INFORMATION BLOCK
On the subject: "Sterilization and its role in the prevention of nosocomial infections"
Teacher: Natalya Mikhailovna Kruglova
Structure of the central sterilization department
The tasks of the central sterilization department (CSO) are to provide a medical institution with medical products and to introduce modern methods of pre-sterilization cleaning and sterilization into practice.
Principles of CSO placement and planning:
Isolation from other premises of the medical institution;
Functional zoning, that is, the purpose and placement of premises corresponds to the rational conduct of the technological process and does not violate the regime in the central office;
Zoning, that is, the division of all rooms of the technological process into zones: sterile and non-sterile;
Threading with the allocation of separate processing threads:
Ø of linen and dressings;
Ø of instruments, syringes, needles, heat-sensitive products;
Ø gloves in an isolated non-passable room.
Sterilization(from Lat. sterilis - Latin provision) ensures the death of vegetative and spore forms of pathogenic and non-pathogenic organisms on sterilized products.
Sterilization should be performed on all products that come into contact with the wound surface, in contact with blood or injectable drugs, as well as medical instruments that come into contact with the mucous membrane during use and can cause damage to it.
PHYSICAL METHOD OF STERILIZATION
Air sterilization (dry hot air)
Dry heat sterilization is carried out in air sterilizers that operate on the principle of hot air circulation, with a fixed temperature regime and time required to complete the sterilization process.
Air sterilizer device:
The air sterilizer consists of a metal case (1) in which the heating elements are located, a sterilization (working) chamber (2) with lattice shelves (3) for placing sterilized objects on them, a thermostat (4).
Air sterilizers can be horizontal, vertical, round, rectangular in shape. Air sterilizers can be stationary and portable.
Sterilization rules
1. Products for sterilization are stacked disassembled;
2. Large items should be placed on the top metal grate so that they do not impede the flow of hot air;
3. The products to be sterilized must be laid horizontally across the slots of the cassettes, shelves, evenly distributing them;
4. Products should not touch each other
5. Be sure to place a sterility indicator in the sterilizer
6. Loading and unloading from air sterilizers should preferably be carried out at a temperature in the chamber of 40-50 ° C.
Advantages dry-heat sterilization method consists in the fact that when it is applied, corrosion of metals and instruments is not observed, glass surfaces are not damaged, and all objects are evenly heated.
Disadvantage of the dry heat method consists in a long cycle time (2-4 hours depending on the volume of the sterilization chamber, the number of objects to be sterilized and the set temperature).
Chemical sterilization
The radiation method is necessary for the sterilization of products made of heat-labile materials, biological (vaccines, serums) and drugs... The sterilizing agent is γ (gamma) and | 3 (beta) - radiation.
GLOSSARY OF TERMS
Antiseptic- a set of therapeutic and prophylactic measures aimed at destroying microbes in a wound, other pathological formation or the body as a whole.
Asepsis- a system of measures aimed at preventing the introduction of infectious agents into the wound, tissues, organs, body cavity of the patient during surgery, dressings, endoscopy and other medical and diagnostic procedures.
Bacteriostaticity- the property of agents of physical, chemical and biological nature to prevent the reproduction of bacteria and cause bacteriostasis.
Bactericidal- the property of agents of physical, chemical and biological nature to cause the death of bacteria. "
Virucidal- the ability of a chemical or physical factor to inactivate viruses.
Invasive procedures- manipulations in which the integrity of tissues, blood vessels, cavities is violated.
Infection control- a system of organizational, preventive and anti-epidemic measures aimed at preventing the emergence and spread of infectious diseases in the hospital, and based on the results of epidemiological diagnostics.
Controversy- the form of reproduction of some lower organisms, such as fungi; some bacteria that are resistant to drying out, to high temperatures and to chemicals take the form of spores.
Sterile field- a workspace free from microorganisms, on which only sterile items are located.
Sterilants- chemicals of various origins and composition, causing the death of all microorganisms, including bacterial spores
INFORMATION BLOCK
In prevention nosocomial infection(NKI) an important role is played by measures aimed at suppressing the action of natural and artificial mechanisms of transmission of infection. The organization and implementation of effective preventive and sanitary-anti-epidemic measures make it possible to ensure the safety of medical care for both patients and personnel, and to reduce the level of NCI.
In the complex of measures for non-specific prophylaxis (NCP), sterilization of medical devices is of paramount importance. The introduction of new methodological approaches and organizational measures to improve sterilization in the practice of medical institutions can significantly increase its reliability, reduce the level of NCI in surgical hospitals.
In recent years in medical practice the use of new medical technologies is expanding. The use of sophisticated equipment and instruments puts forward the task of their reliable disinfection and sterilization.
To the main tasks provision of sterile materials include: improving the organization of sterilization services in each health care facility and in the country as a whole, improving existing methods and sterilization modes, search and implementation of new effective methods, development of new methodological approaches aimed at increasing the reliability of sterilization measures, development, creation and implementation of modern sterilization equipment in practice, optimization of sterilization control methods.
When organizing sterilization measures In a health care facility, it is necessary to solve a whole range of problems: issues of rational planning of premises in the central sterilization department (CSO), equipping with modern equipment, requirements for the operating mode, training of qualified personnel and other important points.
Studies have shown that for effective work of the CSO the correct layout of the premises is of particular importance. When organizing a typical CSO, it was proposed to divide its premises into three zones: dirty, where the received products are received, disassembled and pre-sterilized, clean - for picking, packaging and preparing products for sterilization and sterile.
Department of CSO into three zones minimizes the possibility of microbial contamination of sterilized products from environment, allows to significantly reduce the possibility of re-contamination of products that have undergone pre-sterilization cleaning, to exclude the intersection of cargo flows of sterile and non-sterile materials, to separate the flows of processing instruments, rubber products and other items.
Into the sphere service of our CSO in addition to a multidisciplinary hospital with 1200 beds, more than 30 different medical facilities were included, including a maternity hospital, 4 polyclinics, a rehabilitation center, sanatoriums, rest homes with a radius of up to 80 km. Thus, the CSO has become a sterilization center for medical institutions of various profiles.
Based on the research and generalization of advanced domestic and foreign experience, new methodological approaches were introduced, aimed at increasing the reliability of sterilization. The latter depends primarily on the quality of pre-sterilization cleaning - critical stage modern sterilization. Manual pre-sterilization cleaning is laborious, ineffective, distracting a large number of medical personnel. In this regard, the primary task was to equip the healthcare facility with modern washing equipment for pre-sterilization cleaning.
Neglect of measures to protect against reinfection negates all efforts to prepare and conduct sterilization.
It should be emphasized that the most important role in maintaining sterility is played by modern laminated combined packaging materials. Their use in hospitals allows for a reliable level of asepsis.
Practical implementation of the system measures for the protection of sterile products in the conditions of the Federal State Institution “Central Clinical Hospital with a Polyclinic” of the Presidential Administration of the Russian Federation ruled out the reinfection of sterilized materials.
For a comparative analysis we took three periods: the first period (1981-1986) - the beginning of observations, the second period (1986-1990) - the continuation of observations, and the third period (2005-2009) - the end of the work on this study.
Some authors emphasize endogenous source P. aeruginosa... This is evidenced by data on a significant number of endogenous colonization with Pseudomonas aeruginosa (25.8%) in patients admitted to the clinic (n = 473) at the entrance ( positive results nasal samples, tracheal aspirate, rectal tests). As a result of genotyping, it was found that 50% of cases of P. aeruginosa infection or colonization resulted from the transmission of strains (exogenous source). Other cases are believed to have originated from an endogenous source.
Probably, there is both one and the other transmission path infections, and this depends both on the epidemic situation in the clinic and on the patient population.
To the factors contributing to the exogenous transmission pathway in nosocomial infection(NCI), some authors attribute:
contaminated ventilation equipment (endotracheal and tracheostomy tubes, humidifier);
reusable oral and tracheobronchial tree catheters;
poorly processed bronchoscopes for diagnostic and sanitation bronchoscopy;
hands of medical personnel;
contamination of the air in the resuscitation ward in case of unsatisfactory operation of the supply and exhaust ventilation, etc.
With endogenous primary pathway transmission mechanism penetration of bacteria into the lower respiratory tract can be aspiration of contaminated secretions of the oropharynx from the area where the cuff of the endotracheal tube is located, aspiration of blood and non-sterile contents of the esophagus / stomach.
Nosocomial infections (nosocomial infections) are one of the main problems of modern healthcare. The purpose of the organization of centralized sta
problems of modern health care.
The purpose of organizing centralized sterilization
departments is the prevention of nosocomial infections with parenteral
transmission mechanism.
The process of sterilization of instruments, linen, dressings
materials, etc. is carried out in the Centralized
sterilization departments (CSO), which are
a unique engineering and technical complex equipped with
modern technology, guaranteed to provide
sterility of medical products.
STERILIZATION
Sterilization is a method that ensures death in the sterilized
material of vegetative and spore forms of pathogenic and non-pathogenic
microorganisms.
All items or individual types must be sterilized.
diagnostic equipment in contact with a wound, blood,
injections with damaged mucous membranes. The equipment of the CSO is
medical equipment:
The main tasks of the CSO are: - provision of medical departments (institutions) with sterile medical products; - search, evaluation and implementation
The main tasks of the CSO are:- provision of medical departments (institutions) with sterile
medical devices;
- search, assessment and implementation into practice of modern effective
methods of pre-sterilization processing and sterilization;
- organization of a system of constant monitoring of efficiency
sterilization;
- control over the use of sterile products in clinical
branches;
- training of personnel in the specialty;
All technological equipment used in the central control center must have automatic control, as well as the function of documenting the parameters
All technological equipment,used in the CSO must have
automatic control as well as function
documenting sterilization parameters for
ensuring postoperative control
the quality of the processed products.
Together with the automation of the main
processes, this guarantees high-quality
pre-sterilization cleaning and sterilization. Sterilization of medical products in hospitals
- a complex multistage process consisting of several
stages, each of which determines the quality of sterilization:
preliminary disinfection and processing of products on site
use (in procedural, operating rooms, dressings and
etc.);
pre-sterilization cleaning of products;
azopyram sample
sterilization packaging;
sterilization;
storage and transportation to sterile use
products. Modern central sterilization department
must have 3 zones:
"Dirty", "clean" and "sterile"
according to the requirements of regulatory documents
1. MR No. 15-6 / 8 dated 01.02.90 "Methodological recommendations for the organization
centralized sterilization facilities in hospitals ",
2. "Manual for the design of healthcare institutions (to SNiP2.08.02-89
section 3 "Specialized, auxiliary units and service and household
premises ")",
3.MU 287-113-98 "Guidelines for disinfection, pre-sterilization
cleaning and sterilization of medical devices ",
4. GOST R 51935-2002 (EN 285) “Large steam sterilizers. General technical
requirements and test methods ",
5. GOST R ISO 13683-2000 “Sterilization of medical products. Requirements to
validation and monitoring. The "dirty zone" is the premises
where the tools are delivered
after disinfection, where they undergo further processing.
In the office for receiving instruments, instruments are transferred from hand to
hands, and their number is recorded by the signatures of the CSO employee and
who handed over the tools to
"Journal of receiving instrumentation"
The "Dirty" area communicates with the "Clean" area by means of a closing transfer window (for transferring instruments, washed, disinfected
"Dirty" zone communicates with "Clean" by means of a closingtransfer window (for transferring instruments washed,
disinfected and dried).
The "clean" area is those rooms where tools and
the materials are already clean, but not yet sterile.
These areas include the packing and preparation rooms.
sterilization of instruments, textiles, dressings
materials.
In the clean area, the quality control of cleaning, preparation of sets, packaging and preparation for sterilization of products is carried out.
Azopyram test
Quality controlpre-sterilization cleaning is carried out
by setting an azopyram sample
(to reveal hidden traces of blood). 1% of one name is subject to control,
but not less than 3-5 units.
The working solution is used to treat the investigated
products.
The result is read no later than 1 min.
The lack of staining is regarded as
negative result.
