What are the responsibilities of the hospital infection management team in the operating theatre and how do they fulfil them? Jan 01, 2024
Surgery is the most fundamental and effective treatment for surgical patients, and therefore the operating theatre has become the main battlefield for surgeons, and belongs to the high-risk departments of hospital infections which should be strengthened in sense control management. The quality of infection control work in the operating theatre depends directly on whether the hospital infection management team in the operating theatre really plays its role as the main force, because they are the trainers and promoters of infection control standards and norms, the formulators of the systematic process, and the supervisors and guides of the implementation process. Ward hospital infection management norms on the ward hospital infection management team composition and its responsibilities to give clear requirements, based on the special nature of the work of the operating theatre, so the focus of the team's responsibilities are also different. The following editor and you run through the operating theatre hospital infection management team (referred to as the team) What are the responsibilities? How to perform their duties?

First, strengthen the system construction

Should be the beginning of the year to develop the department sense of control training programme, responsible for the implementation, end of the year summary. Operating room hospital infection management system, disinfection and isolation system, continuous surgery management system, operating room personnel management system, air purification management system, occupational safety protection system, surgical site infection prevention and control system, medical waste management system and other system development and revision work; timely improvement of medical staff surgical hand disinfection, environmental hygiene monitoring, purification system operation and maintenance, environmental surface cleaning and disinfection The team also improves the operating procedures of surgical hand disinfection, environmental hygiene monitoring, operation and maintenance of decontamination systems, cleaning and disinfection of environmental surfaces, and cleaning and disinfection of laryngoscopes. Team members must develop systems and operating procedures in accordance with the specific requirements of laws and regulations combined with the actual work to complete, direct "fetishism" can not be taken; at the same time, team members should be timely organisation of departmental staff to learn the relevant systems and organise the implementation.

Second, strengthen the training, enhance the rate of knowledge

The team should be fully responsible for all personnel in the operating theatre hospital infection management related knowledge and skills training and assessment, the training object includes all the staff of the department, transfer personnel, trainees, interns, surgical personnel and cleaning staff. The training content includes, but is not limited to, technical specifications for the construction of clean surgical departments in hospitals, management specifications for hospital infections in operating rooms, management specifications for the operation and maintenance of clean operating rooms, technical guidelines for the prevention and control of surgical site infections, surgical hand disinfection, aseptic techniques, practice guidelines for nursing care in the operating room, expert consensus on the prevention of bloodstream infections related to anaesthesia catheterisation, management specifications for the operating room of patients with multi-resistant bacterial infections, and occupational safety and protection, classification and disposal of medical waste and its related hospital infection management system and process. At the same time, cleaning staff should be regularly organised to conduct training and assessment on operating theatre zoning, environmental cleaning and disinfection, and occupational protection.

Key point 1: Operating room environmental cleaning and disinfection is very important for the prevention of surgical site infections, it is recommended that the operating room cleaning staff should be relatively young and relatively fixed, with strong executive ability and learning and understanding ability, and should undergo professional training and strict assessment before taking up the job, and be qualified for the job, and then organise regular training with a problem-oriented approach after taking up the job.

Key point 2: Transfer personnel, advanced trainees and interns should undergo strict infection prevention and control knowledge, aseptic operation and surgical hand disinfection related skills training and assessment before taking up the post.

Third, implement monitoring to ensure the safety of the surgical environment

Training of sampling operation skills

The head nurse or part-time nurse is responsible for organising the nursing staff of the department to carry out theoretical training on the preparation work before sampling, sampling methods, sampling precautions, etc., and at the same time, carry out practical exercises and assessment of operational skills to ensure the correctness of sampling and improve the pass rate of environmental monitoring. The daily monitoring work in the department is generally carried out by part-time nurses, and if the part-time nurses are absent on leave, other nursing teachers should be able to perform the work immediately.

Developing a detailed monitoring plan for medical supplies, environmental hygiene and hand hygiene

The operating theatre belongs to the key department of hospital infection management, and according to the requirements of hospital infection surveillance, environmental hygiene monitoring of air, object surfaces and medical staff's hands should be carried out quarterly, and all operating theatres, sterile storage rooms and other auxiliary rooms should be covered once every six months. Therefore, in order to complete the monitoring on time as required, a detailed monitoring plan should be formulated at the beginning of the year, including monitoring time, monitoring items and judgement labelling, and the monitoring should be implemented according to the plan. When unqualified is found, group discussion should be organised in time, serious analysis should be made, improvement measures should be formulated, and timely re-testing should be carried out after rectification, until the monitoring is qualified before the relevant operation can be carried out.

Focus on monitoring results
After sampling and sending for inspection, the head nurse and part-time nurses should follow up the inspection report in time, print it and paste it on the Environmental Hygiene Report Book to pay attention to the monitoring results. When the monitoring results exceed the standard, should be timely organised to discuss and analyse, develop corrective measures, improve and timely re-inspection, until the monitoring results are qualified to carry out the relevant operations.

Key point 3: laryngoscope is necessary for general anesthesia patients, should be strictly enforced one person, one use, one disinfection; if by the disinfection and supply centre centralized decontamination, should be included in the disinfection and supply centre monitoring plan, disinfection of endoscopes should be at least quarterly monitoring, the number of bacterial colonies ≤ 20cfu / piece is qualified.

