This paper mainly discusses the scientific management method of clean operating room. According to the characteristics of the clean operating room, the purification of people and objects and strict management in different areas are carried out. The pollution source is effectively controlled and cross infection is avoided. Pay attention to the quality control, so that the control work of clean operating room can achieve "people do their duty, make the best use of everything", with good quality and efficiency, so as to ensure the safety of operation and patients.
Key words: sterile monitoring of clean operating room
Our hospital is a comprehensive hospital which is managed by the First Affiliated Hospital of Zhongshan Medical University. It integrates medical treatment, teaching, scientific research and prevention, and is characterized by bone and trauma first aid. A new laminar clean operating room was built in February last year. There are eight operating rooms in the room, one level, two level, three level and four level. It has developed rapidly in trauma, spine, artificial joint, nerve, Urology, general surgery, gynecology and obstetrics, otolaryngology and Ophthalmology, with more than 10000 operations performed annually. In recent years, according to the standard of clean operating room of the Ministry of health, the operating room has been monitored. After three times of monitoring by Guangzhou health and epidemic prevention station, the safety standard has been completely reached. However, in the second quarter of 2001, the number of air cultured bacterial colonies exceeded the standard.
In view of this, we have established human, logistics process and strict district management. Our practice is:
1. Avoid cross infection
Change the ward lathe directly into the operating room. One of the factors that may cause cross infection is that the patient transfer car from the hospital to the operating room must cross the polluted area (Ward) and clean area to enter the operating room. In order to avoid this factor, we have changed the way that the ward lathe directly enters the operating room, and selected the exchange bed surface with longitudinal guide rail. The docking car passes through the door of the operating room, and the car body and the docking bed surface move, making the pollution Separate from the clean lathe roller, avoid crossing each other, prevent the transmission of bacteria on the ground, and keep the operation area clean.
2. Ensure comfortable environment of clean operating room
2-1 temperature is generally 22-25 ℃, the relative humidity is 50-60%, which is the best. In the rainy season, the temperature should be lowered to 1-2 ℃ when the machine is started in the morning to facilitate the dehumidification and ensure the quality. The patient adjusted the temperature at 22-25 C after entering the room. It is suitable for patients to feel comfortable A kind of
2-2. Because the operation is relatively compact, if the machine can only be connected after a long time of self purification, it often affects the turnover efficiency of the operation. For example, if the time of self purification is too short, the number of indoor air changes can not achieve the purpose of purification. Therefore, the first level operation (such as joint replacement, cardiac surgery, extracerebral surgery, ophthalmic surgery, etc.) should be performed in the hundred level during the operation Arrange reception. The purification time between stages is about 25 minutes, and the purification time between stages is more than 30 minutes. The operation with more tables can be arranged in another free operating room, which can not only save time, but also achieve the purpose of purification. A kind of
2-3 cleaning time: the cleaning time is 7:00 a.m., which is controlled by the nurse on duty. The test results show that the air filtration and sterilization can be effectively, safely and economically guaranteed after the operation for more than 1 hour. However, it should be emphasized that the machine should be turned on for 1 hour after operation (when cleaning the floor, the purified air conditioning should be adjusted to the lowest speed). To clean the walls, furniture and floors, the quality shall be controlled. Otherwise, the bacteria will exceed the standard. A kind of
3. Air quality and dual channel and door control
3-1 the bacteria controlling the flow of people migrate with the dust particles in the air as the carrier. In the process of operation, the flow of people, the bacteria emitted during the operation, and the droplets pollution during coughing and sneezing make the bacteria unable to be discharged out of the room in time, which is easy to make the harmful bacteria settle at the incision and cause the pollution of the operation site. Control the flow and visit of the personnel between the operations (no visit if the operation is in progress). The visitors can view the operation through the video monitor. Minimizing activities is an effective way to cut off pollution. A kind of
3-2 the route of cleaning medical personnel, patients and cleaning articles for indoor people and objects shall be strictly separated from the postoperative equipment, dressing, dirt, etc., and the sterility shall be placed in the clean area (the personnel shall change clothes strictly, and the articles shall be sterilized). When washing hands and visiting nurses operate between rooms, they should try to reduce the access. In order to prevent frequent access, we put most of the items needed in the operation on the sterile car in the room, so as to keep the operating door closed and maintain the positive pressure in the room. A kind of
4. Sterility monitoring and education
According to the routine, the bacteria monitoring of sterile articles was carried out every month, and the air in the operating room, the surface of objects and the hands of the operators were tested. Through the detection, we found that at the beginning of the operation, the floating colonies were the most, which indicated that when people moved frequently, placed their positions, patients turned over, undressed, and the fibers of cloth shook, the bacteria would unconsciously settle in the sterile operation area and the ground, at this time, the bacteria monitoring, the bacterial content would rise. Therefore, we take the operation, walk gently, reduce the jitter and less use of cloth fiber, and get good results. To eliminate potential risk factors in time, enhance the sensitivity of aseptic operation and sense of control of nurses, and prevent infection are the permanent goals of each operation group. Although doctors used antibiotics before and after the operation. However, it must be recognized that the responsibility of the operating room nurse is the executor who strictly carries out the aseptic operation. Otherwise, the infection during the operation will lead to the failure of the operation.
5. Control the cleaning quality
Before and after the operation, the blood and dust of the door, window, shadowless lamp, infusion stand, instrument table, foot pedal, ground, anesthesia machine, etc. should be removed with 0.5% rapid decontamination wet method. Clean the ceiling, wall and floor once a week, especially the ventilation. The return air port is easy to store dust and bacteria, which should be removed and cleaned. If the cleaning details can not make the air clean, quality control inspection is the work that the head nurse needs to do well. It is found from the quality inspection that cross infection can be caused if the cloth is repeatedly wiped in different places or not cleaned and dried after use. *
6. Effect
After taking the above measures, the air culture in the first level operation room in the third quarter decreased from 64 CFU / cm3 to 10 CFU / cm3, which reached the standard and reduced the infection rate of operation. *
7. Experience
The clean operating room is a multi-functional comprehensive whole. The air purification measures adopted in the clean operating room are to filter and disinfect the dust ions in the air, so as to spread bacteria without carrier. Although air purification is the main contradiction, but more importantly, it depends on the whole process of operation and all-round nursing quality control. We believe that the above measures can effectively control the occurrence of infection, rather than regard air purification as a panacea. So "clean operating room control can not be ignored.". A kind of
References
1. By Yan Huizhong Modern nursing management and quality inspection, Beijing People's Military Medical Publishing House, 1998.53
2. Zhong Xiuling, Cheng Diyan Modern hospital infection nursing, people's military medical press, April 1998 (Beijing)
3. Bao Fei, Zeng yingyu, Yang Xiuxia, Huang Huiqiong, Liu Weiqing: Huangpu hospital, Zhongshan University, 510700
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