Improvement Initiative to Ensure Quality Instrumentation in the OR.

At Seattle Children's Hospital, in November 2016, the operating room (OR) physicians reported experiencing a high number of issues occurring during cases and believed a significant amount was related to sterile processing department (SPD) errors. These errors, hereafter called "defects," were not defined or routinely reported. There was no method of capturing these defects. There was no root cause analysis or trending of defect data. This project aimed to improve the quality of surgical instruments received in the OR. METHODS: The SPD and OR leaders collaborated to develop an OR Case Sign-Out form to capture defects during the case. The data were triaged and assigned to specific departments for root cause analysis. The SPD related data were depicted with a Pareto chart to highlight the most significant opportunities for improvement. We developed a driver diagram and identified the following interventions: orientation and competency, technician OR rotation, capacity/full-time employee analysis, surgical instruments inventory, instrument pouch work trigger, work environment, preventative maintenance, and instrument wrap reduction. RESULTS: A 56% improvement in "Non-Sterile" defects was achieved. While a centerline shift in "Sterile" defects was not observed, the most significant "Sterile" defect, "breach of soft instrument wrap," dropped from 8 occurrences (at baseline) to 1. The number of OR case sign-out forms collected plateaued at 47%, which could indicate missing defect data. CONCLUSIONS: SPD improved quality in the OR by reducing instrument defects. The physicians gained a mechanism for reporting barriers and tracking improvements. Ultimately, the utilization of lean tools and a quality improvement approach helped drive process changes, creating a more efficient, collaborative, and safe procedural environment for patients and staff.

[Latent Chlamydia infections as the cause of health disorders in swine, cattle and sheep breeders in Czechoslovakia]. / Latente Chlamydieninfektionen als Ursache von Gesundheitsstörungen bei Schweine-, Rinder- und Schafzüchtern in der CSFR.

For a twelve year period the health condition of a large group of pig-, cattle- and sheep-breeder was controlled and at the same time an inquiry was carried out why these people suffer from high occurrence of specific health problems which among the rest of the population appear in smaller extent. The performed investigation shows that the primary cause of the specific problems is a latent infection caused by the chlamydia microorganism, namely by the Chlamydia trachomatis group, that can be transferred from animals on people. These microorganisms survive permanently and parasite in the living cells of animals and people and they cause a wide range of specific health difficulties, often subjective, painful and very unpleasant ones, without any manifestation of clinical symptoms which could suggest an infectious disease. These properties of the agent and the fact, that neither human nor veterinary medicine inquire the problems of the relationship between the latent infection and the health of people, makes Chlamydia an extremely dangerous factor affecting people's health. Our paper includes anamnestic data of specific health problems of 746 breeders from 31 farms and results of serological examinations of a group of people with antigens Chlamydia psittaci and Chlamydia trachomatis. The paper also includes a biological experiment which the rise of antibodies of a guinea pig kept and fed with table scraps in the family of one the afflicted breeders as well as the results of serological examinations of a group of animals, the most frequent health problems at the latent course of disease, the course of the disease itself and the author's opinions on necessity of further investigation of the human medicine problems.