Lithium hydride (LiH) ceramics are of significant importance in advanced nuclear energy systems and aerospace applications. However, its failure mechanisms under coupled thermal, mechanical, and hydrogen effects remain poorly understood, particularly the swelling and cracking caused by irradiation-induced hydrogen generation. In this study, we used global sensitivity analysis (GSA) with Latin hypercube sampling (LHS) to identify key factors influencing hydrogen transport. We then developed a deep neural network (DNN)-based surrogate model to efficiently predict hydrogen distribution in LiH. Additionally, we established a fully coupled thermo-mechanical-hydrogen (T-M-H) phase field fracture framework, which modifies the energy functional to integrate mechanical stress, temperature gradients, and internal hydrogen pressure into the fracture driving force. Our results show that temperature gradients dominate the non-uniform distribution of lattice hydrogen in LiH, surpassing the influence of stress gradients. Furthermore, variations in hydrogen pressure effects classify the material's failure into three stages: thermo-mechanical, hydrogen pressure-assisted, and hydrogen pressure-saturated. This work enhances the understanding of hydrogen pressure-assisted cracking under non-isothermal conditions and provides a novel framework for modeling damage evolution in hydrides exposed to extreme environments, supporting applications in nuclear and space technologies.

Lithium hydride (LiH) is one promising material for nuclear reactor shielding due to its high hydrogen content, but its poor mechanical strength and thermal conductivity pose challenges for fabricating large, crack-free ceramic components via conventional sintering. This study explores microwave sintering as a potential solution to enhance heating uniformity and reduce thermal stress during densification of bulk LiH ceramics. Using implicit function and level set methods, we numerically simulated the microwave field distribution and thermal response in both stationary and rotating samples. The results show that rotational heating improves temperature uniformity by up to 12.9% for specific samples, although uniform temperature control remains difficult through rotation alone. To mitigate stress accumulation from thermal gradients, we propose a cyclic sintering-resting strategy, which leverages LiH's tensile strength-temperature envelope to guide safe and efficient processing. This strategy successfully reduced total sintering time from several days to 1.63 h without inducing cracks. Our findings offer practical insights into optimizing microwave sintering parameters for large-scale LiH ceramic production and contribute to enabling its application in advanced nuclear shielding systems.

This study explores the hydrogen diffusion and trapping mechanisms of zirconium alloys under cyclic loading in nuclear reactors. We develop a micromechanical model incorporating multitrap and stress-assisted hydrogen diffusion, along with a hydrogen-induced softening effect. An extensive analysis was conducted to investigate the impacts of various fatigue parameters, including loading frequency, temperature, and hydrogen concentration, on the cyclic behavior of hydrogen diffusion and trapping, explicitly focusing on the dislocation trap. In addition, we quantitatively investigate the effects of Nb trap densities and their binding energy contribute to the enhancement of hydrogen embrittlement resistance in ternary H–Nb–Zr systems. Niobium atoms serve as a beneficial trap, impeding hydrogen diffusion and improving resistance to hydrogen-induced embrittlement. Our findings reveal the competitive mechanisms among different types of traps in regulating hydrogen diffusion and trapping near the crack tip. Evidence demonstrates that an increase in the hydrogen trapping capacity of beneficial traps leads to a more pronounced hydrogen-induced softening effect, thereby increasing the hydrogen trap capacity of dislocations. Conversely, when the amount of hydrogen in the lattice interstitials decreases, trapping hydrogen concentration at the grain boundary also decreases, indicating that increasing the hydrogen trapping capacity of one type of trap can increase the hydrogen trap ability of the other, which is not directly involved with the fracture process. Furthermore, a TS S p -based criterion was employed to quantify hydride-precipitation risk. Results reveal that hydride risk in Zr alloys falls sharply when strong traps and favorable loading conditions act together. Importantly, hydride precipitation is governed jointly by diffusion kinetics, mechanical time scales and trapping thermodynamics, and must be mitigated through a quantitatively balanced, multi-factor strategy.

