The Application of Standard Operation Procedures in Laparoscopic Instruments Reprocessing for Quality Improvement Wu Keping, The Fifth Affiliated Hospital of Sun Yat-sen University Cui Zhidan Layout of CSSD in the Fifth Floor of Medical Tech Building SOP of Processing Optical System, Instruments and Lumens Flushing Washing Rinsing Disinfection Final Rinsing Lubrication Drying CSSD Introduction CSSD1 CSSD2 Reusable medical devices from clinical departments Reusable medical devices from operating rooms There are 30 people in our CSSD, including 1 associate chief nurse, 1 supervising nurse, 6 nurses and 22 technicians. Our CSSD is the training base in Guangdong. We’ve hosted 13 sessions since the foundation in Dec. 2009. The trainees come from 76 hospitals in Guangdong, Guangxi, Hainan and Sichuan. We provide education on collecting ,cleaning, inspection, packaging, sterilization and distribution and we also have trainings in the management of equipment and medical devices and team building. We’ve been promoting the implementation of three national standards and regulations and policies, which has been beneficial for the development of CSSD in Guangdong. Research Method Control group: the instruments are processed according to Technical Standard for Cleaning and Disinfection of Endoscopes (2004). Test group: the instruments are processed according to WS310.2, Guidance to the Cleaning, Disinfection and Sterilization of Rigid Endoscopes, manufacturers’ instructions for use and AAMI ST79 and the Standard Operation Procedures of Laparoscopic Instruments (SOP). 20 sets of laparoscopic instruments (289 in total) that function properly are randomly assigned to the test group and control group. Each group has 10 sets of instruments. The control group has 141 instruments and test group has 148 instruments. Conclusion The importance of cleaning quality of laparoscopic instruments Compared with the common instruments, the laparoscopic instruments are delicate, made of various materials, and complex. The long lumens, dead ends, grooves and crevices are easy to harbor blood and other organic contaminants but difficult to clean. Debris are often found in these places which eventually form hard-to-clean biofilm. It will affect the sterilization [4] and cause hospital acquired infections, which threaten the risks of operation and patients’ lives. The application of SOP in promoting the quality improvement of laparoscopic instruments cleaning • SOP can improve the cleaning quality • SOP can prevent the damages to instruments functions • SOP needs continuous improvements. Hospital Introduction The Fifth Affiliated Hospital of Sun Yat-sen University, a Tertiary A hospital, is the largest one in Zhuhai with adequate equipments and a strong technical force. It’s located not far from beautiful mountains and rivers. The European style buildings are Outpatient Building, Inpatient Building, Medical Tech Building and Center of Treatment and Prevention of Tumor. There are more than 1600 healthcare providers and 1300 bed counts. The Department of General Surgery is the key discipline at provincial level in Guangdong. The Tumor Department and Respiratory Medicine are the key disciplines at municipal level in Zhuhai. It’s a teaching hospital for high level of medical talents for Sun Yat- Sen University. It’s responsible for educating the doctors and postgraduates and undergraduates. Meanwhile, it has been embarking on multiple technical programs at national and provincial and municipal levels. The Zhuhai Medical Tech Research Center has developed over 200 new technologies ever since its establishment in 2003. Background As the minimally invasive technology advances, laparoscopic instrumentss are widely used in diagnosis and treatment. The laparoscopic instrumentss are delicate and expensive with complex structures and big challenges to cleaning. The simplified processing procedures and improper use of cleaning tools are making the situation worse [1] , directly affecting the cleaning effects. The standard operating procedure (SOP) is to describe the step-to-step information on how to execute one thing and lay down the optimized processes. Its purpose is to achieve consistency by following the same procedures. By having the SOP for laparoscopic instruments processing, we will improve the cleaning quality. Results Group Total number Optical system Light guide and camera Cable Instruments Cracks Bad imaging Damage Grey shadow Cracks Missing parts Closure Blades Perfectnes s ratio Test group 148 0 0 0 0 0 0 0 0 100% Control group 141 0 0 0 0 1 1 0 0 98.6% 2.1 Functionality Comparison (see Table 1) Table 1: Functionality Comparison of Instruments in Both Groups Group Optical system Light guide and cable Trocars Instruments Total pass rate Pass Pass rate Pass Pass rate Pass Pass rate Pass Pass rate Test group 10/10 100% 16/20 80% 20/20 100% 87/98 88.8% 89.9% Control group 4/10 40% 0/20 0 16/20 80% 36/91 39.6% 39.7% 2.2 Cleaning Effects Comparison (see Table 2) Table 2: Cleaning Effects Comparison of Instruments in Both Groups Layout of CSSD in the First Floor of Medical Tech Building 敷料间 Manual Cleaning of Rigid Endoscopes and Quality Standards Receiving: CSSD professionals Tools Counting the instruments, the name, specification, quantity and functionality Sorting and disassembly Cleaning separately based on the materials SOP of Processing Cameras, Light Guides and Cable Wiping with tap water Wiping with or soaking in enzymatic detergent Wiping with tap water Wiping with purified water Disinfection Drying About the authors Wu Keping Associate chief nurse, 31 years of experience in nursing. Head nurse of CSSD of the Fifth Affiliated Hospital of Sun Yat-sen University, chairman of committee of Zhuhai Nursing Association, member of standing committee of Guangdong Nursing Association, deputy supervisor of Guangdong Nursing Education Center in CSSD