Phenolphthalein test
The phenolphthalein test is carried out with the aim ofcheck availability detergentsSterilization of medical products
appointments are carried out with the aim of killing all of them
pathogenic and non-pathogenic microorganisms, including
the number of their spore forms. Sterilization is carried out
physical (steam, air, in an environment of heated
balls) and chemical methods(solutions
chemicals, gas) methods.
* With steam sterilization
the sterilizing agent is water
saturated steam under an overpressure of 0.05 MPa - 1.21 MPa with a temperature of 110-135C.
* When sterilized by air
the sterilizing agent is dry hot
air with a temperature of 160 and 180C.
Table "Modes of sterilization of some medical instruments"
Waysterilization
Temperature,
° C
Dry hot
by air
(dry air
sterilizer)
180
Water
saturated
ferry under
redundant
pressure
(autoclave)
132
120
Pressure,
Exposition,
kgf / sq. cm
min.
Material
processed
products
60
According to
instructions
2,0
20
metal, glass,
textile
materials, rubber
1,1
45
rubber, latex,
separate
polymer
materials To control sterilization, special
thermal indicators. They allow you to exercise both external (outside
products) and internal (in packaging with products) control. After graduation
sterilization and always before using sterile material
check tests. They should change color. If at least one strip is not
discolored, all material is re-sterilized.
Shelf life of sterilized products:
in bix without a filter, in a craft bag (on paper clips) - 3 days;
in parchment, non-impregnated sack paper, sack paper
moisture-proof, high-strength packaging paper, crepe paper,
sterilization box with filter - 20 days.
In self-adhesive combination bags - 6 months
In combined packages soldered with a heat-sealing machine - up to 1
of the year.
A heat-sealing machine is installed in the Central Security Service for packaging instruments in paper-laminated bags, followed by sterilization in a
The CSO installsheat sealing machine for
packaging tools
in paper-laminate
packages followed by
sterilization in an autoclave.
Toolkit in such
packaging saves
sterility up to 1 year
(provided that
the integrity of the packaging).
It should be clean in modern healthcare facilities. And special attention is paid to this postulate of Moidodyr, since it is a well-known fact - insidious nosocomial infections find more sophisticated ways to penetrate medical facilities. How to prevent them? Which tool is most effective in using preventive measures? What should be the material and technical support of disinfection and sterilization measures? What is the role of nursing staff? There are many questions. The answers to them are determined by the sanitary requirements for the organization of preventive and anti-epidemic measures, taking into account the profile of medical and preventive institutions, the types and number of manipulations carried out. As part of this publication, we will consider special case... Or rather, we will go to one of the leading specialized medical and preventive institutions of the Republic of Tatarstan - the Republican Clinical Oncological Dispensary, and, using the example of the work of the nursing service, we will try to formulate several principles effective prevention VBI. Our expert in this matter was the chief nurse of GAUZ RKOD MH RT Ramziya Ibragimovna Rakhimova, which spoke mainly about the measures and features of disinfection of those rooms in which cancer patients are located after surgery.
— The spread of nosocomial infections (nosocomial infections) in medical institutions is determined by a number of factors, such as: the type of institution, the etiological structure of nosocomial infections, the peculiarities of their distribution, the mechanism and routes of transmission, the organization of medical care, the level of sanitary and hygienic and anti-epidemic regime. All this, of course, significantly enhances the role of disinfection and sterilization measures included in the system for the prevention of nosocomial infections. So, one of the most effective methods for the prevention of nosocomial infections is ultraviolet irradiation, aimed at suppressing the vital activity of microorganisms in air environment and on surfaces. All manipulation rooms and wards of our hospital are equipped with stationary wall-mounted ultraviolet bactericidal lamps. open type... In addition to wall-mounted bactericidal lamps of an open type, a mobile irradiator-recirculator "Dezar-4" is also used in dressing rooms for dressing patients and in postoperative wards of surgical departments. The operating unit and the resuscitation and intensive care wards are equipped with wall-mounted irradiators-recirculators "Dezar-3" (closed type), which make it possible to disinfect the air in the presence of patients and personnel.
- What role does disinfection play in the prevention of nosocomial infections?
- Huge, if not - leading. The problem of prevention of nosocomial infection is extremely urgent today. In the activities of the chief nurse of any healthcare facility, the prevention of nosocomial infections is one of the most responsible sections of the work. Monitoring the implementation of measures to interrupt the transmission of infection, providing all services of the dispensary with disinfectants, disposable consumables, disposing of hospital waste, training personnel to comply with the anti-epidemic regime, participation in the work of the anti-epidemic commission, and much more are included in a number of her job duties. This large and multifaceted work is being carried out jointly with the epidemiological department and the Council of Nurses.
In the dispensary, nursing staff in terms of the prevention of nosocomial infections is assigned the role of an organizer, a responsible executor and a supervising body.
Of course, the contact of medical personnel with patients is carried out by hand. Therefore, their protection is so necessary. To date, the dispensary is working on the implementation of the European standard for hand treatment EN - 1500. To resolve this issue, modern skin antiseptics, antibacterial soap have been purchased, and practical classes are being held with medical personnel to study hand treatment technology. Disinfecting wipes of single use are used in palliative care and emergency departments, their use facilitates and simplifies the technique of treating the skin of the injection field, in addition, the wipes are convenient for hygienic treatment of hands.
- You have a disinfection and sterilization department. What is the essence of his work?
- 5 years ago, a disinfection and sterilization department (DSO) began to function in our dispensary. This department has united: central sterilization department ( CSO), a disinfection unit and a hospital laundry. One of the main tasks of the department is, of course, the prevention of nosocomial infections in medical institution and prevention of occupational diseases of the personnel. The main task of the CSO is to provide the dispensary with sterile medical products and dressings. This greatly facilitates the work of medical personnel in the field. Considering that high-tech operations are carried out in our dispensary, where modern instruments are used, the CSO division is equipped with high-quality equipment: through-type washing and disinfection machines, heat-sealing machines, drying ovens and through-type steam sterilizers. Sterilizers are equipped with a computer device that allows you to constantly monitor the temperature and pressure (these data are recorded by recorders on the diagram). Of course, this procedure kills all pathogenic and non-pathogenic microorganisms. At the same time, the effectiveness of the disinfection Various physical and chemical factors will be affected: temperature, concentration of disinfectant solution, properties and quality of water, configuration of processed products, massiveness of microbial contamination and duration of treatment. Such a moment is important, before processing it is necessary to disassemble the tools in order to provide access disinfectants agents to all surfaces of products. Of particular importance is the presence of residues of blood, purulent, medicinal and other contaminants on the instruments. In practical conditions, it is impossible to allow the residues of organic contamination to dry on the instruments, therefore, all used instruments are immersed in a disinfectant immediately after use.
- What is the role of the laundry? Are disposable underwear used and when?
— The bed linen of the patient is changed by the staff as many times as necessary to maintain cleanliness in the ward. The disinfection chamber unit carries out a full-fledged disinfection and disinfection of bedding and, if necessary, clothes in des. camera. In this disinfection chamber, things for processing are put on a trolley, the number of things is normalized by the volume of the trolley, foam rubber, synthetic and cotton items can be processed at the same time. Bedding is processed after each patient is discharged and during hospital transfers. The device and equipment of the laundry is part of a unified system for the prevention of nosocomial infections and is aimed at reducing the risk of their occurrence and spread by introducing a perfect organization of the linen regime and modern technologies for processing textiles. The set of equipment includes barrier washing machines, tumble dryers, ironing rollers. All linen from the departments (without pretreatment) in packed form is handed over to the laundry, where it is put into the washing machines of the pass-through type, in which the linen is disinfected and washed at the same time. The laundry is already returned to the operating units in a sterile form. And one more important point- data on the work of the entire department (laundry, disinfection camera, CSO) in the context of departments and offices are daily entered into a computer, which makes it possible to conduct a retrospective analysis for any period of time in order to prevent the emergence and spread of nosocomial infections.
- What innovative methods are used for cleaning premises?
- Since March 2011, the Center for Nuclear Medicine began to introduce the bucket-free method of SWEP High Speed (Vileda). This method aims to provide a safe and adequate sanitation environment. The main goal of professional cleaning is to thoroughly remove dust and various organic contaminants. When cleaning, you must adhere to a certain order.
- What?
- cleaning should start from a cleaner surface and gradually move on to a dirtier one. A hospital multifunctional integrated cleaning system is used to clean the center - an innovative cleaning system designed with special needs in mind, does not require the use of buckets of working solution. The attachments are pre-soaked with a disinfectant solution, used once and folded into a bag for used attachments for further washing and disinfection. Color coding is used for different cleaning zones, which eliminates the possibility of contamination of objects.
The introduction of this system leads to savings in disinfectants and water, an increase in labor productivity, and allows to reduce physical activity on junior medical personnel, effectively in order to prevent nosocomial infection of patients and staff.
In conclusion, it should be noted that the correctness of actions in the process of diagnosis, treatment and patient care will depend on the knowledge and practical skills of the staff. Consciousness and careful implementation of the anti-epidemic regime by medical personnel can prevent occupational morbidity of employees and nosocomial infection of patients.
Ministry of Education and Science of the Samara Region
Department of Health of the Administration of Samara
GOU SPO Samara Medical College named after N. Lyapina
GRADUATE QUALIFICATION (DIPLOMA) WORK
The role of the head's sister in improving the organization of work of the CSO MMUGKB No. 1 named after N.I. Pirogova
Samara 2007
Introduction
1.1 Quality medical services and the activities of health care institutions to ensure the quality of medical services
Chapter Conclusions
Chapter Conclusions
Conclusion
Bibliography
Subject of the research: analysis of the professional activity of the nurse-organizer of the CSO MMUGKB № 1 named. NI Pirogov to improve the organization of the work of the department.
Purpose of the study: increasing the role of the organizer sister in organizing the activities and personnel management of the CSO to improve the quality of healthcare services aimed at preventing nosocomial infectious diseases among patients and medical personnel of the Moscow Medical Clinical Hospital No. 1 named after N.I. Pirogova.
Research objectives:
1. To reveal the content of the concept of "quality of medical care", to define the professional role of the nurse-organizer in the implementation of measures to create a safe environment for patients and medical personnel in the Moscow Medical Clinical Hospital No. 1 named after NI Pirogov and prevention of nosocomial infectious diseases in them;
2. Consider the main technologies and approaches in the organization of activities and personnel management, and their effectiveness in applying in health care institutions;
3. Determine the main factors of influence on the organization of activities and personnel management of a medical institution;
4. Investigate the effectiveness of the organization of activities and personnel management in the CSO MMUGKB № 1 named. N.I. Pirogova;
Research methods:
· Work with medical and statistical documentation;
· Qualitative and quantitative analysis of the personnel of the Central Social Service and its impact on the creation of a safe environment for patients and medical personnel in the Moscow Medical and Clinical Hospital No. 1 named after N.I. Pirogova;
· Analysis of the results of professional activities of the organizing sister and the medical staff of the department.
Practical significance: to show in practice the role of the nurse-organizer in organizing the activities of the CSO to improve the quality of medical services, aimed at creating a safe environment for patients and medical personnel in the hospital.
Chapter 1. Theoretical study of the problem of organizing the improvement of the quality of medical services
1.1 The quality of medical services and the activities of health care institutions to ensure the quality of medical services
Currently, every healthcare institution faces the need to solve many complex problems arising from the constant increase in the cost of medical services. In search of a solution to these problems, the administration of each of these institutions and its medical personnel must make every effort to improve the efficiency of their institution while maintaining the quality of the services provided. Successful healthcare institutions today must coordinate their medical, administrative, nursing and other personnel to confront cost and quality issues through efficient resource management.
The quality of care in a large hospital depends on many different factors.
Their systematization and organization of management of relevant processes is an important step in creating a quality assurance management system for medical care.
The main activities to ensure the quality of medical services of a healthcare institution are:
· Control of infections;
· An overview of accidents, injuries, patient safety and issues of greatest risk;
These quality assurance activities focus on those areas that have the greatest impact across the organization. They should be included in the organization's overall quality assurance program to ensure effective integration and effective operation.