Background:Wet pack after steam sterilization of medical devices in healthcare facilities are unacceptable. Purpose:To retrieve, evaluate and integrate the best evidence related to wet pack management. Methods:We searched the JBI, Up To Date, BMJ, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Cochrane library, PubMed, Guideline International Network (GIN), AORN Journal, and other databases using the pyramid "6S" model for guidelines, expert consensus, systematic reviews, evidence summaries, decisions, recommended practices, and technical reports on wet pack management. The period of the literature search is from the establishment of the database to January 2024. Two researchers evaluated the literature quality independently, and evidence was extracted from the literature that met the quality standards. AGREE II assessment system, Cochrane bias risk assessment, and JBI Evidence-Based Health care center authenticity assessment were used as the literature evaluation criteria and the JBI 2014 edition evidence pre-grading system for intervention studies. For all types of research, the literature quality and evidence level was evaluated, extracted, and summarized according to the theme. Results:Based on the inclusion criteria, seven pieces of literature were selected, including three guidelines, three randomized controlled trials, and consensus from an expert. Twenty pieces of evidence were obtained from seven different aspects: device packaging stage, loading stage, sterilization stage, unloading and cooling stage, distribution stage, wet package evaluation and analysis, and personnel training. Conclusion:This study summarizes the best evidence on wet pack management and can provide a reference for staff practices in disinfection supply centers to reduce the incidence of wet packs.

LiH is valued by researchers and engineers for its high-temperature resistance, high strength, high hydrogen storage capacity of up to 12.6 wt%, and high neutron absorption cross section. However, sintering and application of this material are difficult. Lithium hydride is a highly effective neutron shielding material. The neutron shielding ability of lithium hydride is directly affected by the homogeneity of the total amount and distribution of hydrogen. The heat migration of hydrogen reduces the neutron shielding effectiveness of lithium hydride. It is critical to forecast H's diffusion behavior. The diffusion coefficient is a critical metric for determining the diffusion efficiency. As a result, the stability, electronic structure, and bonding properties of LiH, LiOH, and H entering the tetrahedral interstitial sites of LiH were calculated using first principles based on density functional theory (DFT). The elastic modulus of the system was also examined to find the lowest thermal conductivity, and some thermodynamic parameters were derived by calculating LiH phonons. Finally, static calculations were used to determine the diffusion coefficient and diffusion activation energy of H in the LiH solid solution. The results revealed that the addition of H altered the characteristics of the LiH semiconductor, giving it metallic features. The lowest thermal conductivity of the LiH system was 2.9. W$m-1 K-1. The diffusion coefficient was D = (2.638 x 10-2 cm2/s )exp( -5.811 x 10-3 cal / KBT). The activation energy for diffusion was 0.252 eV. The diffusion coefficients, elastic constants, and lattice parameters all corresponded well with previously published results. The density functional theory was employed to study the material's system energy and electrical structure, and the microscopic migratory behavior of hydrogen was predicted theoretically. The calculation of the lowest thermal conductivity provided a reference for the screening of ceramic materials.(c) 2023 Hydrogen Energy Publications LLC. Published by Elsevier Ltd. All rights reserved.

The safety and stability of metal hydride reactor (MHR) structure are significantly important for normal operations of hydrogen isotope storage and supply system. Moreover, considering that the experiments of studying the fatigue and creep properties of MHR structure are always time, money, difficulty and energy consuming. To further improve the service life of MHR as well as lower the failure risk, this paper proposes a system integration method based on ASME code validation, which combines genetic algorithm (GA) and back propagation neural network (BPNN) for rapid assessment of creep-fatigue life (CFL) and optimal design of structural parameters. First, numerical simulation is applied to perform thermal-mechanical coupled finite element analysis and verified by ASME code. Then, parametric sensitivity analysis and experimental design of parameter-based training set based on Taguchi method were performed, and response values are obtained from physical models combined with numerical simulations. Finally, a parametric optimization procedure combining BPNN and GA is developed based on the training data. In the workflow, parametric data flow is passed through the experimental design, numerical simulation, prediction and optimization processes. The results show that the proposed BPNN proxy model based on ASME code validation has good performance in predicting the life of MHR. Based on this, the life of the MHR is improved by 8% compared to the reference sample.

BACKGROUND Central sterile supply departments (CSSDs) play a vital role in hospital infection control. We investigate the factors associated with wet pack occurrence after steam sterilization. MATERIAL AND METHODS We designed a log sheet to record information concerning sterilized packs. The data included the type of sterilized pack; outside weather (sunny, overcast, or rainy); the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been laid flat, upright, or leaning at an acute angle; which sterilizer was used for sterilization of the pack; whether the pack had been placed on the top or bottom shelf inside the sterilizer chamber; whether the pack had been loaded in compliance with guidelines; the drying time following sterilization; and cooling time after sterilization. The sterilized packs in our study were selected from all of the packs that were sterilized in the CSSD of the authors' institution during June to December 2021. RESULTS Factors associated with wet pack occurrence after steam sterilization include: outside weather on the day of sterilization; the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been placed on the top or bottom shelf; and cooling time after sterilization. Statistically significant differences (P<0.05) in wet pack incidence were identified for all of these factors. CONCLUSIONS Various factors are associated with wet pack occurrence after steam sterilization. Recommendations for reducing the risk of wet packs include regular maintenance of the steam pipeline, regular replacement of thermal insulation materials for the steam pipeline, and extension of the drying time.

