Department of Infection Prevention & Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Infect Control Hosp Epidemiol. 2019 Oct;40(10):1151-1156. doi: 10.1017/ice.2019.199. Epub 2019 Jul 26.
To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection.
A 60-day quality improvement and implementation project.
A quaternary academic pediatric referral facility.
A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies.
Median room turnover decreased from 130 minutes (range, 93-294 minutes) to 65 minutes (range, 48-95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001).
We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.
为了防止病原体的环境传播，安置在基于传播预防措施的患者的病房会进行广泛的清洁，并使用紫外线（UV）灯进行消毒。要做到这一点需要时间和协调，这些程序必须避免患者流程延迟和相关的安全风险。我们试图提高房间周转率效率，以进行 UV 消毒。
60 天的质量改进和实施项目。
一家四级学术儿科转诊机构。
一个多学科的医疗保健团队参与了一项为期 60 天的前后试验，该试验遵循丰田生产系统精益方法学。我们使用价值流映射和手动时间研究来确定改进的领域。解决的领域包括房间清理、房间清洁以及清洁与消毒之间的等待时间。房间周转率的测量方法是从出院患者离开隔离病房到 UV 消毒完成的时间（以分钟为单位）。使用干预后的手动时间研究来衡量影响。
房间周转率中位数从 130 分钟（范围，93-294 分钟）降至 65 分钟（范围，48-95 分钟；P<.0001）。其他结果包括房间清理到清洁开始时间的中位数时间减少（从 10 分钟到 3 分钟；P=.004），房间清洁完成到 UV 消毒开始的中位数时间减少（从 36 分钟到 8 分钟；P<.0001），以及房间清洁和窗帘更换的时间减少（从 57 分钟到 37 分钟；P<.0001）。
我们通过减少常规任务之间和期间的时间，将房间周转率时间缩短了一半。利用精益方法学和手动时间研究可以帮助团队了解和改进医院流程和系统。