1. Infection control
Effective infection control includes measures for the prevention, detection and control of infections received in a given institution or brought in from outside. Since in this case all departments are exposed to infection, its control is a function common to the entire medical institution.
Studies show that approximately 2.1 million patients (6% of all hospitalizations) are infected with nosocomial infections each year.
Each year, 20,000 to 80,000 deaths are the result of these infections, placing hospital-acquired infections among the top 10 leading causes of death, even in developed countries (such as the United States). On average, nosocomial infections that do not lead to a lethal outcome add 4 extra days to the hospital stay and cost approximately 36,000 rubles; these costs are usually borne by the hospital and not the patient.
An infection control program has several basic elements:
1. Identification of nosocomial infection for surveillance purposes to ensure early, widespread detection and reporting of infection and to establish an indicator of patient infection rates.
A practical system for communicating, evaluating and maintaining medical records of infections among patients and staff. Such a system includes the allocation of responsibility for the ongoing collection and analytical review of data, and the necessary follow-up.
2. Continuous review and evaluation of all aseptic, antiseptic and decontamination methods used in the hospital in accordance with generally accepted methodology and practice.
3. A formally developed methodology that defines specific guidelines for isolation conditions in accordance with the state of health in each individual case. It ensures that the quality of services, including nursing services and the use of monitoring and other special equipment, does not deteriorate for patients in need of isolation.
4. Prophylactic, control and review procedures related to the logistics of this hospital, including sterilization, centralized services, cleaning, laundry, maintenance, food sterility, and garbage and waste disposal. These processes need to be constantly evaluated and analyzed.
5. Providing all necessary laboratory support, especially microbiological and serological.
6. Participation in the development of a comprehensive health program for employees.
7. Orientation of all new hires on the importance of infection control and personal hygiene, and communication of the degree of participation in the program. This includes special in-service training for staff related to prevention and control for all departments / services.
8. Coordination of activities of medical personnel based on data obtained from a systematic assessment clinical use medicines.
Any medical institution must have a developed and written, formal strategy. practical action for all their services. In addition to the general requirements for antiseptics and asepsis, there are written methods and practices for each field of activity, including any requirements dictated by the physical location of the department, the personnel and equipment involved, and in the field of providing medical services to the patient, the type of patient to be hospitalized and treated. ... This methodology and practice is being developed in collaboration with all departments and services of the clinical hospital.
Specific guidelines should be developed and made available to all personnel for all procedures commonly used in patient care for potential nosocomial infections. These instructions should also cover the selection, storage, handling, use and disposal of used items. Such formalized methodologies and practices should be reviewed at least once a year and revised as necessary.
When evaluating the effectiveness of a hospital infection control program, at least the following should be considered:
· Infections within the hospital, especially with regard to their management and epidemiological potential;
· Sufficient culture of medical personnel required from the medical institution by the rules or instructions of the federal, regional, local level;
· Results of trends identified during the antimicrobial susceptibility / resistance study;
· Proposals and minutes special studies facility-wide infection control and any follow-up data;
· Medical records showing the presence of infections that were not included in the final diagnosis.
Infection control authority communicates its data and recommendations to medical personnel, chief executive officer and supervisor nursing department or service.
2. Analysis of resource use
The purpose of the resource use analysis program (material and labor) is to ensure that hospital resources are used adequately to provide high-quality patient care in the most efficient way. To identify resource use problems, management personnel should review all data relevant to the relevant quality assurance activities and other required documents.
Resource management consists of planning, organizing, directing and controlling hospital resources in cost-effective ways while maintaining high-quality care and contributing to the overall goals of the institution. This is achieved through the judicious use of resources to control unnecessary hospitalizations of patients and unnecessarily long hospital stays and the use of ancillary services.
The resource use analysis is used to assess, based on objective criteria, the level of adequacy of the use of professional medical care, services, procedures and equipment to provide high-quality and cost-effective patient care.
The resource utilization analysis program takes into account the overuse, underutilization of resources and their ineffective planning through a documented plan that includes the resource use program and manages its execution.
This plan must be approved by the medical staff, the administration and the governing body. The plan should include at least the following:
· Description of the job descriptions and entitlements of those involved in performing the resource utilization review work, including members of medical personnel, health workers (not physicians), administrative personnel, and any qualified personnel contracted to carry out activities specified in the plan;
· A strategy based on a conflict of interest applicable to all activities included in the analysis of resource use;
· Confidentiality practices applicable to all review activities, including any findings and recommendations;
· Description of method (s) for identifying problems related to resource use, including the justification and medical necessity of hospitalizations, length of hospital stay and use of ancillary services, and delays in the provision of ancillary services;
· Procedures for conducting a concurrent review, including the timing of the start of such a review after hospitalization, and the length of stay that should be applied in setting dates for continued hospital stay;
· Mechanism for ensuring the planning of the statement.
To identify resource use problems, staff should review the associated quality results and other relevant documents, such as:
· Analysis of experience;
· Results of the study of assessing the quality of services to patients;
· Surgery review findings, drug use assessments, blood tests and infection control activities;
· Reports on the use of resources for obtaining compensation from agencies, specific to each institution.
Such retrospective monitoring of the hospital's resource use is ongoing.
3. Security
The healthcare facility's safety program is designed to ensure safe environment to patients, staff and visitors through systematic environmental monitoring. Important characteristics of a safety program include reporting and reviewing all accidents, injuries and risk situations, and appropriate follow-up measures.
No safety program can provide complete assurance that patients, visitors, and staff are never injured in an accident. However, an effective safety management program is designed to create an environment that poses a minimum risk to patients and the work of medical personnel, to reduce the risk of human injury. A properly applied security program can offer many benefits, including:
· Reducing the risk of injury;
· Cost reduction;
· Accountability;
· Compliance with external requirements;
Implementing an effective safety program can reduce the chances of accidental injury while creating a safe environment for patients, staff and visitors. A properly managed safety program can also increase the cost-effectiveness of services by reducing the number and volume of complaints and grievances and compensation payments to personnel due to industrial accidents. In addition, an effective safety program can lead to a decrease in the insurance premium of the medical institution.
It can be assumed that patients prefer to receive medical care in institutions with a good reputation and a decent public image. A safety program can enhance the reputation of a healthcare facility by guaranteeing a safe environment for healthcare delivery. A properly designed and effectively managed security program can help an institution ensure that it obtains and maintains accreditation while meeting all government regulations.
The safety program should cover those issues that affect the entire health care facility, including
· Service equipment;
· Accidents on the heating, ventilation, air conditioning, electricity and local water supply systems;
· Security problems.
A comprehensive safety program should include the following elements:
· Identifying, developing, implementing and reviewing security strategies and measures for all offices and services;
· A system for identifying and studying all accidents due to injuries to patients, staff, visitors, occupational diseases or damage to property;
· Documenting and summarizing all reports and measures to eliminate them.
Effective security management involves implementing a training program for new employees, both in general security and for a specific department. The safety program also includes data from the quality assurance program, safety committee, infection control committee and other relevant committees; thus, there are ongoing opportunities for information exchange for all levels and types of medical personnel.
Such a program ensures competent resolution of all types of emerging unforeseen situations. Continuous on-the-job orientation and training of staff is an additional important means of informing and updating staff on changes in the safety strategy and activities of a given hospital. For operational readiness, the hospital should provide training and education for all personnel. It is important that such a plan includes emergency situations that do not pose an immediate threat to life and do not cause material harm, did not interrupt the operation of the equipment, etc.
An effective safety program is an imperatively dynamic, ongoing process that must reflect general changes in the field of health care, as well as specific weaknesses identified within the healthcare organization. Using the results of the implementation of safety and infection control programs, as well as information from other sources outside the institution, will help ensure the real success of the safety management program.
4. Risk management
One of the goals of risk management is to minimize and finance, usually through insurance, predictable hospital losses.
An important step in managing risk is avoiding those that are most likely to lead to liability, including adverse outcomes and incidents. Risk management functions related to the clinical aspects of patient care and safety should be practically linked to the assurance of the quality program.
The traditional distinction between risk management and quality assurance is based on the contrast between their primary goals. Quality assurance is primarily a professional function designed to identify and solve problems in patient care and to identify and exploit opportunities to improve the quality of care. The primary purpose of risk management has always been to protect an organization's finances by:
· Providing adequate financial protection against potential liability through adequate insurance coverage;
· Reduction of liability in the event of the above circumstances;
· Prevention of events that may lead to liability.
It is in this third area that the overlap between the responsibility of risk management and the quality assurance program becomes most apparent. There is no doubt that low-quality medical care poses a risk to the patient and thus causes significant financial risk for both individual doctors and the entire medical institution.
Despite the importance of the traditional distinction between quality assurance and risk management programs, the main emphasis in both today is identifying and solving problems in the provision of patient services. Effective quality assurance and risk management depend on:
· Establishing appropriate screening mechanisms (indicators and criteria);
· Collection and analysis of data related to these indicators and criteria;
· Correcting identified problems through change systems and improving individual practice.
Therefore, active functional collaboration between clinical and management personnel is essential, as well as timely information needed to identify problems and assess the success of corrective actions.
Specific activities for a professional liability risk management program include:
· Managing an effective case-by-case reporting system;
· Investigation of all cases that could potentially lead to financial claims against the medical institution;
· Development and maintenance of a database that includes accidents with patients and visitors, negative treatment outcomes, patient injuries (regardless of the cause), professional liability claims against a medical institution and members of its medical staff;
· Performing an internal audit to identify potential risk opportunities;
· Development and provision of education and training programs for personnel to reduce the number of potentially risky situations and losses for a medical institution;
· Providing advice on the patient relationship program and its management, if one exists;
· Development and coordination of the property protection program;
· Development and / or participation in the product evaluation system;
· Guarantee of coordination with the quality assurance program.
Both quality assurance and risk management must be supported by standards.
Risk management standards include only those functions that relate to clinical and administrative activities designed to identify, assess and reduce the risk of injury to patients during treatment. The full scope of risk management functions covers the activities of a healthcare institution aimed at protecting financial resources from losses. These functions include a range of administrative activities aimed at reducing losses and injuries to patients, employees and visitors; losses related to property damage; and other sources of potential liability of a medical organization.
It is recommended in the Medical Personnel section that medical personnel are actively involved in the following risk management areas related to clinical aspects patient care and safety:
· Identifying common areas of potential risk in clinical aspects of patient care and safety;
· Development of criteria for identifying specific cases with potential risk in the clinical aspects of patient care and safety, assessment of these cases;
· Solving problems in the clinical aspects of patient care and patient safety through risk management activities;
· Development of risk reduction programs in clinical aspects of patient care and safety;
The operational link between risk management functions, which are dependent on clinical aspects of patient care and patient safety, and quality assurance functions;
The availability of the quality assurance function to existing information derived from risk management activities that can be useful in determining clinical problems and opportunities to improve the quality of patient care.
It is recommended in the Governing Body section to apply the following resourcing and support standards to perform risk management functions related to patient care and safety. It is essential that the chief executive through the management and administrative staff supports:
· Appropriate participation of medical personnel in the clinical aspects of risk management;
· Operational links between quality assurance and clinical aspects of risk management;
· The quality assurance program has access to relevant risk management information.
These standards are intended to address the overlapping risk management and quality assurance functions and coordinate their activities accordingly.
To summarize, infection control, resource management review, safety and risk management are four quality assurance activities of an organization that are vital to delivering high-quality, informed patient care across a healthcare facility. This activity should:
· Be integrated within the quality assurance program of the entire healthcare organization;
· Carried out systematically;
· Be documented;
· Constantly reviewed and revised.
The purpose of infection control is to prevent, detect and control them in a health care setting; an overview of resource use is designed to conserve and efficiently use the organization's resources; safety program includes accidents, injuries, patient safety and safety threats; risk management is aimed at minimizing adverse clinical events that should be associated with quality assurance activities.