Background: Improper cleaning is one of the main causes of sub-optimal levels of sterilization, and also a risk factor in terms of nosocomial infections. We aimed to investigate the factors associated with the cleaning quality of the reusable medical devices and prescribe improvement measures for ensuring the safe use of the devices and for iatrogenic infection control. Methods: An expert consultation was conducted to identify the factors associated with the cleaning quality of reusable medical devices. A self-designed quality inspection form for reusable medical device cleaning was used to collect the data concerning the factors associated with the cleaning quality of the reusable medical devices cleaned at our hospital's central sterile supply department (CSSD) during January to June 2022. We also investigated the cleaning personnel's perceptions and knowledge of medical devices cleaning by means of a self-designed questionnaire. Results: Statistically significant differences (P < 0.05) were identified among incorrect cleaning procedures, improper cleaning methods, non-standard pre-treatment, wrong perceptions or lack of knowledge of medical device cleaning, and complex device structure. Correct cleaning procedures (odds ratio (OR) = 0.216, 95 % confidential interval (CI): 0.170–0.275), choice of cleaning method (ultrasonic cleaning OR = 3.995, 95 % CI: 2.937–5.434; spray cleaning OR = 0.893, 95 % CI: 0.735–1.085), standard pre-treatment (OR = 1.470, 95 % CI: 1.191–1.815), complex device structure (OR = 1.534, 95 % CI: 1.247–1.888) and cleaning personnel's correct perceptions of medical device cleaning (OR = 0.530, 95 % CI: 0.436–0.645) were the independent factors associated with the cleaning quality. Conclusions: The quality of reusable medical device cleaning should be improved by: adherence to standard cleaning procedures, choosing the correct cleaning method and pre-treatment, improving cleaning personnel's knowledge and perceptions of medical device cleaning, and disassembling the medical devices with complex structures so as to reduce the quality defects of medical device cleaning.

Failure typically occurs during sintering due to high thermal stress and poor strength of LiH ceramics. The short sintering time has shown to be beneficial in preventing excessive grain growth and improving ceramic performance. In this study, we built a genetic algorithm back propagation artificial neural network (GA-BP-ANN) model to predict the strength margins under different work conditions. Sensitivity analysis showed that the thickness and end control time were the most relevant parameters for strength margins, and the GA-BP-ANN model demonstrated the most efficient sintering work condition for a given thickness. Through statistical analysis of the strength margin predicted by the GA-BP-ANN model, we found that the bilinear temperature control method expanded the range of safe sintering conditions by 30% compared to the linear temperature control method. The research results of this study may serve as a reference for the safe and efficient sintering of LiH ceramics.

Due to its lightweight and strong neutron shielding, lithium hydride (LiH) is a potential candidate shielding material in small modular reactors (SMR). However, the preparation of large-sized, thick-walled lithium hydride blocks using conventional methods faces challenges such as slow ramp-up rates, excessive grain growth, and large temperature gradients, and microwave sintering technology may offer a good solution to the above problems. The material's dielectric spectrum properties and thermal conductivity parameters were evaluated using first principles calculations, which may serve as a reference for exploring the lithium hydride microwave sintering mechanism. The static dielectric constant of lithium hydride was 4.4 and the optical dielectric constant was 1. The thermal conductivity at 300 K was 15.88 (W m- 1 k-1), which was consistent with the existing experimental value of 14.7 (W m- 1 k-1). Furthermore, we discussed the effect of temperature and vacancy defects on the dielectric temperature spectral properties of the material. The results showed that while the thermal conductivity decreased with increasing temperature, and the phonon thermal conductivity of LiH (vacancy defects) decreased. The presence of a vacancy defect in LiH leads to an increase in the number of free electrons near the Fermi level, thereby enhancing its electron thermal conductivity. The optimal sintering frequency of LiH with vacancy defects also decreased.

Lithium hydride (LiH) is an important hydrogen storage, heat storage and neutron shielding material. When used in neutron shielding structure, its size and strength have certain requirements, which would be met by LiH ceramics. However, it fails easily during sintering due to severe thermal stress and high brittleness. In this study, the influences of the dimension, furnace temperature cooling rate, and convection condition on the mechanical behavior were systematically examined. The results indicated that larger dimensions and faster furnace temperature cooling rates resulted in higher maximum stresses. Furthermore, convection was beneficial for reducing the thermal stress. Accordingly, a process-based failure assessment diagram method was proposed to evaluate the safety of LiH ceramics, and a bilinear precise temperature control approach was proposed. Based on this method, the tube thickness was increased by 25 % and the cooling time was reduced by 32 % compared to those using linear temperature control in an example. The conclusion and method could be applied to optimize the temperature control for more practical large-dimension sintering.

