The Application of Standard Operation Procedures in Laparoscopic Instruments Reprocessing for Quality Improvement

Wu Keping, The Fifth Affiliated Hospital of Sun Yat-sen UniversityCui Zhidan

Layout of CSSD in the Fifth Floor of Medical Tech Building

SOP of Processing Optical System, Instruments and Lumens

Flushing

Washing

Rinsing

Disinfection

Final Rinsing

Lubrication

Drying

CSSD Introduction

CSSD1 CSSD2p

Reusablemedical devices

from clinical departments

Reusablemedical devices from operating

rooms

There are 30 people in our CSSD, including 1 associate chief nurse, 1 supervising nurse, 6 nurses and 22 technicians.

Our CSSD is the training base in Guangdong. We’ve hosted 13 sessions since the foundation in Dec. 2009. The trainees come from 76 hospitals in Guangdong, Guangxi, Hainan and Sichuan. We provide education on collecting ,cleaning, inspection, packaging, sterilization and distribution and we also have trainings in the management of equipment and medical devices and team building. We’ve been promoting the implementation of three national standards and regulations and policies, which has been beneficial for the development of CSSD in Guangdong.

Research Method

Control group: the instruments are processed according to Technical

Standard for Cleaning and Disinfection of Endoscopes (2004).

Test group: the instruments are processed according to WS310.2,

Guidance to the Cleaning, Disinfection and Sterilization of Rigid

Endoscopes, manufacturers’ instructions for use and AAMI ST79 and

the Standard Operation Procedures of Laparoscopic Instruments (SOP).

20 sets of laparoscopic instruments (289 in total) that function properly are

randomly assigned to the test group and control group. Each group has 10 sets of

instruments. The control group has 141 instruments and test group has 148

instruments.

Conclusion The importance of cleaning quality of laparoscopic instruments

Compared with the common instruments, the laparoscopic instruments are delicate, made of various materials, and complex. The long lumens, dead ends, grooves and crevices are easy to harbor blood and other organic contaminants but difficult to clean. Debris are often found in these places which eventually form hard-to-clean biofilm. It will affect the sterilization[4] andcause hospital acquired infections, which threaten the risks of operation and patients’ lives.

The application of SOP in promoting the quality improvement of laparoscopic instruments cleaning

• SOP can improve the cleaning quality

• SOP can prevent the damages to instruments functions

• SOP needs continuous improvements.

Hospital IntroductionThe Fifth Affiliated Hospital of Sun Yat-sen University, a Tertiary A

hospital, is the largest one in Zhuhai with adequate equipments and

a strong technical force. It’s located not far from beautiful mountains

and rivers. The European style buildings are Outpatient Building,

Inpatient Building, Medical Tech Building and Center of Treatment

and Prevention of Tumor. There are more than 1600 healthcare

providers and 1300 bed counts. The Department of General Surgery

is the key discipline at provincial level in Guangdong. The Tumor

Department and Respiratory Medicine are the key disciplines at

municipal level in Zhuhai.

It’s a teaching hospital for high level of medical talents for Sun Yat-

Sen University. It’s responsible for educating the doctors and

postgraduates and undergraduates. Meanwhile, it has been

embarking on multiple technical programs at national and provincial

and municipal levels. The Zhuhai Medical Tech Research Center

has developed over 200 new technologies ever since its

establishment in 2003.

BackgroundAs the minimally invasive technology advances, laparoscopic instrumentss are widely

used in diagnosis and treatment. The laparoscopic instrumentss are delicate and

expensive with complex structures and big challenges to cleaning. The simplified

processing procedures and improper use of cleaning tools are making the situation

worse[1], directly affecting the cleaning effects. The standard operating procedure (SOP)

is to describe the step-to-step information on how to execute one thing and lay down the

optimized processes. Its purpose is to achieve consistency by following the same

procedures. By having the SOP for laparoscopic instruments processing, we will improve

the cleaning quality.

Results

Group Totalnumber

Optical system Light guide andcamera

Cable Instruments

Cracks Badimaging

Damage Greyshadow

Cracks Missingparts

Closure Blades Perfectness ratio

Testgroup

148 0 0 0 0 0 0 0 0 100%

Controlgroup

141 0 0 0 0 1 1 0 0 98.6%

2.1 Functionality Comparison (see Table 1)Table 1: Functionality Comparison of Instruments in Both Groups

Group Optical system Light guide and cable Trocars Instruments Total passrate

Pass Passrate

Pass Pass rate Pass Passrate

Pass Pass rate

Testgroup

10/10 100% 16/20 80% 20/20 100% 87/98 88.8% 89.9%

Controlgroup

4/10 40% 0/20 0 16/20 80% 36/91 39.6% 39.7%

2.2 Cleaning Effects Comparison (see Table 2)Table 2: Cleaning Effects Comparison of Instruments in Both Groups

Layout of CSSD in the First Floor of Medical Tech Building

敷料间

Manual Cleaning of Rigid Endoscopes and Quality Standards

Receiving:CSSD professionals

Tools

Counting the instruments, the name, specification, quantity and

functionality

Sorting and disassembly

Cleaning separately based on the materials

SOP of Processing Cameras, Light Guides and Cable

Wiping with tap water

Wiping with or soaking in enzymatic detergent

Wiping with tap water

Wiping with purified water

Disinfection

Drying

About the authors

Wu KepingAssociate chief nurse, 31 years of experience in nursing. Head nurse of CSSD of the Fifth Affiliated Hospital of Sun Yat-sen University, chairman of committee of Zhuhai Nursing Association, member of standing committee of Guangdong Nursing Association, deputy supervisor of Guangdong Nursing Education Center in CSSD