中国医院消毒供应中心质量管理现状的Meta分析

 目的 评估中国医院消毒供应中心(CSSD)质量管理现状及存在问题,为规范管理CSSD、预防和控制医院感染提供参考依据。方法 检索2012年1月1日—2022年1月31日发表在中国知网、维普、万方、PubMed、Embase和Web of Science数据库中关于中国各地区医院CSSD质量管理现状的文献,由2名研究者进行文献筛选和数据提取,应用Stata14.0软件进行Meta分析。结果 最终纳入12篇文献,共1 435所医院。Meta分析结果显示,根据医院级别进行亚组分析:CSSD集中管理落实率三级医院(81%,95%CI:65%~97%)高于二级医院(61%,95%CI:30%~92%),专业人员配置与管理三级医院(86%,95%CI:76%~97%)优于二级医院(74%,95%CI:59%~89%);在建筑布局设计方面:医院CSSD建筑位置选择合理三级医院(85%,95%CI:75%~95%)优于二级医院(62%,95%CI:34%,91%);在重要设备配置方面:全自动清洗消毒器配置率三级医院(79%,95%CI:64%~94%)高于二级医院(48%,95%CI:20%~76%),医用绝缘检测仪配置率三级医院(44%,95%CI:30%~58%)高于二级医院(18%,95%CI:8%~28%),压力蒸汽灭菌器配置率三级医院(86%,95%CI:68%~105%)高于二级医院(80%,95%CI:67%~94%),信息化质量追溯系统落实率三级医院(47%,95%CI:34%~61%)高于二级医院(23%,95%CI:14%~32%)。结论 中国医院CSSD在质量管理方面,存在集中管理落实不到位、专业人员配置不足及管理不规范、建筑布局设计欠合理、设备设施配置不完善以及未全面采用信息化质量追溯系统等问题,存在一定的安全隐患。建议医院应认真落实卫生行业标准要求,加强CSSD科学管理,保障医疗质量和患者生命安全。

Quality management status of central sterile supply department in China: a Meta-analysis

Objective To evaluate the quality management status and existing problems of central sterile supply department (CSSD) in China, and provide reference basis for standardizing the management of CSSD as well as prevention and control of healthcare-associated infection (HAI). Methods Literatures on the current status of CSSD quality management in hospitals in various regions of China published on China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, PubMed, Embase, and Web of Science from January 1, 2012 to January 31, 2022 were searched, literatures were screened and data were extracted by two researchers, Stata14.0 software was adop-ted for Meta-analysis. Results A total of 12 literatures were included, involving 1 435 hospitals, Meta-analysis results showed that according to the subgroup analysis of hospital level, the implementation rate of CSSD centralized management in tertiary hospitals was higher than that in secondary hospitals (81% 95%CI: 65%-97%] vs 61% 95%CI: 30%-92%]); staffing and management of professionals in tertiary hospitals was better than that in se-condary hospitals (86% 95%CI: 76%-97%] vs 74% 95% CI: 59%-89%]); in terms of architectural layout design: the rationality selection of CSSD building location of tertiary hospitals was better than that of secondary hospitals (85% 95%CI: 75%-95%] vs 62% 95%CI: 34%-91%]); in terms of important equipment allocation: the allocation rate of automatic cleaning sterilizer in tertiary hospitals was higher than that in secondary hospitals (79% 95%CI: 64%-94%] vs 48% 95%CI: 20%-76%]); the allocation rate of medical insulation detector in tertiary hospitals was higher than that in secondary hospitals (44% 95%CI: 30%-58%] vs 18% 95%CI: 8%-28%]); allocation rate of pressure steam sterilizer in tertiary hospitals was higher than that in secondary hospitals (86% 95%CI: 68%-105%] vs 80% 95%CI: 67%-94%]); implementation rate of information quality traceability system in tertiary hospitals was higher than that in secondary hospitals (47% 95%CI: 34%-61%] vs 23% 95%CI: 14%-32%]). Conclusion There are some problems in quality management of hospital CSSD in China, including inadequate implementation of centralized management, insufficient allocation and non-standard management of professionals, irrational building layout design, insufficient allocation of equipment and facilities, as well as incomplete adoption of information-based quality traceability system, which exists certain potential safety problems. It is suggested that hospitals should conscientiously implement the requirements of health industry standards, strengthen the scientific management of CSSD, ensure medical quality and patient life safety.