改善手術全期護理人員執行術前護理評估之專案——以新住民手術病人為例

Reducing the Difficulty of Performing Preoperative Nursing Assessment for Perioperative Nurses on Immigrant Resident Surgical Patient

手術器械盤包如發生潮濕視同滅菌失敗，易引起手術部位的感染，本專案目的在改善手術器械盤包滅菌現象後潮濕盤包件數，以落實感染管控之病人安全目標。專案前手術器械盤包潮濕每月平均為21.7件，經現況分析發現導因有配備包裝、滅菌裝載、滅菌後處理流程不佳及設備不足等因素。運用決策矩陣分析法擬定解決辦法為修訂器械配備包裝、滅菌裝載及滅菌後冷卻之標準作業程序及查核機制，及時發現問題與處理、舉辦教育訓練課程充實人員感控知識及採購汽水分離器、增加滅菌鍋架等措施；專案實施後，2012年12月至2013年8月，手術器械盤包滅菌後潮濕件數降至每月平均0.4件，且均能經由品管機制攔截不良品；有效提昇滅菌品質並落實病人安全控制。

A wet pack refers to a set of operation instruments in a central supply room that have not been sterilized appropriately. Wet packs can easily induce surgical-site infections. The purpose of this project was to reduce the occurrence of wet packs and to meet the infection control requirements for patient safety goals. An average of 21.7 wet packs of operation instruments occurred per month. After analyzing the current situations, several factors for improper wrapping of instruments trays, loading of sterilization carts, poor processing after sterilization, and shortage of equipments were observed. The decision-matrix analysis method was applied to establish a solution for revising the instrument tray packing process, the standard operating procedure, and the verification mechanism for loading sterilized instruments and cooling after sterilization. Additional objectives involved determining problems and solving them in a timely manner, conducting a training course for enhancing infection control knowledge, adding a steam-water separator, and increasing the number of shelves for sterilization. After this project commenced, the occurrence of wet packs was reduced to 0.4 per month from December 2012 to August 2013. The problematic items could be intercepted using the mechanism of the quality control system. This project effectively increased the quality of sterilization and implementation of patient safety control.