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.

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.

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.

[Effects of extracts of Ginkgo biloba leaves on apelin concentration and expressions in plasma and myocardium of rats with myocardial ischemia injury].

OBJECTIVE: To investigate the changes of apelin in plasma and myocardium of model rats and the protective mechanisms of Extracts of Ginkgo biloba leaves (EGb) on myocardial ischemia injury induced by isoproterenol. METHODS: The model of myocardial ischemia injury was induced by subcutaneous injection of high dose isoproterenol. ELISA (enzyme linked immunosorbent assay) was used to measure the apelin concentration in plasma and myocardium. Semi-Quantitative RT-PCR was used to measure the apelin mRNA level in myocardium. The pathomorphology changes of myocardium was observed with light microscope. EGb was administered for 7 weeks. RESULTS: Compared with the normal control group, the apelin concentration in plasma and myocardium and the apelin mRNA level in myocardium significantly decreased in the model group (P < 0.01). Compared with the model group, the apelin concentration in plasma and myocardium and the apelin mRNA level in myocardium obviously increased in the EGb group (P < 0.01). Meanwhile, the NO content in serum also obviously increased and the pathological damage of myocardium was obviously improved. CONCLUSION: The protective mechanisms of EGb on myocardial ischemia injury may be related to the elevation of apelin contents and apelin mRNA level.