Concentration of processing of medical devices subject to sterilization in the centralized inspection center allows the use of reliable methods of pre-sterilization cleaning and sterilization, constant monitoring of them, mechanization of labor-intensive operations for the pre-sterilization cleaning of instruments, syringes, and Centralization of sterilization of medical devices increases the culture and quality health care, frees up additional time for attendants to work with patients.
1. Tasks and functions of centralized sterilization
The tasks of the centralized sterilization rooms are:
· Provision of medical institutions with sterile medical products - surgical instruments, syringes, needles, catheters, probes, surgical gloves, dressing and suture materials, linen, etc .;
· Introduction into practice of modern methods of pre-sterilization cleaning and sterilization.
Centralized sterilization facilities carry out:
1. Reception and storage prior to processing of non-sterile products used in the departments of the hospital, polyclinic, reception and storage of dressing and operating room materials prepared for sterilization before sterilization.
2. Disassembly, rejection, accounting and replacement of broken and faulty products.
3. Pre-sterilization cleaning (washing, drying, etc.) of surgical instruments.
4. Picking, packaging, packing in sterilization boxes or packaging of reusable or single use products.
5. Sterilization of products.
6. Quality control of pre-sterilization cleaning and sterilization of products and registration:
· Results of accounting for the quality of pre-sterilization cleaning of products from blood and residues of detergents (form N 366 / y);
· Results of sterilizer operation control (form N 257 / y);
· Results of studies on sterility (form N 258 / y).
7. Record keeping and strict accounting of the receipt and issue of products with an indication of the range, quantity, size of syringes, needles, etc., as well as residues from the department.
8. Issuance of sterile products to hospital departments (polyclinics).
9. Minor repairs and tool sharpening.
10. Instructing the medical personnel of the departments on the rules for the preliminary processing of medical products before sending them to the central office, on the rules for collecting and placing linen, dressings in sterilization boxes, and on the rules for using sterile products and materials in the field.
1.2 Enhancing the role of the organizing sister in organizing the activities of healthcare institutions to improve the quality of medical services
In recent years, the need of society for the provision of highly qualified medical care has increased. Nurses are the largest category of health workers. They ensure the operation of various services and, of course, the quality and efficiency of medical care depend on them. In accordance with the Concept for the Development of Healthcare and Medical Science, adopted by the Government of the Russian Federation in 1997, an increase in the number of nurses while reducing the number of doctors, with a particular emphasis on high professional training of nurses. When implementing this Concept, the National Program for the Development of Nursing in Russia was developed. A multilevel system of nursing education has been created, which includes basic (basic) training; advanced (advanced) level of training and higher nursing education.
In today's difficult socio-economic conditions, there is a growing understanding that crisis phenomena in health care are insurmountable without the development and transformation of the management sphere, without the formation of professional management personnel. In this regard, the issue of training managers - organizers of all levels of the health care system becomes especially acute.
Orders No. 209 of June 25, 2002 and No. 267 of August 16, 2002 on amending the order of the Ministry of Health of Russia No. 337 "On the Nomenclature of Specialties in Healthcare Institutions of the Russian Federation" introduced the specialty 040601 "Nursing Management", as well as a list of compliance with the specialty "Management nursing activities "positions of specialists with higher nursing education in the specialty" Nursing ".
Unfortunately, in spite of the normative acts, the heads of health care facilities do not fully use the potential of the nursing staff, taking into account their professional competence. The nurse should be more responsive to the needs of the population rather than the needs of the health care system. It should transform itself into a well-educated professional, an equal partner, work independently with the staff and the population, contributing to the strengthening of the health of society. It is the nurse who now plays a key role in medical and social assistance to the elderly, patients with incurable diseases, health education, the organization of educational programs, and the promotion of a healthy lifestyle. For this role, the most suitable employee may be a nurse with a higher education who has undergone advanced training in management, economics, medical commodity science, etc.
A nurse - a manager must combine a variety of personal qualities, have good communication skills, pedagogical skills, competence in a wide variety of areas of knowledge: economic, legal, psychological, the ability to independently make decisions, be a leader in a team.
Professionalism in the activities of nursing leaders at all levels of the management hierarchy, from the senior nurse of the hospital department to the senior nurse of the Ministry of Health, is the key to success not only in the work of nursing services, but also in the entire health care system as a whole, in improving the quality of medical services and efficiency. health care.
According to the Ministry of Health of the Russian Federation, the reserve for improving the quality of nursing care is the effective organization of the work of nursing services: rational placement of personnel, redistribution of functions between middle and junior medical personnel, work planning, reduction of non-production costs of working time, etc. nursing staff of departments - to senior nurses.
The quality of organization of the department's activities and, accordingly, the quality of medical services largely depend on the personal, professional and business qualities of the organizing sister. This also applies to the sister of the organizer of the CSO of the clinical hospital, perhaps even more so.
The problem of nosocomial infections (nosocomial infections) in recent years has acquired exclusively great importance for all countries of the world. The rapid growth rates of medical institutions, the creation of new types of medical (therapeutic and diagnostic) equipment, the use of the latest drugs, which have immunosuppressive properties, artificial suppression of immunity during organ and tissue transplantation - these, as well as many other factors, increase the threat of the spread of infections among patients and staff of medical institutions.
Modern scientific facts, cited in works by foreign and domestic researchers, suggest that nosocomial infections occur in at least 5-12% of patients admitted to hospitals. So, in the USA, up to 2,000,000 diseases are registered annually in hospitals, in Germany, 500,000-700,000, which is approximately 1% of the population of these countries. In the United States, out of 120,000 or more patients infected with nosocomial infections, about 25% of cases die and, according to experts, nosocomial infections are the main cause deaths... The data obtained in recent years indicate that nosocomial infections significantly lengthen the period of stay of patients in hospitals, and the damage they cause annually ranges from 5 to 10 billion dollars in the United States, in Germany - about 500 million marks.
Conventionally, three types of nosocomial infections can be distinguished:
· In patients infected in hospitals;
· In patients who are infected while receiving outpatient care;
· From medical workers who became infected while providing medical care to patients in hospitals and clinics.
All three types of infections are united by the place of infection - a medical institution.
In order to correctly understand the main directions of prevention of nosocomial infections, it is advisable to briefly describe their structure.
The analysis of the available data shows that in the structure of nosocomial infections detected in large multidisciplinary hospitals, purulent-septic infections (PSI) occupy a leading place, accounting for up to 75-80% of their total number. Most often, GSI is registered in patients with a surgical profile, especially in the departments of emergency and abdominal surgery, traumatology and urology. The main risk factors for the occurrence of GSI are: an increase in the number of carriers of resident-type strains among employees, the formation of hospital strains, an increase in the contamination of the air, surrounding objects and the hands of personnel, diagnostic and therapeutic manipulations, non-compliance with the rules for placing patients and caring for them.
Another large group of nosocomial infections is intestinal infections. In some cases, they make up 7-12% of their total. Salmonellosis predominates among intestinal infections. Salmonellosis is recorded mainly (up to 80%) in debilitated patients of surgical and intensive care units who have undergone extensive abdominal surgery or have severe somatic pathology. Discharged from patients and from objects external environment Salmonella strains are highly resistant to antibiotics and external influences... The leading routes of transmission of the pathogen in the conditions of medical treatment facilities are contact-household and air-dust.
A significant role in nosocomial pathology is played by blood-borne viral hepatitis B, C, D, accounting for 6-7% in its general structure. Patients who undergo extensive surgical interventions followed by blood replacement therapy, programmed hemodialysis, infusion therapy. Examinations carried out by inpatients with various pathologies reveal up to 7-24% of persons in whose blood markers of these infections are found. A special category of risk is represented by the medical personnel of hospitals, whose duties include performing surgical procedures or working with blood (surgical, hematological, laboratory, hemodialysis departments). The examinations reveal that the carriers of markers of blood-borne viral hepatitis are up to 15-62% of the personnel working in these departments. These categories of persons in health care facilities constitute and maintain powerful reservoirs of chronic viral hepatitis.
The share of other infections registered in health care facilities accounts for up to 5-6% of the total morbidity. Such infections include influenza and other acute respiratory infections, diphtheria, tuberculosis, etc.
The problem of prevention of nosocomial infections is multifaceted and very difficult to solve for a number of reasons - organizational, epidemiological, scientific and methodological. The effectiveness of the fight against nosocomial infections is determined by whether the constructive solution of the medical facility building corresponds to the latest scientific achievements, as well as modern equipment of the medical facility and strict compliance with the requirements of the anti-epidemic regime at all stages of the provision of medical care. In a healthcare facility, regardless of the profile, three important requirements must be met:
· Minimizing the possibility of infection;
· Exclusion of in-hospital infections;
· Exclusion of the transfer of infection outside the hospital.
Disinfection is one of the most important areas of nosocomial infection prevention. This aspect of the activity of medical personnel is multicomponent and has as its goal the destruction of pathogenic and opportunistic microorganisms at objects of the external environment of wards and functional rooms of inpatient departments, medical instruments and equipment. The organization of the disinfection business and its implementation by junior nurses is a complex, time-consuming daily responsibility.
It should be emphasized the particular importance of this area of staff activity in relation to the prevention of nosocomial infections, since in a number of cases (GSI, nosocomial intestinal infections, including salmonellosis), disinfection is practically the only way to reduce the incidence in the hospital.
In matters of prophylaxis of nosocomial infections in hospitals, junior and paramedical personnel are assigned the main, dominant role - the role of the organizer, the responsible executor, and also the controller. Daily, careful and strict fulfillment of the requirements of the sanitary-hygienic and anti-epidemic regime in the course of the performance of their professional duties is the basis of the list of measures for the prevention of nosocomial infections.
In this regard, it is necessary to emphasize the importance of the role of the senior nurse of the CSO of the hospital. Basically it is long time a nursing staff who has worked in the specialty, has organizational skills, is well versed in matters of a security nature and personnel management.
1.3 Problems of personnel management in health care institutions as a factor in improving the quality of medical services
Human resource is a special resource: despite various professional and personal characteristics, a person will not bring returns until he sees personal subjective motivation. Unlike equipment, capital, people, you cannot simply buy. Man is not controlled by direct influence. Influences on a given object should be mediated, and correspond to the inner desires and needs of a person. In order for a desire to work to form in a person's mind, a system of motivation, including material motivation, must be properly designed at the enterprise.
The problem of personnel management in large organizations is fairly well known to practitioners, but its consideration is usually reduced to recommendations of a general nature, and there are relatively few serious scientific justifications, but they are for the most part of a general nature.
Practical managers, on the other hand, need specific recommendations that would help them, by increasing the manageability of teams, to increase the efficiency of organizations. Particular difficulties can arise in the management of the personnel of large medical institutions, since the managers of such enterprises are, in fact, in a tight grip of budgetary constraints and the needs of the contingent of employees and / or the population, whose health falls under the control of these institutions. This can be schematically represented as shown in Figure 1 of Appendix 1. Based on the provisions of Figure 1, the following relationship for information flows can be drawn.
Where D - organization's activities,
· ∂D / ∂t - its change in time (partial derivatives are used, since D can depend on many variables);
R - requirements of consumers (population and / or employees of the organization as potential patients or persons interested in them);
· B - budgetary possibilities and / or restrictions, in fact, the amount of funds available to the organization.
In expression (1), quantities of different nature are compared, therefore it is not an equation, but a functional relationship. To translate it into an equation, its components must be expressed with respect to one quantity, which in this case depends on the time t. Such a value can be the cost of services and other actions, so this is in line with the approach adopted in financial analysis, which is commonly called monetary translation.
Consumer requirements can be easily translated into monetary terms using the cost L of those medical services in which there is a need for the population, outside the correct volumes and specialization of these services and the dimensional coefficient of proportionality k 1, so that R = k 1 L
The organization's activities also have a financial dimension G, but it must be interpreted taking into account two coefficients k 2 and k 3. The first of them, k 2, as well as k 1, is the dimensional coefficient of proportionality. The second k 3 reflects the efficiency of the use of funds in a medical institution and, in turn, consists of four factors. The first factor w 1 represents, in essence, the direct arithmetic efficiency of using the organization's capabilities, and it is customary to measure it in terms of bed occupancy. The second factor h 1 represents the real level of effectiveness of modern medical science. The third s 1 marks the level of mastery of the achievements of modern medical science in this medical institution. The fourth m 1 represents the level of motivation of the staff of the considered medical institution.
