identified following scenario analysis, interviews, group discussions, and expert consultation to develop improvement measures. The training program characterized by CSSD was developed in the spiral circular process of "Plan-Act-Observe-Reflect". RESULTS: After the two rounds of training, the CSSD nurses significantly improved their professional knowledge, skills, and satisfaction with training compared with those before improvement. The nurses' overall satisfaction with the training and their performance improved. CONCLUSIONS: The implementation of the training program designed based on action research can improve CSSD nurses' professional knowledge and skills and increase their enthusiasm for learning, laying the foundation for CSSD talent development.

Optimizing Sterilization Packaging through Root Cause Analysis: An Exploration into Sealing Defects of Paper-Plastic Pouches.

BACKGROUND Paper-plastic sterilization pouches are essential in healthcare for preventing instrument contamination. However, sealing defects in these pouches can jeopardize patient safety. To address this issue, our study uses Root Cause Analysis (RCA), aiming to identify contributing factors to these defects and propose practical solutions. Through this, we aim to enhance the overall sterilization process. MATERIAL AND METHODS A retrospective analysis was conducted on 35,762 instruments sterilized and packaged in paper-plastic pouches at our hospital's Central Sterile Supply Department (CSSD) across two periods: July 2020 to June 2021 (pre-RCA, 17,563 instruments) and September 2021 to August 2022 (post-RCA, 18,199 instruments). We evaluated RCA scores, packaging personnel's perceptions of sealing quality, and sealing defect rates before and after RCA implementation. RESULTS Root causes for sealing defects included lack of a standardized inspection procedure, inadequately sized packing table, missed inspections, incorrect distribution procedures, inadequate staff training, and insufficient lighting through the pass-through window between storage and distribution rooms. Among these, lack of a standardized inspection procedure, small packing table size, and missed inspections were statistically significant risk factors (P<0.05). The sealing defect rate decreased from 0.15% pre-RCA implementation to 0.07% post-RCA implementation. CONCLUSIONS Implementing RCA has been shown to effectively enhance the CSSD staff's perception of sealing quality and significantly reduce the incidence of sealing defects in paper-plastic pouches. Thus, RCA serves as an invaluable tool for quality improvement in sterilization packaging processes.

Enhancing Nighttime Surgical Instrument Cleaning Efficiency: An ECRS-Based Approach.

BACKGROUND Efficient and timely cleaning of surgical instruments is paramount for optimal patient care. Challenges often arise during the collection and processing of instruments utilized in nighttime surgical procedures, impeding effective cleaning. To address these inefficiencies, we employed the Eliminate-Combine-Rearrange-Simplify (ECRS) strategy to improve the quality and efficiency of nighttime surgical instrument cleaning processes. MATERIAL AND METHODS We optimized the nighttime surgical instrument cleaning process using the ECRS methodology. For the study, 27,308 surgical instruments cleaned between May and June 2021 were categorized as the control group, while 28,471 instruments cleaned between October and November 2021 constituted the observation group. We compared the number of quality defects in instrument cleaning, procedure times, and quantities of cleaning agents used before and after the implementation of ECRS. RESULTS With the ECRS application, the cleaning process was streamlined from 14 steps to 13. The quality defect rate, cleaning time per instrument batch, and average quantity of cleaning agent used per instrument were initially 2.11%, 115 minutes, and 0.278 mL/piece, respectively. Post-ECRS implementation, these measures were significantly reduced to 0.26%, 91 minutes, and 0.193 mL/piece, correspondingly. CONCLUSIONS The ECRS strategy presents a practical solution to optimize the cleaning process for surgical instruments used during nighttime procedures. This approach not only improves the quality and efficiency of cleaning but also contributes to cost reduction. This underscores the potential of ECRS in enhancing healthcare operation management.

Factors associated with deficiencies in packaging of surgical instrument by staff at a single center in China.

BACKGROUND: Surgical instrument packaging quality directly affects the safety and performance of surgery. We aimed to investigate the factors causing defects in surgical instrument packaging and recommend strategies to prevent defects in surgical instrument packaging. METHODS: We collected surgical instrument packaging data regarding age, gender, length of service, educational background, number of staff dealing with packaging, time period of packaging, instrument specification, where the wrap was intact, whether the wrap reached the required quality of cleaning, and whether the instruments were satisfactorily cleaned in compliance with guidelines from 5000 surgical instrument packages during June-December 2018 at Central Sterile Supply Department of the West China Second University Hospital, Sichuan University. Meanwhile, a questionnaire survey completed by the operating room staff using surgical instruments was used to measure the level of their satisfaction with the instruments in the packages. We utilized single-factor analysis to investigate possible factors that might cause defects in surgical instrument packaging, and conducted multivariate logistic regression analysis of the factors associated with defects in packaging. RESULTS: Length of service, educational background, number of staff dealing with packaging, time period of packaging, instrument structure, whether the wrap was intact, whether the wrap reached the required quality of cleaning, and whether the surgical instruments were satisfactorily cleaned in compliance with guidelines were the factors significantly (P < 0.05) associated with defects in surgical instrument packaging. CONCLUSION: This study reveals that various factors are associated with defects in surgical instrument packaging. Recommendations for reducing incidences of defects include improved scheduling of packaging workload, greater provision of training in packaging skills, and standardization of packaging procedure.