Fourth, regular completion of quality control
The content of quality control: the team completes quality control every month according to the "Quality Assessment Standards for Hospital Infection Management in Operating Rooms" of various inspections, mainly including the system process, departmental training, environmental temperature and humidity and differential pressure, personnel management (number of personnel in the operating room and standardised dress code), management of surgical instruments, management of aseptic items, aseptic operation, surgical hand disinfection compliance and the correct rate of the use of a class of cuts of antimicrobial drugs, Personal protection, medical waste management, self-cleaning and environmental cleaning and disinfection in the operating room of the receiving table, monitoring of disinfection effect, implementation of infection prevention and control measures for surgical sites, operation and maintenance of decontamination systems, and implementation of prevention and control measures for infected patients, such as multi-resistant patients, etc., were comprehensively quality-controlled. It analyses the causes of the problems feedback from the hospital infection management department, formulates corrective measures, supervises the implementation of the measures and follows up the effect of the corrective measures, so as to achieve closed-loop management.
Quality control methods
(1) The team members take random sampling to check the cleanliness of luminal instruments to indirectly evaluate the effect of sterilisation of surgical instruments, on-site inspection of the implementation of infection prevention and control measures for surgical site clustering and daily monitoring, on-site demonstration of the environmental hygiene sampling method, access to monitoring to check the surgical staff's and the followers' compliance with surgical hand disinfection and the correctness, asking questions to the staff to understand the content of the training, and the tracking method to check the transfer, transfer, placement and end-of-stage management of multinociceptive patient handover, transfer and placement. In addition, the staff should conduct self-inspection on the knowledge and implementation of relevant measures in various ways, such as transfer, placement and implementation of final disinfection measures, as well as disposal of pathological wastes such as placenta and limbs, etc., and feedback to the parties concerned in a timely manner when problems are found, as well as conveying and re-emphasising them during the morning shift changeover time.
Quality control meeting: at least one hospital infection management quality control activity meeting should be held every month to inform the problems found by quality control at hospital and departmental levels in this month, and to analyse the root causes from the aspects of people, machines, environment, materials, methods and measurements, and to brainstorm, formulate corrective action plans and implement them, and the person-in-charge of the department should evaluate the effect of the corrective action on a regular basis, and improve the minutes of the quality control activity meetings in a timely manner.
V. Risk assessment
Hospital infection prevention and control of the fourth of the ten basic systems of infection risk assessment system, a clear requirement of medical institutions and their departments, departments should be carried out regularly to assess the risk of infection control; hospital level assessment standards also clearly required to strengthen the key departments, key links and key groups of people to carry out risk assessment. Therefore, the operating theatre as a key department of hospital infection should carry out risk assessment. Team members should set up a risk assessment project team to identify and prioritise risks from management indicators (establishment of systems and processes, implementation of systems and processes, and knowledge of hospital infection prevention and control), process indicators (surgical hand disinfection, use of antimicrobial drugs before surgery, temperature, humidity and differential pressure in the operating room, environmental cleanliness and disinfection, environmental hygiene monitoring, aseptic operation, pre-treatment of surgical instruments, intraoperative comprehensive insulation, cleaning of surgical sites, skin preparation, etc.), and risk identification and prioritisation. ) Risk identification, priority ranking, cause analysis, countermeasure formulation and implementation, risk intervention effect evaluation through the results of indicators (environmental hygiene monitoring pass rate, environmental cleaning and disinfection pass rate, skin preparation normative rate, surgical hand disinfection compliance and correct rate, etc.).

VI. Regularly organise emergency drills for occupational exposure
All kinds of puncture, suture, instrument delivery, etc. will cause sharp instrument injury occupational exposure of operating room staff, daily work should be implemented in all standard prevention, safe injection and contact-free delivery to avoid or reduce the occurrence of occupational exposure. However, walking by the river may occasionally result in wet shoes. Timely and standardised emergency treatment after occupational exposure will greatly reduce the risk of being infected, and this is a skill that everyone must be proficient in. Therefore, the team should formulate an emergency drill plan for occupational exposure, drill scripts and organise regular drills according to the requirements of relevant norms and standards, identify problems through drills, summarise and analyse them in a timely manner, and formulate improvement plans. Through practical drills, the emergency response ability can be improved and the risk of being infected can be truly reduced.

VII. Understanding the incidence of surgical site infection
The team should pay attention to the sense of control department issued by the hospital infection monitoring and analysis report every month to understand the incidence of surgical site infections this month, the occurrence of departments and infected parts, etc., especially attaches great importance to a class of incision infections, organisational discussions, brainstorming, from the people, machines, environment, materials, methods, measurements of the six aspects of the analysis of the operating room may be related to infection risk factors for the focus on the need to improve in-depth study of the norms, evidence-based literature The main purpose of this project is to improve the quality of the operating theatre and to improve the quality of the operating theatre.

Eight, careful planning, timely summary
Group every six months and the end of the year in a timely manner on the completion of the department's hospital infection management work to sum up, including the development of systems and processes, the department's training, the completion of the relevant indicators and deficiencies in the daily work. The team carefully analyses the shortcomings and makes detailed work plans according to the norms and standards, including training plans, monitoring plans, emergency drills and hospital infection management plans, and supervises the departmental staff to complete the relevant work in a timely manner.

As a key department of hospital infection management, the operating room has a complex surgical team, including anaesthesiologists, visiting nurses, instrumentation nurses, and surgeons; invasive operations, including surgical treatments, deep vein cannulation and various anaesthesia puncture; at the same time, if the operation and maintenance of the clean operating room is not timely or in place, it will significantly increase the risk of infection. Therefore, the departmental hospital infection management team should give full play to its corresponding role, strictly perform the duties of training, supervision, education and guidance, improve the organisational structure, strengthen the construction of the system, implement the process management, and look at the process through the results of the indicators, so as to escort the safety of surgical patients.


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