After substitution, you can get the following equation:
In other words, the change in activity over time looks like
· K 1 and k 2 are constants and can be easily determined from the current documentation of medical institutions.
H 1 is also taken as a constant, since its change over time, from the point of view of specialists, occurs quickly, but from the point of view of society, its rates are so insufficient that sometimes they even seem negative, since they lag behind the emergence and development of more and more new diseases and weighting the current known.
· S 1 also changes, but during the controlled reporting period per year, this change can also be neglected, since its value does not at all correspond to the needs of society.
· B - grows over time, since financing of medicine under the influence of society's requirements is gradually increasing, but part of this increase is "eaten up" by inflation, and here there are three components.
The first is general economic for the entire country and is associated with inflationary and similar processes.
The second is a consequence of the increasing complexity and knowledge-intensiveness of drugs, devices, technologies and treatment methods, and its growth is more intensive.
For one of the large clinical hospitals in Moscow, the dependence of the expenditure budget can be expressed, as follows from Figure 2 of Appendix 1, by the following formula:
It is necessary to add to this dependence by multiplying the influence of inflation processes taking into account the source data, which are presented in Figure 3 of Appendix 1.
The cost of services for medical profile L first falls over time and then rises, as evidenced by the data in Figure 4 of Appendix 1, for the same hospital. The dependence in Figure 4 is approximated by the expression: b 3 = 17 (t - 0.7) 4 + 0.03t + 0.3 (5)
Further calculations carried out in the studies showed the need for a preliminary accumulation of experience by a medical institution, "the formation of a school", i.e. accumulation of the necessary traditions, skills and abilities, personnel acquisitions and the establishment of appropriate relationships with other medical and scientific institutions (Figure 5 Appendix 1).
Figure 5 shows that the dependence crosses the abscissa axis in the region of a point with an abscissa of 0.3, then the increase proceeds almost linearly, and the corresponding regression line is characterized by the expression 0.371t - 0.052. Then:
G = (0.371t -0.052) / k 2 w 1 h 1 s 1 m 1 (6)
k 2 and h 1 are constants. w 1 is also a constant, but its value is easy to measure, and for the above-mentioned clinical hospital, chosen by the authors as a base for comparison, is 0.997. Obviously, the possibilities for its growth are not very great, and the effect this will give, in comparison with the influence of other factors, is rather insignificant.
"For management in the hands of the managers of the medical institution, there are two factors determined by the indicators s 1 and m 1"
The first of them, although very important, requires significant costs and for the most part lies beyond the control capabilities at this hierarchical level. Thus, it can be seen that, in essence, the only control lever in the hands of managers is staff motivation. Although this conclusion may seem obvious, it can probably be attributed to any other organization in any other field of activity, but there are also other factors of intensification of activity, such as reconstruction, restructuring, searching for new sales markets, technological breakthroughs and much more. , due to the specifics of the functioning of medical institutions are inaccessible.
This confirms the conclusion about the need for special attention to the motivation of personnel in medical institutions.
It should be noted that there are a number of important distinctive features, starting with the talk of the town of low wages, the actual erosion of the framework of "free medicine", a general decline in the educational level of society and the professional level of graduates of medical universities, which can have irreparable and unpredictable consequences.
On the one hand, workers in medical institutions, especially large hospitals, are somewhat akin to soldiers of a large army. At the same time, they are forced to work not by the threat of prosecution, like soldiers and officers, but by the threat of creating insufficient care for human life through negligence. In addition, for many, the requirement of conscience is likely to be important. In fact, this is not just non-economic motivation, but to a certain extent it is a continuation of the traditional approach for our country, according to which people are certain elements of a certain "system", in this case, the health care system, and must fulfill their responsibilities for this system to work, since , except for them, "there is no one else."
At the same time, there are real sources of motivation, among which interaction with people plays an important role, despite the fact that it is tiresome. Probably, this can be partially correlated with the social theory of E. Mayo, but the other part reflects the realization of people's desire to take care of someone, which, due to the traditions and history of the formation of the human community and each individual, is their integral feature, so that motivation is carried out in the form realization of this desire to take care of people.
In addition, it should be noted that motivation works according to the achievements of D. McClelland and J. Atkinson, since this is manifested in the fact that, with successful actions, the result is expressed in the fact that the medical worker has cured, achieved victory over the disease and human nature.
Material motivation, as already mentioned, leaves much to be desired, but here, too, some progress has been outlined in recent years. An important role is played by motivation by social status in society. Probably, it is possible to single out a special type of motivation specifically for medical workers, namely, professional aptitude. Perhaps it can be attributed to other spheres of activity, but only physicians deal with the most complex object at the disposal of mankind - man.
You can probably single out and enough new approach, expressed in motivation by a secret, which, in essence, is an unconscious motivation. A medical worker, by the will of circumstances, is forced to solve this mystery every day, and, unlike the theory of motivation by "logical traps", the new theory says that such behavior among doctors is fixed and becomes stereotyped. And this consolidation, stereotyping of cognitive behavior in relation to patients, in fact, having passed to the level of the subconscious, becomes part of the personality, moves to the level of attitudes, and this means the strongest motivation of the real possible.
All these mechanisms operate in parallel with each other and in parallel with the "stimulation by the system", which is noted above. In fact, in hospitals, a hybrid model of motivation is implemented, which on equal terms includes the specified "incentive by the system" and other mechanisms of motivation for the realization of needs, such as: social theory, rational-economic theory, achievement motivation model, caring opportunity motivation model and the theory proposed above motivation by unconscious behavior. This can be taken into account by using the analogy with the parallel connection of resistances, considering that each of the coefficients describes the incompleteness of the application of the corresponding motivation mechanism. Then the completeness of application is described by the value inverse to each of the coefficients.
A schematic of this analysis is shown in Figure 6 in Appendix 1.
A check for one of the medical institutions with its real indicators at the end of the reporting time interval gave a G value equal to 0.282, i.e. the financial component of the efficiency of a large medical institution actually depends by 28.2% on the correctly set motivation of medical personnel.
Analysis of the possibilities of changing the coefficients included in the formula of the hybrid model of motivation allows managers of large medical and treatment-and-prophylactic institutions to choose the ways of intensifying the activities of medical organizations that are available to them and the most effective in their real situations.
Chapter Conclusions
Analysis of theoretical material on the research problem showed that the main criterion for increasing the efficiency of a healthcare institution is the quality of medical services provided.
The quality of care in a large hospital depends on many different factors. However, the main activities to ensure the quality of medical services of a healthcare institution are:
· Control of infections;
· Analysis of resource use;
· An overview of accidents, injuries, patient safety and issues of greatest risk.
The problem of nosocomial infections (nosocomial infections) in recent years has become extremely important for all countries of the world.
Successful infection control is the result of an active organization-wide program using effective measures to prevent, detect, and control infections originating in a health facility or brought in from outside.
The correct organization of sterilization services in medical institutions is an important measure aimed at preventing nosocomial infections, and, above all, with the parenteral transmission mechanism: viral hepatitis, AIDS, etc.
An important area of activity in organizing the management of the quality of medical care is the improvement of sanitary and epidemiological control and the prevention of nosocomial infections (NOS) in the activities of a clinical hospital. In this regard, it is necessary to note the importance of the activity of the Central Sterilization Department in the structure of the clinical hospital, as a unit responsible for the prevention of nosocomial infections.
In matters of prophylaxis of nosocomial infections in hospitals, junior and paramedical personnel are assigned the main, dominant role - the role of the organizer, the responsible executor, and also the controller.
Pre-sterilization treatment of medical devices is carried out in the centralized inspection center and consists in their disinfection and pre-sterilization cleaning.
At the head of all this multifaceted work on the prevention of nosocomial infections in health care facilities is a nurse - the main organizer, performer and responsible controller, the correctness of whose activity depends on the knowledge and practical skills obtained in the course of training to solve this problem. The conscientious attitude and careful implementation of the requirements of the anti-epidemic regime by medical personnel will prevent occupational morbidity of employees, which will significantly reduce the risk of nosocomial infections and preserve the health of patients.
In connection with the above, it should be emphasized:
1. The importance of the role of the sister organizer of the CSO of the clinical hospital;
2. The growing role of the sister-organizer in improving the organization of the activities of the CSO of the clinical hospital for the prevention of nosocomial infections, improving the quality of medical services and increasing the efficiency of the entire medical institution.
Chapter 2. The role of the organizing nurse in improving the organization of the activities of the CSO of a clinical hospital to improve the quality of medical services
2.1 Characteristics of the professional activities of the sister-organizer of the CSO MMUGB No. 1 named after N.I. Pirogova
The central sterilization department for sterilization of instruments and autoclaving of dressings and linen was created on the basis of the mountains. Hospital № 1 named. NI Pirogov and began to function on April 1, 1995.
CSO works taking into account the provision of sterile products for the entire medical institution.
The place of the CSO in the activities and structure of the Moscow State Medical University Hospital No. 1 named after NI Pirogov is presented in Figure 7 Appendix 2.
The central sterilization department includes the following departments:
1. Admission department
2. Washing department
3. Packing department
4. Sterilization department
5. Expeditionary department
At the head of the work of the CSO MMUGKB No. 1 named after NI Pirogova for the prevention of nosocomial infection is the deputy chief physician for work with nurses and the senior nurse of the department. The senior nurse is the organizer, executor and responsible controller of the correctness of the actions of the nursing staff. The prevention of occupational diseases of employees and the non-proliferation of nosocomial infections among patients depend on knowledge and practical skills, a conscientious attitude to work, careful fulfillment of the requirements of the anti-epidemic regime by nurses.
The work of the senior nurse of the CSO is regulated by the Regulation on the senior nurse of the CSO, regulatory and organizational-methodological documents (Appendices 3-9).
The senior nurse of the CSO is directly subordinate to the deputy chief physician for work with nurses.
The elder sister-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the staff of the CSO and coordinates the activities of the functional units of the CSO. In her work, the elder sister-organizer of the CSO is guided by:
a) the basics of labor legislation of the Russian Federation;
b) instructions, orders and guidelines of the Ministry of Health of the Russian Federation;
c) orders and orders of regional health authorities;
d) instructions and orders of the Chief Physician of the hospital;
e) CSO work plan;
e) job description;
g) hospital internal regulations;
h) rules of safety and fire safety.
Among the main documents regulating the activities of the CSO MMUGKB No. 1 named. N.I. Pirogov are:
1. "Guidelines for the epidemiological surveillance of nosocomial infections of the Ministry of Health of the USSR dated 02.09.87 No. 28-6 / 34".
2. "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection." Order of the Ministry of Health of the USSR dated 07.31.78 No. 720.
3. "On measures to reduce the incidence of viral hepatitis in the country." Order of the Ministry of Health of the USSR dated 12.07.89 No. 408.
4. "On improving the work on identifying HIV-infected, dispensary supervision, organization of treatment of patients, prevention of HIV infection in the Samara region "Order No. 16/9 of 27.01.2006.
The main functions of the senior nurse-organizer of the CSO for managing the quality of medical services are:
a) provision of sterile materials and instruments for all departments of the hospital;
b) control over the correct storage and use of sterile materials and instruments in hospital departments;
c) ensuring the correct and effective use of medical equipment through its operation by qualified medical staff of the department and constant monitoring of the equipment of specialists;
d) equipping the CSO with additional means of the main and auxiliary medical equipment and packaging means to expand the scope of the CSO work and improve it;
e) training of personnel serving the equipment of the department;
f) the introduction of elements of the NOT, contributing to an increase in labor productivity;
j) control over the timely receipt of primary cleaned instruments and other medical products and materials from hospital departments;
k) control over the quality of pre-sterilization processing of medical instruments and products;
l) control over the quality of picking, packaging and sterilization of linen, dressings and instruments;
m) control over the issuance of sterile materials and medical instruments to medical and preventive institutions attached to the CSO for service;
o) control over the correct maintenance of accounting and reporting documentation;
o) annual scheduling of vacations for employees of the department;
The main task of the elder sister-organizer of the CSO is to organize and manage all the activities of the centralized sterilization and ensure the high quality of its work.
