Current Situation Of Work Quality Management In Central Sterile Supply Department Of Secondary And Tertiary Public Hospitals In Shandong Province

BackgroundCentral sterile supply department(CSSD)is a department that undertakes the cleaning,disinfection and sterilization of reusable medical devices,cleaning excipients and other articles in various departments as well as the supply of sterile articles,and is the core of hospital disinfection,isolated contamination and infection control.The main harm caused by inadequate management of CSSD is nosocomial infection,which also causes additional economic burden to both the hospital and the patient.It not only threatens the life and health of the patient,but also causes harm to the medical staff.With the continuous progress of medical and health system reform and the continuous expansion of health care scale in various regions,hospital CSSD presents the characteristics of large throughput of devices and articles,fast turnover speed and strict technical operation requirements,and its building layout,equipment allocation,human resources,training mechanism,management mode and informatization construction will affect the work quality of CSSD to varying degrees.Since the Ministry of Health issued three mandatory health industry standards WS310-2009 for the construction of CSSD in hospitals in 2009,Shandong Province established the Disinfection Supply Quality Control Center in 2012 and began to implement the centralized management mode of CSSD throughout the province.In 2015,Shandong Province formulated the quality evaluation indicators of disinfection supply and required the secondary and tertiary hospitals in the province to report eight quality monthly indicators,aiming to monitor and supervise the quality of CSSD in the hospitals in the province,evaluate the work quality of CSSD in each hospital in accordance with the unified standard,and carried out the quality evaluation of CSSD in the secondary and tertiary public hospitals in the province for the first time in 2016.However,there has been a lack of empirical research since the initiation of quality evaluation for three years.Since each quality indicator has only basic data,lacks specific evaluation criteria and does not distinguish the importance degree from each other,it is impossible to compare the overall quality between different hospitals and conduct a comprehensive evaluation on the quality of CSSD work in hospitals at all levels in Shandong Province.Therefore,this study will comprehensively analyze the two dimensions of the hospital's attention to the quality management of CSSD and the current situation of the quality of CSSD work,understand the current situation of the quality management of CSSD work,timely discover and correct the problems in the management,and promote the continuous improvement of the quality of CSSD.ObjectivesThe main purpose of this study is to analyze the current situation of CSSD work quality management in secondary and tertiary hospitals in Shandong Province and to put forward suggestions for improving CSSD quality management in hospitals.The specific objectives are as follows:(1)To analyze the current situation of CSSD work quality management in secondary and tertiary hospitals in Shandong Province(2)To explore the factors affecting CSSD work quality in secondary and tertiary hospitals(3)To propose countermeasures and suggestions to improve the quality management of CSSD in hospitalsMethodsThis study is a retrospective study using second-hand data.It mainly analyzes the data of 8 CSSD quality indicators collected by Shandong Quality Control Center for Disinfection Supply from 2016 to 2018,so as to study the current work quality management status of CSSD in hospitals at all levels in Shandong Province.In this study,the current situation of CSSD work quality management is mainly analyzed from two dimensions,one is the importance of hospitals to quality management,through the participation of hospitals in quality evaluation analysis;the other is to evaluate the current situation of CSSD work quality in hospitals.The study mainly includes three parts.The first part is the participation of secondary and tertiary public hospitals in quality evaluation of CSSD in 2016-2018 in Shandong Province,which is mainly described in terms of participation and completeness to reflect the importance that each hospital attaches to quality management of CSSD;the second part is the analysis on the current situation of quality of CSSD work in 73 hospitals that have completely reported quality indicators in 2017 and 2018(the inclusion criteria for complete reporting are hospitals that have reported for 9 months or more in both 2017 and 2018,and continuous reporting for 9 months or more is not required)to understand the differences in the quality level of CSSD work in hospitals of different levels and regions;the third part is to conduct interviews with the CSSD responsible persons of hospitals with poor reporting of quality indicators and poor quality level,find out the factors affecting the reporting of indicators and quality level,and put forward suggestions on improving the quality management of CSSD work.The quantitative data of this paper are mainly analyzed by SPSS 22.0 after entered in Excel,in which the main adoption rate and constituent ratio are described for the analysis of the basic situation of hospitals participating in CSSD quality evaluation.Chi-square test and rank sum test are used for the analysis of the current situation of CSSD work quality in different categories of hospitals from 2017 to 2018;analytic hierarchy process is used to determine the weights of 8 work quality indicators;qualitative data are mainly qualitative interviews with hospitals with poor reporting and poor overall quality evaluation.By sorting out,summarizing the interview contents,the quantitative data are explained to find the reasons affecting the reporting and CSSD work quality.ResultsSince the CSSD quality evaluation was carried out in Shandong Province in 2016,the number of secondary and tertiary public hospitals participating in the quality evaluation has shown an increasing trend,and the hospitals participating in the filling in are mainly tertiary hospitals.With the improvement of various aspects of quality control center and the intensification of publicity,the participation of hospitals at all levels in quality evaluation has been increasing year by year,but the participation of secondary hospitals is relatively low.For the 73 hospitals that completely reported the quality indicators,the quality status of CSSD was analyzed.The overall quality status of CSSD in Shandong hospitals in 2018 was improved compared with that in 2017.From the quality status of CSSD in various hospitals at all levels in 2017-2018,the workload in 2018 increased compared with that in 2017,the qualified rate of cleaning of sterilizer pack and the qualified rate of sterile articles increased,but the qualified rate of packaging of sterilization pack decreased from 96.02%in 2017 to 95.88%in 2018,especially the qualified rate of packaging of hospitals in western China decreased significantly,by 0.86%;in terms of adverse events,the incidence rate of wet pack,occupational exposure and the occurrence of adverse events decreased to varying degrees.According to the results of qualitative interview,there are two reasons why some hospitals fail to report the monthly quality indicators on time as required.There are self-management problems,such as insufficient attention by hospitals and problems in work handover.The online filling system of quality control center has defects,resulting in problems in filling in and submission.According to the person in charge of CSSD of each hospital,the main factors affecting the quality of CSSD work include obsolete equipment and lack of maintenance,unreasonable allocation of human resources,unreasonable building layout and imperfect management system,and some relevant suggestions are put forward.Conclusions and SuggestionsThe participation of secondary hospitals in quality evaluation is not very high,and hospitals still do not pay enough attention to the quality management of CSSD.The quality of CSSD work in the secondary and tertiary hospitals in Shandong Province has been improved from 2017 to 2018,the compliance of device processing has been generally improved,and the occurrence of negative events has been reduced,indicating that the quality control indicators of disinfection supply have played a good role in supervision and feedback.However,the qualified rate of packaging of the medical device package to be sterilized has been reduced,which needs to be noticed by the CSSD of the hospital.At present,CSSD mainly has the problems of insufficient staff,older staff,unsound management system and imperfect informatization construction,which seriously affect the work efficiency and work quality.In order to further improve the quality level of CSSD in the whole province,quality control centers should intensify the publicity and training of secondary hospitals and increase the attention.Hospital administrators shall further improve the allocation and organization of CSSD personnel,transport enough and high-quality talents to undertake relevant work,intensify training,and promote the optimization of human resources;at the same time,improve the informatization construction of hospitals and quality control centers,realize the standardization of data management,and ensure the smooth progress of various work;when conditions permit,encourage the construction of regional CSSD and share the work burden of local hospital CSSD.