Factors affecting implementation and pass rates of surgical instrument moistening.

BACKGROUND: Moistening of surgical instruments affects the quality of instrument cleaning, thereby affecting the degree of cross-contamination and in-hospital infection among patients. Surgical instruments should be kept moist immediately after use in order to avoid concentrations of contamination remaining on surgical instrument surfaces. Implementation and pass rates of surgical instrument moistening have been rarely studied. We aimed to investigate the factors affecting implementation and pass rates of surgical instrument moistening. METHODS: A cross-sectional study was conducted to investigate surgical instrument moistening procedures within 22 clinical departments of the West China Second University Hospital, Sichuan University over 122 days between September and December 2019. We collected data from departmental staff using an interviewer-administrated questionnaire. Data about implementation and pass rates of surgical instrument moistening was analyzed in SPSS20.0. RESULTS: Implementation and pass rates of surgical instrument moistening were 57.25% and 31.98%, respectively. Factor analysis showed that implementation rates of moistening were affected by instrument structure (X2 = 143.670; P = 0.001), the number of instruments inside the pack (X2 = 140.135; P = 0.001), and the person responsible for keeping surgical instruments moist (X2 = 8.052; P = 0.005). Correlation analysis showed that instrument structure and the number of instruments inside the pack were negatively correlated with implementation rates of moistening. The more complex the structure and the greater the number of the instruments inside the pack, the lower implementation rates of moistening. CONCLUSION: Implementation and pass rates of surgical instrument moistening were low, and failed to meet the central sterile supply department applicable industrial standard, hence the potential risk of hospital-acquired infection was considerable. Staff that manipulate reusable surgical instruments should be trained to properly moisten the instruments and institutional protocols should be established to ensure standardization and respect of guidelines.

Mental state of central sterile supply department staff during COVID-19 epidemic and CART analysis.

BACKGROUND: During the COVID-19 epidemic, the central sterile supply department (CSSD) staff handled many devices, implements and non-disposable protective articles used by suspected or confirmed COVID-19 patients. As a result, the CSSD staff may have experienced psychological stress, however, the mental state of the CSSD staff during the COVID-19 epidemic has been rarely studied. We aim to investigate the mental state of the CSSD staff and relevant influencing factors experienced during the COVID-19 epidemic. METHODS: The survey utilising a general information questionnaire, Chinese perceived stress scale (CPSS), self-rating anxiety scale (SAS), and Connor-Davidson resilience scale (CD-RISC) was conducted with 423 CSSD staff members from 35 hospitals in Sichuan Province, China. Data was analysed in SPSS24.0. Classification and regression tree (CART) was utilised to analyse variables and find variation between groups. A chi-square test was performed on enumeration data, and t-test and analysis of variance were performed on measurement data. RESULTS: The CSSD staff's SAS score was 37.39 ± 8.458, their CPSS score was 19.21 ± 7.265, and their CD-RISC score was 64.26 ± 15.129 (Tenacity factor score: 31.70 ± 8.066, Strength factor score: 21.60 ± 5.066, Optimism factor scores: 10.96 ± 3.189). The CPSS score was positively correlated with the SAS score (r = 0.66; P < 0.01), the CPSS score was negatively correlated with the CD-RISC score (r = - 0.617, P < 0.01), and the SAS score was negatively correlated with the CD-RISC score (r = - 0.477, P < 0.01). The job position, age, and political status of the CSSD staff were the main factors affecting their mental state; for example, the CPSS score and SAS score of the CSSD nurses were significantly different from those of the CSSD logistic staff (P < 0.01). CONCLUSION: During the epidemic, the CSSD staff's psychological resilience was at a low level; the anxiety level of the CSSD nurses was higher than that of the CSSD logistic staff. Therefore, more attention should be given to the mental health of the CSSD staff, including taking protective measures regarding the risk factors to ensure they can maintain a healthy mental state.

Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.