The most important element of the managerial activity of the organizer sister is the control of the professional activities of nurses, disinfectants and nurses. Strict and constant monitoring allows you to effectively prevent the occurrence of nosocomial infections and occupational diseases in hospital departments. The presence of permanent control allows you to timely correct the identified deficiencies. Control work should be constant and carried out both in a planned manner, which employees are aware of, as a rule, in advance, and without warning the controlled persons.
Scheduled control is carried out daily. The order in the department is checked, the department is bypassed for compliance with the sanitary and epidemiological regime. Every day, nurses carry out quality control of the pre-sterilization cleaning. The sister organizer does this once a week.
Complete sterilization control comprises a large number of items, each of which is essential for the success of the entire sterilization process. The types of control and sterilization are presented in Table 1 of Appendix 10.
2.2 Analysis of the qualitative and quantitative composition of the personnel of the CSO MMUGKB No. 1 named after Pirogov
In the totality of the enterprise's resources, a special place is occupied by labor resources. At the level of an individual enterprise, instead of the term "labor resources", the terms "personnel" and "personnel" are more often used. Under the personnel of the enterprise it is customary to understand the main (staff) composition of the enterprise's employees.
Labor resources are a part of the population with physical development, mental abilities and knowledge, which is able to work.
There is a growing need for knowledge of the technology underlying the processes and devices for sterilization, computer literacy, the multifunctional use of an increasing number of workers, the elimination of economic illiteracy, especially in the management of healthcare organizations.
All this requires skillful regulation of the processes associated with the formation and use of labor resources in any industry, including healthcare. To a large extent, the problem of regulation is solved by skillful management of labor resources. The human resources management system is aimed at increasing the efficiency of the use of personnel.
The purpose of the analysis of the efficiency of the use of labor resources is to reveal the reserves for increasing the efficiency of health care and improving the quality of medical services through a more rational use of the number of employees and their working time.
In recent years, there has been a significant increase in the interest of leaders of organizations in technologies in the field of human resource management. The formation of personnel policy is very closely related to the plans and strategic objectives of the organization as a whole. Of the three components of any firm, which represent financial, human and technical resources, personnel is the most important and main factor that can influence the rest of the company's resources. The human factor cannot be ignored, since it is PEOPLE who are the main value of any organization.
A well-planned personnel policy can directly or indirectly affect a firm's income by:
· Selection of qualified personnel that meets the requirements of the company; increasing the labor potential of the firm's personnel;
· Increase in labor productivity;
· Decrease in staff turnover;
· Improving the quality of services provided;
· Reduction of absenteeism due to temporary disability;
· Strengthening labor discipline.
When planning all these goals, methods and measures are developed to achieve them, which are called personnel management technology.
Personnel management technology is a set of techniques, methods and methods of influencing personnel in the process of recruiting, using, developing and releasing in order to obtain the best end results of labor activity. Personnel management technology is regulated by specially developed regulatory and methodological documents.
HR management technology in CSO covers a wide range of functions from hiring to dismissing personnel.
The main elements of personnel management technologies in the asset of the older sister-organizer include:
Personnel planning,
Recruitment and selection of personnel,
Determination of wages and benefits,
Vocational guidance and adaptation,
· education,
Performance assessment,
Preparation of the reserve and management of development,
Industrial relations,
· Health protection, social issues.
Personnel management technology is regulated by specially developed regulatory and methodological documents, including job descriptions. Job descriptions allow, within the framework of a certain position, to perform job duties efficiently and professionally. The duties of the disinfectant and the hostess of the CSO are presented in Appendix 11.
A profession is a set of special theoretical knowledge and practical skills necessary to perform a certain type of work in any industry.
Specialty is a division within a profession that requires additional skills and knowledge to perform work in a specific area of production.
The ratio of the listed categories of workers in their total number, expressed as a percentage, is called the structure of personnel. Or: "The ratio of various categories of workers in their total number is called the structure of personnel (personnel). It can be determined by the following criteria: age, gender, education level, length of service, qualifications."
The personnel structure of any enterprise changes over time, and these changes are due to the action of various factors. The classification of the personnel of the CSO MMUGKB No. 1 is presented in Table 2 and in Figure 8 of Appendix 12. The indicators of the number and composition of personnel for the indicated groups and categories are regulated in accordance with the Instruction on statistics of the number and wages of workers and employees.
The assessment of the available labor resources, which makes it possible to judge the necessary changes in the number of employees, is based both on data on the volume of work performed and on the analysis of its content. The purpose of this analysis is to clarify the tasks for individual groups of performers and the formation of adequate qualification requirements, as well as the identification of reserves for increasing labor productivity in each specific area of work. Correspondence of the availability of personnel of the CSO MMUGKB No. 1 to the required number (according to the staffing table) are presented in Table 3 and in Figure 9 of Appendix 12.
The analysis of the qualitative and quantitative indicators of the personnel of the CSO makes it possible to determine the professional skills of the personnel and, accordingly, the quality of medical services. Appendix 13 presents the structure of the CSO personnel by quality:
· By age
By experience
· Of Education
The incentive system in the CSO is developed on the basis of the labor force participation rate. The main provisions of the incentive system:
1. The size of the KTU may increase or decrease depending on the state of the employee's labor, production, and executive discipline.
1. Systematic (three or more times a month performance of work on an adjacent site).
2. Participation in the social life of the team, mentoring.
3. Continuous professional development.
4. Compliance with labor discipline.
5. Knowledge of orders No. 720, No. 408, No. 16/9. Compliance with measures for sanitary and hygienic and anti-epidemic regime.
1. Violation of labor, production and performance discipline.
2. Violation of the sanitary and epidemiological regime.
3. Defective work, violation of tool processing technology.
Various indicators are used to record and reflect changes in the number of personnel.
1. The indicator of the average number of employees () is determined by the formula:
medical staff healthcare hospital
(7) ,
where P 1, P 2, P 3 ... P 11, P 12 - the number of employees by months.
2. The coefficient of recruitment of personnel (K p) is determined by the ratio of the number of employees hired by the enterprise for a certain period of time to the average number of personnel for the same period:
where R p is the number of hired workers, people;
Average number of personnel, people
3. The retirement rate (Kv) is determined by the ratio of the number of employees dismissed for all reasons for a given period of time to the average number of employees for the same period:
where R uv - the number of dismissed workers, people;
Average number of personnel, people
For CSO as a whole:
At the beginning of 2005 - 12 people.
At the end of 2005 - 12 people.
At the beginning of 2006 - 12 people.
At the end of 2006 - 12 people.
Average number of staff: 12 people.
The indicators of the movement of the staff and the efficiency of using working time, presented in tables 7-8 of Appendix 14, indicate that the CSO team works stably, there is no staff turnover. In 2005-2006, the personnel potential has been stable, there have been no violations of labor discipline, no work absenteeism without good reason. This testifies to the effectiveness of management in the department, and the correct motivation of the staff of the CSO.
2.3 Analysis of the use of modern technologies and equipment in the work of the CSO MMUGKB No. 1 to improve the quality of medical services
Medical devices that penetrate normally sterile tissues of the patient's body that come into contact with blood and injectable drugs during manipulation are referred to as so-called "critical" ones, representing a high risk of infection of the patient in the event of microbial contamination of these devices. Given the available data on outbreaks of infections associated with inadequate handling of devices used in surgical practice, sterilization of devices, in particular, surgical instruments, dressings and linen, plays an important role.
Consequently, the quality of medical services is influenced by modern technologies and equipment used in the work of the CSO.
To solve the problem of improving the quality of pre-sterilization treatment and sterilization, modern equipment is used in CSO MMUGKB No. 1:
Sterilizers
Washing machines
The requirements for pre-sterilization treatment in modern conditions provide for a differentiated approach to the selection of the required pre-sterilization treatment process and are extremely high than ever.
To solve the problem of improving the quality of pre-sterilization treatment, the CSO MMGKB No. 1 uses mechanical washing and washing manually. For mechanical washing, Italian-made machines of the INNOVA M 3 type are used, which are characterized by the following parameters:
Economy / efficiency
· safety
Easy and convenient use
Easy maintenance of the device
INNOVA M 3 is (Figure 1 Appendix 15) a compact machine with a built-in dosing system for supplying detergents and neutralizing agents, "high pressure" drying and a wide range of applications. The machines of this class are characterized by flexible programming, which allows the machine to be adapted to all user requirements. Thanks to the new control technique, control over the pre-sterilization treatment process and many other innovations, the CSO managed to achieve high quality pre-sterilization treatment.
Quality control of pre-sterilization processing is assessed by setting an azopyram sample for the presence of residual blood and phenolphthalein samples for the presence of alkaline components of detergents on the basis of the Methodological Guidelines for pre-sterilization cleaning of medical devices (No. 28-6 / 13 dated 06/08/82).
Control is subject to 1% of simultaneously processed products (but not less than 3 units). The results of the pre-sterilization treatment control are recorded in the "Journal of the quality of pre-sterilization cleaning" (form No. 366 / y).
According to the data of the "Journal of the quality control of pre-sterilization cleaning" for 2006, 20600 units of products were tested. Test results are negative.
Traditional thermal sterilization methods - steam and air - still occupy a leading position in healthcare facilities due to such undoubted advantages as the ability to sterilize packaged products and the absence of the need to remove (by washing or degassing) the remains of the sterilizing agent.
In devices of the new generation, sterilization modes are implemented, characterized by a smaller spread in the values of temperature parameters, and in some cases, by a shorter sterilization holding time. Such sterilizers are equipped with automatic systems for achieving and maintaining the required values of the parameters of the sterilization modes, process indication systems, as well as its blocking (if the achieved values do not correspond to the set ones).
Among modern steam sterilizers one can characterize "Sterimatic" - series 2000; 4000.
Autoclaves of this type are stationary, fully automatic instruments. The control of the passage of the cycles is carried out by the processor control with the display of information on the built-in monitor.
Sterimatic 4000, representing a new generation of sterilizers, is equipped with a software system that allows you to flexibly change the course of the sterilization program and the choice of the menu language (French, English, Russian).
Autoclaves are produced in one or two-door design (in the Central Social Service Center of the Moscow State Medical University №1, two-door autoclaves are used). A rectangular chamber with a double shell. The doors are sealed with pneumatic gaskets. Automatic door control. Type of sterilizer "Sterimatic" - series 2000; 4000 are presented in Figures 2 and 3 of Appendix 15.
In the CSO MMUGKB No. 1 for 2006, it was sterilized:
Instruments -12176 bix
Rubber - 9040 bix
Linen - 26 724 knots
Dressing material - 13132 bix
In the CSO MMUGKB No. 1, the means of control of the sterilization process are used in accordance with GOST R 519350-2002:
· For normal mode - urea with phenol red, IP 132.
· For a gentle regime - benzoic acid with fuchsin, IS 120.
In order to control the quality of sterilization, a culture for sterility is used in the centralized inspection center. In 2006, 179 cultures were taken for sterility - the result: the cultures are sterile.
2.4 Recommendations for improving the organization of activities of the CSO MMUGKB No. 1
Improving the organization of the activities of the CSO will significantly improve the quality of medical services provided by the Moscow Medical Clinical Hospital No. 1, which will ultimately increase the efficiency of the health care facilities.
To do this, the head of the hospital. NI Pirogova, together with the sister-organizer of the CSO, it is necessary to carry out constant monitoring of infection safety. In addition, it is necessary to develop a system for assessing infectious safety, which allows tracking the activities of departments by such parameters as:
· Registration of infectious morbidity and transmission of information on it;
· Implementation of the sanitary and epidemiological regime by the medical staff;
· Collection of epidemiological analysis and preventive research;
· Observance of the rules of collection, storage and transportation of bakery;
· Training of personnel in the principles of infectious safety of the treatment and diagnostic process.
