Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2024 Aug 30;189(9-10):e1910-e1916. doi: 10.1093/milmed/usad499.
Point of use (POU) treatment is a critical first step of medical device reprocessing. Reusable instruments and flexible endoscopes require a minimum of terminal sterilization or high-level disinfection, neither of which can be guaranteed if POU is performed incorrectly. Compliance considerations for POU include hospital accreditation readiness, unique austere surgical mission requirements, and the transition of future conflict towards Large Scale Combat Operations. This integrative review aims to describe POU for reusable instruments and endoscopes, and extrapolate implications for Military Health System policies and future considerations.
The authors performed an integrative review and comprehensive literature search in PubMed and CINAHL with the keywords "point of use," "point of use cleaning," "POU," "instrument," "high-level disinfection," "endoscope," and "clean." Articles were limited to "English" and "human" from 2017 to 2023. The authors also performed a thorough review of the Defense Health Agency and service-specific doctrine, as well as national guidelines regarding POU adherence.
The literature review yielded 18 articles that discussed the transport and reprocessing of reusable medical devices. Regulatory standards and national guidelines were used to supplement the literature. Seventeen evidence-based criteria were extrapolated from the literature to generate two step-by-step guides for the POU treatment of endoscopes and reusable instruments (Tables I and II). Despite increased morbidity and mortality rates linked to inadequate device reprocessing, compliance with POU procedures remains low. Barriers to practice included complex POU processes, intricately designed surgical instruments and endoscopes, lack of healthcare worker (HCW) knowledge and competency, and inadequate or ambiguously written policies. Training, competency assessments, and clearly written policies and procedures can be cost-effective, evidence-based, and feasible solutions.
Completing POU treatment is critical to a successful surgical mission in both the hospital and austere environment. Implications to practice include implementing evidence-based POU programs that improve patient outcomes and readiness while decreasing costs.
即时处理（Point of Use，POU）是医疗器械再处理的关键第一步。可重复使用的器械和软性内镜需要进行最低限度的终端灭菌或高水平消毒，如果 POU 处理不当，这两种方法都无法保证。POU 的合规性考虑因素包括医院认证准备、独特的严峻手术任务要求，以及未来冲突向大规模作战行动的转变。本综合评价旨在描述可重复使用器械和内镜的 POU，并推断出对军事卫生系统政策和未来考虑的影响。
作者在 PubMed 和 CINAHL 上进行了综合评价和全面的文献检索，使用的关键词是“即时处理”、“即时处理清洗”、“POU”、“器械”、“高水平消毒”、“内镜”和“清洗”。文章仅限于 2017 年至 2023 年的“英语”和“人类”。作者还对国防卫生局和特定服务的学说以及国家关于 POU 遵守情况的准则进行了彻底审查。
文献综述共得到 18 篇讨论可重复使用医疗器械运输和再处理的文章。利用监管标准和国家准则补充文献。从文献中推断出 17 项基于证据的标准，以生成两步法指南，用于内镜和可重复使用器械的 POU 处理（表 I 和表 II）。尽管设备再处理不当与发病率和死亡率增加有关，但 POU 程序的遵守情况仍然很低。实践中的障碍包括复杂的 POU 流程、设计复杂的手术器械和内镜、医护人员知识和能力不足，以及政策不充分或表述不清。培训、能力评估以及明确的政策和程序可以是具有成本效益、基于证据且可行的解决方案。
完成 POU 处理对于医院和严峻环境中成功的手术任务至关重要。对实践的影响包括实施基于证据的 POU 计划，以改善患者预后和准备情况，同时降低成本。