BACKGROUND AND OBJECTIVES: Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. METHODS: We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. RESULTS: We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). CONCLUSION: Evidence-based nursing-sensitive quality indicators for the CSSD were established.

Factors associated with cleaning quality of reusable medical devices at a single center in China.

Background: Improper cleaning is one of the main causes of sub-optimal levels of sterilization, and also a risk factor in terms of nosocomial infections. We aimed to investigate the factors associated with the cleaning quality of the reusable medical devices and prescribe improvement measures for ensuring the safe use of the devices and for iatrogenic infection control. Methods: An expert consultation was conducted to identify the factors associated with the cleaning quality of reusable medical devices. A self-designed quality inspection form for reusable medical device cleaning was used to collect the data concerning the factors associated with the cleaning quality of the reusable medical devices cleaned at our hospital's central sterile supply department (CSSD) during January to June 2022. We also investigated the cleaning personnel's perceptions and knowledge of medical devices cleaning by means of a self-designed questionnaire. Results: Statistically significant differences (P < 0.05) were identified among incorrect cleaning procedures, improper cleaning methods, non-standard pre-treatment, wrong perceptions or lack of knowledge of medical device cleaning, and complex device structure. Correct cleaning procedures (odds ratio (OR) = 0.216, 95 % confidential interval (CI): 0.170-0.275), choice of cleaning method (ultrasonic cleaning OR = 3.995, 95 % CI: 2.937-5.434; spray cleaning OR = 0.893, 95 % CI: 0.735-1.085), standard pre-treatment (OR = 1.470, 95 % CI: 1.191-1.815), complex device structure (OR = 1.534, 95 % CI: 1.247-1.888) and cleaning personnel's correct perceptions of medical device cleaning (OR = 0.530, 95 % CI: 0.436-0.645) were the independent factors associated with the cleaning quality. Conclusions: The quality of reusable medical device cleaning should be improved by: adherence to standard cleaning procedures, choosing the correct cleaning method and pre-treatment, improving cleaning personnel's knowledge and perceptions of medical device cleaning, and disassembling the medical devices with complex structures so as to reduce the quality defects of medical device cleaning.

An action research study of quality improvement in instrument packaging procedures for the central sterile supply department.

This study aimed to reduce instrument packaging defects in the Central Sterile Supply Department (CSSD) using action research. Data of the instrument packs packaged by the packaging personnel at the CSSD of the authors' institution during March to May 2023 were collected and analyzed. After identifying the problems, 2 rounds of cyclic process of "plan-action-observe-reflect" were implemented to standardize the packaging procedures and develop and improve the applicable check of standard operating procedures for the CSSD. After strictly implementing the packaging operation standards and checklists, the number of packaging defect cases dropped from 274 to 41. A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 3 items for maintenance. Also, 1 item for assembly had significant differences compared with the baseline number after the first cycle (P ≤ 0.001). A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 20 items for 6 components after the second cycle compared with that after the first cycle (P ≤ 0.05). Through action research methodology, strict implementation of standardized packaging procedures in the CSSD can reduce packaging defects, thereby decreasing clinical complaints and ensuring patient safety.

The effects of health belief model-based intervention on nurses' sterilizing practices when moistening surgical instruments.

OBJECTIVE: We investigated the effects of the Health Belief Model (HBM)-based intervention on nurses' behaviors in terms of keeping surgical instruments moist. MATERIALS AND METHODS: Pre- and post-training surveys about instrument moistening were conducted with the same 356 nurses from a hospital in China. Both of the surveys contained questionnaire concerning general knowledge relating to instrument moistening, perception scale-based questions concerning the same issue, and an inspection form concerning the implementation of moistening procedures. Three months' training was provided for the nurses. RESULTS: After training, the nurses' knowledge, attitudes, beliefs, and behaviors for instrument moistening were improved. CONCLUSIONS: The HBM-based intervention can bring about a significant improvement in nurses' compliance with surgical instrument moistening requirements, and corresponding improvements in instrument cleanliness and patient safety.

OBJETIVO: Investigar los efectos de la intervención basada en el modelo de creencias de salud en los comportamientos de las enfermeras en términos de mantener húmedos los instrumentos quirúrgicos. MÉTODO: Se realizaron encuestas previas y posteriores a la capacitación sobre la humectación de instrumentos con las mismas 356 enfermeras de un hospital en China. Ambas encuestas contenían un cuestionario sobre el conocimiento general relacionado con la humectación del instrumento, preguntas basadas en escalas de percepción sobre el mismo tema y un formulario de inspección sobre la implementación de los procedimientos de humectación. Se proporcionó una formación de 3 meses a las enfermeras. RESULTADOS: Después de la capacitación se mejoraron los conocimientos, las actitudes, las creencias y los comportamientos de las enfermeras para la humectación del instrumento. CONCLUSIONES: La intervención basada en el modelo de creencias en salud puede generar una mejora significativa en el cumplimiento de los requisitos de humectación del instrumental quirúrgico por parte de las enfermeras, y las correspondientes mejoras en la limpieza del instrumental y la seguridad del paciente.