Of great importance in improving the quality of sterilization of medical devices is the increased role of sterilization control, especially in connection with the development of various chemical indicators belonging to different classes (from 1 to 6) according to GOST R ISO 11140-1-2000 and allowing to carry out in sterilizers different types operational external (in the sterilizer chamber) and internal (inside packages with products and in products) control.
Any processing and sterilization of medical products on the spot in medical and diagnostic units should be prohibited, entrusting this work to a centralized inspection center equipped with modern sterilization and washing equipment that provides a full medical and technological cycle: preliminary disinfection, pre-sterilization cleaning, packaging, sterilization, storage and delivery of sterilized products to the points of use.
Economically, it is more expedient to equip a large CSO with modern expensive and high-performance equipment than to spray funds over small healthcare facilities.
Steam sterilizers installed in the central control center must comply with the new standard for this equipment GOST R 51935-2002, which came into force on 01.07.2003.
The centralized control center should conduct a comprehensive quality control of sterilization and the operation of sterilizers: physical (using control and measuring equipment), chemical (using chemical indicators in accordance with GOST ISO 11140-1-2000) and bacteriological (according to "Methodological instructions for disinfection, pre-sterilization cleaning and sterilization of medical products ", approved by the Ministry of Health of the Russian Federation No. MU-287-113 dated 30.12.1998).
Sterilizers with foreline pumping must pass the test for the tightness of the chamber and the "Vacuum test" system, as well as the test for the completeness of air removal from the chamber "Bowie-Dick test".
The packaging of medical products must comply with the requirements of the new state standard GOST R ISO 11607-2002.
Medical workers who have completed advanced training courses for nurses at the Central Social Service Center under the programs approved by the Ministry of Health of the Russian Federation can be allowed to sterilize medical devices.
When licensing the activities of a hospital in the sterilization section, the following indicators should be taken into account:
· Availability of a CSO equipped with sterilization and washing equipment that meets the above requirements, providing pre-treatment and disinfection, pre-sterilization cleaning, packaging, sterilization, storage facilities and delivery to places of consumption of sterile products.
· In the absence of such a CSO, a healthcare facility must have a contract for sterilization of medical devices with another hospital that has a CSO that meets the above requirements.
Sterilizers should be with automatic program control with a process documentation system. Steam sterilizers should be with fore-vacuum pumping and programs for "vacuum test" and "Bowie-Dick test".
Washing equipment must cover the processing of all types and materials of medical devices, for which it is necessary to have a complete set of washing machines. Equipment for pre-sterilization cleaning of medical devices should also be automatic with program control.
CSO must be equipped with medical devices packaging in accordance with GOST R ISO 11607-2002.
CSO must have means of control of the sterilization process and the operation of sterilizers with the possibility of documentation in accordance with GOST R 519350-2002.
Medical professionals involved in the processing and sterilization of medical devices must have an appropriate certificate of completion of refresher courses in sterilization.
It is necessary to develop a unified Technological Regulation for the sterilization of medical devices in a healthcare facility and adopt it in the form of a law of the Russian Federation.
CSO must be entered into the nomenclature of health care units.
Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical devices from a spontaneous, uncontrolled process turn into a standardized system that will provide a reliable barrier to parenteral nosocomial infections .. Therefore, in order to improve the organization of CSO activities and improve the quality of staff work, it is necessary to develop a list of basic new national standards for sterilization of medical products (Appendix 16 ).
Chapter Conclusions
CSO MMU GKB No. 1 named after NI Pirogova works taking into account the provision of sterile products for the entire medical institution.
At the head of the work of the CSO MMUGKB No. 1 named after NI Pirogova for the prevention of nosocomial infection is the senior nurse of the department. She is the main organizer, executor and responsible controller of the correctness of the actions of nursing staff. The prevention of occupational diseases of employees and the non-proliferation of nosocomial infections among patients depend on knowledge and practical skills, a conscious attitude to work, careful implementation of the requirements of the anti-epidemic regime by nurses, which significantly affects the quality of medical services.
The elder sister-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the staff of the CSO and coordinates the activities of the functional units of the CSO. The efficiency of organizing the activities of the CSO personnel depends on her knowledge, professional, business and personal qualities.
The most important element of the managerial activity of the organizer's sister is:
Control of the professional activities of nurses, disinfectants and nursing staff
Motivation of staff for effective work
· Creation of a favorable psychological climate in the department, contributing to the effective and high-quality activities of personnel.
The development of science and technology causes changes in the technology of influencing the subject of labor, which in turn changes the content of labor activity, makes high demands on the composition and quality of personnel.
There is a growing need for knowledge of the technology underlying sterilization processes and apparatus, computer literacy, and the multifunctional use of an increasing number of workers.
Therefore, the role of the senior sister-organizer in personnel management of the CSO in the field of training and monitoring the professional knowledge of personnel is growing. The role of instruction, knowledge of the main orders and instructions that regulate the activities of the CSO is growing.
The indicators of the qualitative composition of the staff of the CSO, the movement of the staff and the efficiency of using working time indicate that the staff of the CSO works stably, there is no staff turnover, which indicates the effectiveness of management in the department, its correct motivation.
Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical devices turn from a spontaneous, uncontrolled process into a standardized system that will provide a reliable barrier to nosocomial parenteral infections.
Conclusion
For the Russian healthcare system, the problem of improving the quality of medical care is now especially urgent. In this regard, it is necessary to fundamentally solve managerial, organizational and economic problems in order to create a mechanism for the effective functioning of this most important social sphere.
From the point of view of national interests, it is necessary to ensure the national economic efficiency of health care as the most important social sphere. The quality of care in a large hospital depends on many different factors.
It is necessary to optimize the work to create a safe environment for patients and the work of medical personnel in health care institutions. Most of the work in this direction is done by the sister organizer.
To improve methods of prevention, reduce the level of morbidity and mortality in nosocomial infections, and reduce economic damage, it is necessary to introduce modern systems of epidemiological surveillance and complexes of effective organizational measures into public health practice.
In recent years, the need of society for the provision of highly qualified medical care has increased. Nurses are the largest category of health workers. They ensure the operation of various services and, of course, the quality and efficiency of medical care depend on them.
The correct organization of sterilization services in medical institutions is an important measure aimed at preventing nosocomial infections, and, above all, with the parenteral transmission mechanism: viral hepatitis, AIDS, etc.
Pre-sterilization treatment of medical devices is carried out in the centralized inspection center and consists in their disinfection and pre-sterilization cleaning. For these purposes, modern equipment is used: washing machines and sterilizers.
At the head of all this multifaceted work on the prevention of nosocomial infections in health care facilities is a nurse - the main organizer, performer and responsible controller, the correctness of whose activity depends on the knowledge and practical skills obtained in the course of training to solve this problem. The conscientious attitude and careful implementation of the requirements of the anti-epidemic regime by medical personnel will prevent occupational morbidity of employees, which will significantly reduce the risk of nosocomial infections and preserve the health of patients. Therefore, at present, the importance of the role of the sister-organizer of the CSO of the clinical hospital is growing.
It is also necessary to note the increasing role of the organizing sister in improving the organization of the activities of the CSO of the clinical hospital for the prevention of nosocomial infections, improving the quality of medical services and increasing the efficiency of the entire medical institution.
The role of the senior sister-organizer for personnel management of the CSO in the field of training and monitoring the professional knowledge of personnel is growing.
Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical devices turn from a spontaneous, uncontrolled process into a standardized system that will provide a reliable barrier to nosocomial parenteral infections and improve the quality of medical services.
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Annex 1
Appendix 2
Appendix 3
CALCULATION OF THE NEED FOR STERILIZED PRODUCTS AND EQUIPMENT 2.1. The centralized sterilization room works with the provision of sterile products for the entire medical and prophylactic institution or a group of institutions. 2.2. In the centralized sterilization room, it should be possible to store a minimum daily stock of products. 2.3. The calculation of the needs of medical institutions in the required quantities of sterilized products according to the nomenclature must be carried out based on the specific needs of specific medical institutions serviced by this centralized sterilization room, taking into account: - the profile of the medical institution; - the number of beds in the department; - the volume of surgical interventions ; - the nature and number of visits to polyclinic institutions; - the presence of three changes of products (one change in the department, the second in the sterilization room, the third spare). 2.4. The calculation of the required number of commonly used products is carried out according to the formulas given in the "Methodological recommendations for the calculation and selection of the main technological equipment for various departments of the hospital", developed by the GiproNIZdrav of the USSR Ministry of Health, Moscow, 1988: - syringe consumption per day, Shs, pcs. Shs = 3 p, is the consumption of needles per day, Is, pcs. Is = 6 p, - the consumption of linen per day, Rbs, kg Rbs = 0.6 p, - the consumption of dressings per day, taking into account emergency operations and the needs of the clinic, Rpms, kg Rpms = 0.4 p, - the consumption of gloves per day , Ps, steam, Ps = Qi x 24, where P = hospital bed capacity, Qi = the number of operating tables in the hospital Notes: - calculation formulas are given taking into account the need for sterile products for emergency operations and the outpatient department of the hospital. Without taking into account the latter, the estimated consumption of sterile products should be reduced by 1.4 times; - calculation formulas are given for one-shift operation of the centralized system. For other shifts, appropriate amendments should be made. In the case of a central heating system with two days off, the entire consumption of materials (linen, syringes, needles, etc.) should be increased by 7/5 - 1.4 times. 2.5. The choice of equipment for the centralized sterilization room is carried out in accordance with the current catalogs, reference books and orders, taking into account the amount of work performed by the CA. (Appendix 3). In some cases, the types of sterilizers are chosen depending on the layout and area of the room. It is preferable to use sterilizers of the same type with a large capacity. To carry out air sterilization, it is advisable to use electric double-sided air sterilizers with forced air circulation, which ensures the most uniform temperature distribution throughout the chamber volume. 2.6. When calculating the number of sterilizers, the need for repair and inspection should be taken into account. For this purpose, a (minimum) backup sterilizer is allocated. 2.7. Number of machines for processing surgical instruments, syringes, etc. determined based on the performance of the machine and the amount of work performed. For processing blood transfusion systems, catheters, etc. additionally put baths for locking, washing, rinsing and two tables. Drying cabinets for drying products are installed on the basis of: one - for tools; the other for other products. 2.8. To calculate the number of steam and air sterilizers and auxiliary equipment, it is necessary to use the guidelines (clause 2.4). When installing steam sterilizers, one should be guided by the "Rules for operation and safety when working on autoclaves", M., 1971. 2.9. The number of containers and packaging materials is not standardized. The calculation of the need for them is carried out taking into account the volume of work performed.
Appendix 4
The procedure for applying the estimated time norms for the sterilization of medical devices in medical institutions. The number of positions of medical personnel is calculated based on the volume of work performed per shift, taking into account the estimated time norms for processing medical devices by manual and mechanized methods. For example, in a centralized 3,930 sets (syringe and 2 needles), 142 sterilization boxes with dressing material, 46 boxes of surgical linen, 355 droppers and 100 catheters are processed in an average of one 6-hour shift by a mechanized method. sterilization, UEC): 3930 x 1.0 + 142 x 1 + 46 x 1.3 + 355 x 1.7 + 100 x 1.0 = 4877.9 UEC The resulting value should be divided by the duration of the work shift (360 min) : 4877.9: 360 = 13.5 Thus, to perform the specified amount of work in the centralized sterilization room, you must have 13.5 units. personnel with a work shift duration of 6 hours.
