Bauer M, Scheithauer S, Moerer O, Pütz H, Sliwa B, Schmidt C E, Russo S G, Waeschle R M
Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Stabsstelle OP Management, Universitätsmedizin Göttingen, Göttingen, Deutschland.
Anaesthesist. 2015 Oct;64(10):765-77. doi: 10.1007/s00101-015-0086-7.
The assurance of high standards of care is a major requirement in German hospitals while cost reduction and efficient use of resources are mandatory. These requirements are particularly evident in the high-risk and cost-intensive operating theatre field with multiple process steps. The cleaning of operating rooms (OR) between surgical procedures is of major relevance for patient safety and requires time and human resources. The hygiene procedure plan for OR cleaning between operations at the university hospital in Göttingen was revised and optimized according to the plan-do-check-act principle due to not clearly defined specifications of responsibilities, use of resources, prolonged process times and increased staff engagement.
The current status was evaluated in 2012 as part of the first step "plan". The subsequent step "do" included an expert symposium with external consultants, interdisciplinary consensus conferences with an actualization of the former hygiene procedure plan and the implementation process. All staff members involved were integrated into this management change process. The penetration rate of the training and information measures as well as the acceptance and compliance with the new hygiene procedure plan were reviewed within step "check". The rates of positive swabs and air sampling as well as of postoperative wound infections were analyzed for quality control and no evidence for a reduced effectiveness of the new hygiene plan was found. After the successful implementation of these measures the next improvement cycle ("act") was performed in 2014 which led to a simplification of the hygiene plan by reduction of the number of defined cleaning and disinfection programs for preparation of the OR.
The reorganization measures described led to a comprehensive commitment of the hygiene procedure plan by distinct specifications for responsibilities, for the course of action and for the use of resources. Furthermore, a simplification of the plan, a rational staff assignment and reduced process times were accomplished. Finally, potential conflicts due to an insufficient evidence-based knowledge of personnel was reduced.
This present project description can be used by other hospitals as a guideline for similar changes in management processes.
在德国医院，确保高标准的医疗护理是一项主要要求，同时降低成本和有效利用资源也是必不可少的。这些要求在具有多个流程步骤的高风险和成本密集型手术室领域尤为明显。手术之间对手术室的清洁对于患者安全至关重要，并且需要时间和人力资源。由于职责、资源使用、流程时间延长和员工参与度增加等规范未明确界定，哥廷根大学医院手术间清洁的卫生程序计划根据计划-执行-检查-行动原则进行了修订和优化。
2012年作为第一步“计划”的一部分对现状进行了评估。后续的“执行”步骤包括与外部顾问举行专家研讨会、召开跨学科共识会议，更新以前的卫生程序计划并实施该过程。所有相关工作人员都融入了这一管理变革过程。在“检查”步骤中审查了培训和信息措施的普及率以及对新卫生程序计划的接受程度和遵守情况。分析了阳性拭子和空气采样率以及术后伤口感染率以进行质量控制，未发现新卫生计划有效性降低的证据。在成功实施这些措施后，2014年进行了下一个改进周期（“行动”），通过减少手术室准备的清洁和消毒程序数量简化了卫生计划。
所描述的重组措施通过明确的职责、行动过程和资源使用规范，使卫生程序计划得到了全面落实。此外，还实现了计划的简化、合理的人员分配和流程时间的减少。最后，减少了由于人员缺乏循证知识而产生的潜在冲突。
本项目描述可供其他医院用作管理流程类似变革的指南。