A FOCUS-PDCA quality improvement model for reducing the distribution defect rate of sterile packages.

This study aimed to investigate the effect of the application of the FOCUS-PDCA quality improvement model in terms of reducing the distribution defect rate of the sterile packages processed by the CSSD. The FOCUS-PDCA quality improvement model was applied to analyze the causes of the distribution defects of sterile packages, develop improvement measures, and compare the distribution defect rates before and after the application of the FOCUS-PDCA model. Following implementation of the FOCUS-PDCA quality improvement model, the distribution defect rate of sterile packages decreased from 1.74 to 0.37% (P < 0.05). The FOCUS-PDCA quality improvement model can produce a substantial reduction in the distribution defect rate of sterile packages, ensuring the quality of sterile supplies.

Using the health belief model to analyze nurses' perception toward their behaviors for keeping surgical instruments moist: a cross-sectional study.

BACKGROUND: Nurses' perception toward their behaviors for keeping surgical instruments moist has been rarely studied. METHODS: The survey which utilized a questionnaire regarding respondent's demographic information and a self-designed nurses' perception-behavior scale for keeping surgical instruments moist was conducted with 360 nurses from a hospital in China. RESULTS: Total score of nurses' perception-behavior scale for keeping surgical instruments moist was 139.93 ± 15.145. Score of nurses' perception-behavior scale for keeping surgical instruments moist varied with age, length of service, and job title, with a statistically significant difference (p < 0.05). Length of service was the main factor affecting nurses' perception toward their behaviors for keeping surgical instruments moist. CONCLUSIONS: Nurses should be offered intensive training on keeping surgical instruments moist due to their inadequate perception on it. The nurses' change in health beliefs and behaviors must be based on developing the right attitude.

OBJETIVO: La percepción de los enfermeros sobre sus comportamientos para mantener húmedo el instrumental quirúrgico ha sido poco estudiada. MÉTODOS: La encuesta que utilizó un cuestionario sobre la información demográfica del encuestado y una escala de percepción y comportamiento de las enfermeras de diseño propio para mantener húmedos los instrumentos quirúrgicos se realizó con 360 enfermeras de un hospital en China. RESULTADOS: La puntuación total de la escala de percepción-conducta de las enfermeras para mantener húmedo el instrumental quirúrgico fue de 139.93 ± 15.145. La puntuación de la escala de percepción-conducta de las enfermeras para mantener húmedos los instrumentos quirúrgicos varió con la edad, la duración del servicio y el cargo, con una diferencia estadísticamente significativa (p < 0,05). El tiempo de servicio fue el principal factor que influyó en la percepción de los enfermeros sobre sus comportamientos para mantener húmedo el instrumental quirúrgico. CONCLUSIÓN: Se debe ofrecer a las enfermeras un entrenamiento intensivo sobre el mantenimiento de la humedad del instrumental quirúrgico por su inadecuada percepción al respecto. El cambio de creencias y comportamientos de salud de las enfermeras debe basarse en el desarrollo de la actitud correcta.

Application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects.

Surgical instrument packaging defects may affect the safety of medical care and patients and waste the hospital workforce, material resources, and financial resources. This study explored the application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects. We retrospectively evaluated the packaging process of 183,642 surgical instruments packaged in our hospital during January-June 2020 using the healthcare failure mode and effect analysis. Besides, we used a decision tree model to determine the steps requiring improvement and formulate the improvement measures. We applied the improvement measures to 190,231 surgical instrument packs packaged in our hospital during July-December 2020. Based on the healthcare failure mode and effect analysis, we compared the packaging defect rates before and after adopting the improvement measures. Of the 183,642 packs selected before adopting the improvement measures, 98 defects occurred, with a defect rate of 0.053%. However, of the 190,231 packs selected after adopting the improvement measures, 22 defects occurred, with a defect rate of 0.012%. The defect rate of surgical instrument packaging handled by the central sterile supply department staff was significantly reduced (χ2 = 50.822, P = 0.001) after adopting the improvement measures. Using the medical failure mode and effect analysis method to control the defects in surgical instrument packaging can effectively reduce the packaging defect rate, ensuring patient safety.