Appendix 5
OFFICIAL INSTRUCTIONS OF THE HEAD OF THE CENTRALIZED STERILIZATION DEPARTMENT I. General 1. The main task of the head of the CSO is the organization and management of all activities of the centralized sterilization and ensuring the high quality of its work. 2. The head of the CSO is appointed and dismissed by the Chief Physician of the hospital. 3. The head of the CSO must have a higher or secondary medical education. 4. The head of the CSO is directly subordinate to the Chief Physician of the hospital and his deputy for the medical part (organizational - method. Work). 5. The head of the CSO supervises the staff of the centralized sterilization room. Carries out direct control over the work head nurse and coordinates the activities of the functional units of the CSO. 6. In his work, the head. The CSO is guided by: a) the fundamentals of labor legislation; b) instructions, orders and guidelines of the USSR Ministry of Health; c) orders and orders of health authorities; d) instructions and orders of the Chief Physician of the hospital and his deputy for the medical part (organizational method. Work) ; e) CSO work plan; f) these Methodological Recommendations; g) this job description; h) CSO internal regulations; i) safety and fire safety rules. II. Functions of the head of the CSO 1. The work area of the head of the CSO is: a) operation of the medical equipment of the CSO, producing pre-sterilization processing and sterilization of surgical instruments and other medical products and materials; b) provision of sterile materials and instruments to all departments of the hospital and medical institutions attached to the CSO for service; c) control over the correct storage and use of sterile materials and instruments in hospital departments. 2. The list of types of work that make up the fulfillment of the functions assigned to the head of the CSO: a) ensuring the correct effective use of medical equipment by operating it by qualified medical personnel of the department and constant monitoring of the equipment of Medtekhnika specialists; b) equipping the CSO with additional means of basic and auxiliary medical equipment and packaging means for expanding the scope of work of the Central Social Service Center and its improvement; c) training of personnel serving the equipment of the department; d) introduction of the elements of IT that contribute to an increase in labor productivity; e) control over the timely receipt of primary cleaned instruments and other medical products and materials from hospital departments; f) control over the quality of pre-sterilization processing of medical instruments and products; g) control over the procurement of dressings (napkins, tampons, turunda, etc.); h) control over the quality of packaging, packaging and sterilization b clothes, dressing materials and instruments; i) control over the timely delivery of sterile materials and medical instruments to all departments of the hospital; j) control over the issuance of sterile -reporting documentation; l) annual scheduling of vacations for department employees; m) submission of proposals to the Chief Physician of the hospital for appointments, relocations, for collection and incentives for CSO employees. III. Responsibilities 1. The head of the CSO is obliged to ensure the timely and high-quality implementation of the CSO work plan. 2. The head of the CSO is obliged to comply with the requirements of general moral and ethical standards. 3. The head of the CSO is obliged to ensure the observance of the work schedule and labor discipline by the staff of the CSO. 4. The head of the CSO is obliged to constantly improve his qualifications and contribute to the improvement of the qualifications of his subordinate employees. The head of the CSO is obliged to conduct practical exercises with all newly recruited nurses under the CSO technical minimum program and, after accepting the test, allow them to work independently. The head of the CSO is obliged to implement full interchangeability of nurses at all production sites of the CSO.IV. Rights 1. The head of the CSO has the right to make proposals to the management on issues production activities, working conditions and safety measures. 2. Require the provision of CSOs with reagents, detergents, packaging and other materials. 3. Participate in meetings at which issues on the profile of work are considered. 4. Receive information necessary to perform functional duties. 5. Make decisions within their competence.
Appendix 6
OFFICE INSTRUCTIONS FOR THE HEAD NURSE OF THE CENTRALIZED STERILIZATION DEPARTMENT I. General 1.1. A nurse with special training in sterilization is appointed to the position of a senior nurse in a centralized sterilization room (CSO). 1.2. Appointment or dismissal of a senior nurse is carried out by the head of a medical and preventive institution in accordance with labor legislation. 1.3. The senior nurse is guided in her work by these Methodological Recommendations, this job description and other official documents. 1.4. The senior nurse reports directly to the head of the CSO, the deputy chief physician for the medical part. 1.5. The senior nurse is a financially responsible person and is responsible in accordance with the established procedure for the equipment and property of the center. II. Main job responsibilities The senior nurse of the CSO is obliged to: 2.1. Ensure uninterrupted operation of the centralized service center. 2.2. Ensure the rational organization of work of the middle and junior medical staff of the CSO, as well as the technical personnel serving the CSO, for which it is necessary: - to draw up a schedule of work and vacations in agreement with the head of the CSO; work, etc.; - ensure the timely replacement of nurses and orderlies who did not come to work; - control the work of nurses and orderlies, immediately eliminate the identified shortcomings in work; - control the annual medical examination by employees of the Central Social Service. 2.3. Exercise daily control over the work of nurses and nurses of the central medical center: - for the correct reception, sorting and pre-sterilization processing of medical devices, their packaging and sterilization; - for the correct transportation of sterile products to the clinical diagnostic departments; - for monitoring the pre-sterilization processing of medical devices; - the sanitary condition of the production facilities of the central control center; - compliance by the employees with the internal regulations of the institution. 2.4. Take samples of sterilized products and send them to a bacteriological laboratory for sterility testing. 2.5. To carry out the discharge, receipt, storage and delivery of consumables, detergents and disinfectants, chemicals, etc. 2.6. Monitor the serviceability of the equipment and the rules of its operation. 2.7. Be financially responsible for the safety of medical equipment. 2.8. Carry out timely write-off of products and equipment unsuitable for further use. 2.9. To systematically improve their qualifications and ideological and political level. III. Rights The senior nurse of the CSO has the right to: 3.1. Make proposals aimed at improving the work. 3.2. To carry out the reshuffle of nurses within the department in cases of industrial necessity in agreement with the head of the CSO. 3.3. Monitor the correct storage and use of sterilized products in medical and diagnostic departments.
Appendix 7
OFFICE INSTRUCTIONS OF A MEDICAL NURSE OF A CENTRALIZED STERILIZATION DEPARTMENT I. General part 1.1. Persons with secondary medical education are appointed to the position of a nurse of the CSO. 1.2. The CSO nurse is appointed and dismissed by the order of the head physician of the institution. 1.3. The nurse of the CSO is directly subordinate to the senior nurse and the head of the CSO. 1.4. A nurse in her work is guided by these Methodological Recommendations, instructional and methodological materials on sterilization issues, this job description, as well as instructions and orders of the head of the institution, the head of the CSO and the senior nurse. II. Main job responsibilities 2.1. In accordance with the regulation on the CSO, a nurse is obliged to perfectly master all the production operations of the technological process for pre-sterilization processing and sterilization of medical devices: - when entering the sterilization of used medical devices, check the completeness of instruments, syringes, etc., carry out their rejection and distribute them along the processing flows ; - carry out pre-sterilization treatment of medical devices in accordance with the existing instructions; - carry out quality control of pre-sterilization treatment of each batch of medical devices by setting amidopyrine and azopyram samples, as well as phenolphthalein and samples to control residual amounts of detergents and fatty contaminants; - at the end of pre-sterilization treatment and carrying out control to carry out the collection of sets of surgical instruments and other products, their packaging and preparation for sterilization. Before packing the instrumental kits, the nurse must enclose in each kit a "passport" with an indicator of sterilization, indicating the date and her name. 2.2. When carrying out sterilization, strictly observe the regime and requirements when working on steam, gas, air sterilizers in accordance with the instructions. Carry out optimal loading of sterilization equipment, observe loading rules. 2.3. While working in the sterile area, strictly observe the rules for unloading sterilized products and the requirements of asepsis. 2.4. Ensure that the requirements for maintaining the sterility of sterilized products are met when they are delivered to the clinical diagnostic departments and when they are exchanged. 2.5. Comply with all labor protection and safety requirements, fire-prevention measures, sanitary and anti-epidemic regulations and the internal regulations of the institution. 2.6. Timely, competently and correctly maintain medical records. 2.7. Raise your professional, ideological and political level. The head of the CSO and the senior nurse have the right to supplement the scope of duties of a nurse. III. Nurse's rights A nurse has the right to make proposals aimed at improving the organization of work and working conditions in the department. IV. Qualification Requirements 4.1. A CSO nurse must have a secondary medical education, know the specifics of the department's work, master the work on sterilization and washing equipment, at least once every 5 years undergo specialization in courses on sterilization in medical institutions. 4.2. All newly recruited nurses at the CSO must undergo specialization at the workplace, annually pass a test in accordance with the rules of operation and safety when working on pressure devices, and have an appropriate certificate, which gives the right to work on steam and gas sterilizers.
Appendix 8
Appendix 9
Appendix 10
Table 1: Types of sterilization control in healthcare facilities
| Controlled indicators | Controlled positions |
| Ensuring the required values of the parameters of the sterilization modes | The operation of the sterilization apparatus (with the help of physical, chemical and bacteriological control) |
Chemical sterilant: the quality of the product (compliance with the regulated values of the controlled indicators); observance of the term and conditions of storage of funds; compliance with the rules for the preparation, storage and use of working solutions |
|
| Sterilization mode with a solution of a chemical agent: the concentration of the active substance in the solution (if there are appropriate chemical indicators), the temperature of the solution, the holding time in the solution | |
| Providing the necessary accompanying conditions for sterilization | Sterilization packaging: conformity of the packaging material to the sterilization method; compliance with the rules for the use of packaging material |
| Correct loading / placement of products during sterilization in containers with solutions, in packages, in the working chambers of the equipment | |
| Ensuring aseptic conditions after cessation of sterilizing agent action | |
| The result of the combined action of all factors of the performed sterilization process | |
| Sterility of products |
Appendix 11
Appendix 12
Figure 8. Personnel structure by main categories of employees
Table 3. Analysis of the number of personnel of the CSO MMUGB No. 1 by category
Figure 9. Demand and actual availability of personnel by main categories of employees
Appendix 13
Table 4. Personnel structure of the CSO MMUGB No. 1 by age
Figure 9. Personnel structure of CSO MMUGKB No. 1 by age
Table 5. Personnel characteristics of CSO MMUGKB No. 1 by length of service
Figure 10. Personnel characteristics of the CSO MMUGKB No. 1 by experience
Table 6. Characteristics of the personnel of the CSO MMUGB No. 1 by level of education
Figure 11. Characteristics of the personnel of the CSO MMUGB No. 1 according to the level of education
Appendix 14
Table 7. Indicators of changes in the number and composition of personnel of the CSO MMUGKB No. 1 for 2005-2006
Table 8. Indicators of the effectiveness of the use of working time by personnel of the CSO MMUGKB No. 1 for 2005-2006
Appendix 15
Picture 1 - Washing machine INNOVA M 3
Figure 2 - Sterilizer
Figure 3 - Sterilizer
Appendix 16
List of the main new national standards for sterilization of medical products:
1. GOST R ISO 11737-1-95. Sterilization of medical products. Microbiological methods... Part 1: Estimation of the population of microorganisms in the product.
2.GOST R 51609-2000. Medical products. Classification according to the potential risk of use. General requirements.
3. GOST R ISO Sh38-1-2000. Sterilization of medical products. Biological indicators. Part 1. Technical requirements.
4.GOST R 51935-2002. Steam sterilizers are large. Are common technical requirements and test methods.
5. GOST R ISO 13683-2000. Sterilization of medical products. Requirements for validation and monitoring. Damp heat sterilization in healthcare facilities.
6.GOST R ISO Sh40-1-2000. Sterilization of medical products. Chemical indicators. Part 1 General requirements.
7.GOST R ISO 11607-2003. Packaging for medical devices subject to terminal sterilization. General requirements.
8.GOST R ISO 11140-2-2001. Sterilization of medical products. Chemical indicators. Part 2: Equipment and methods.
9.GOST R ISO 11138-3-2000. Sterilization of medical products. Biological indicators Part 3. Biological indicators for moist heat sterilization (steam sterilization).
10.GOST R ISO 11134-2000. Sterilization of medical products. Requirements for validation and monitoring. Industrial wet heat sterilization.
In the newly adopted standards, instead of the term "medical devices (MP)", the term " medical devices(MI) ". In accordance with existing standards, today these two terms have an equal right to exist. The term" medical devices "will be canceled only after the abolition of GOST 25375-82.
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