BACKGROUND Previous studies on professional identity, self-directed learning competence, and self-efficacy among central sterile supply department (CSSD) nurses are rare. We investigated the status of these 3 characteristics among CSSD nurses and offered suggestions, to provide a reference for CSSD talent development. MATERIAL AND METHODS CSSD nurses working in 45 hospitals in southwest China were invited to participate in a questionnaire survey in August 2021. The survey comprised a general information questionnaire, a self-directed learning competence rating scale, a professional identity scale, and a general self-efficacy scale. RESULTS The CSSD nurses' scores for professional identity, self-directed learning competence, and self-efficacy were 109.92±17.161, 125.77±21.316, and 26.92±6.633, respectively. For professional identity, statistically significant differences were identified (P≤0.05) for 3 factors: monthly income, reason for studying nursing, and reason for working in the CSSD. For self-directed learning competence, statistically significant differences (P≤0.05) were identified for 5 factors: age, hospital grade, type of employee, monthly income, and reason for working in the CSSD. For self-efficacy, statistically significant differences were identified (P≤0.05) for 3 factors: age, reason for studying nursing and working in the CSSD, and whether the CSSD nurses wished their children to become nurses. CONCLUSIONS The professional identity, self-directed learning competence, and self-efficacy of the CSSD nurses in this study were at the medium level. More attention should be paid to career planning of young nurses and improvement of their professional identity and self-directed learning competence.

BACKGROUND:Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures.METHODS:This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes.RESULTS:The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%.CONCLUSION:The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs.

Objective This study aimed to evaluate the current status of cleaning and disinfection management for digestive endoscopy, provide data for standardization processing techniques, and improve the quality of cleaning and disinfection. Methods Two reviewers independently and comprehensively searched the PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang, and CBM databases on February 1, 2023. The inclusion and exclusion criteria were strictly followed during the literature survey and data extraction. All observational studies detailing the current cleaning and disinfection management status for digestive endoscopy in hospitals were included. Meta-analysis was performed using STATA 16.0 software. Results After removing different articles, the meta-analysis finally included 54 articles associated with multiple countries. The authors favor auditing staffers to confirm compliance with guidelines. The meta-analysis results indicated a configuration rate of 76% (95% CI: 68-83%) for separate rooms designated for reprocessing; 79% (95% CI: 72-84%) for reprocessing rooms with adequate ventilation; 30% (95% CI: 24-36%) for automated endoscope washer-disinfectors; 68% (95% CI: 55-81%) for complete protective equipment usage; 90% (95% CI: 83-95%) for the configuration rate of endoscope and accessory storage cabinets; 50% (95% CI: 38-61%) for changing enzymatic-type detergents after each use; 51% (95% CI: 30-71%) for the use of purified or sterilized water for final rinsing; 80% (95% CI: 70-88%) for monitoring disinfectant concentration; 87% (95% CI: 80-93%) for microbial monitoring; and 44% (95% CI: 26-62%) for the usage of protective equipment. Conclusion The configuration of the automated endoscope washer-disinfector, non-standard cleaning and disinfection procedures, and a lack of occupational protection awareness among personnel responsible for cleaning and disinfecting digestive endoscopy were all apparent issues. It was suggested that all departments enhance their levels of management and supervision, standardize reprocessing procedures and quality control details, upgrade hardware facilities and spatial layouts, reinforce personnel training, and increase staff awareness of nosocomial infection risks.

Background: Paper-plastic sterilization pouches are essential in healthcare for preventing instrument contamination. However, sealing defects in these pouches can jeopardize patient safety. To address this issue, our study uses Root Cause Analysis (RCA), aiming to identify contributing factors to these defects and propose practical solutions. Through this, we aim to enhance the overall sterilization process Material/Methods: A retrospective analysis was conducted on 35,762 instruments sterilized and packaged in paper-plastic pouch-es at our hospital's Central Sterile Supply Department (CSSD) across two periods: July 2020 to June 2021 (pre-RCA, 17,563 instruments) and September 2021 to August 2022 (post-RCA, 18,199 instruments). We evaluat-ed RCA scores, packaging personnel's perceptions of sealing quality, and sealing defect rates before and after RCA implementation. Results: Root causes for sealing defects included lack of a standardized inspection procedure, inadequately sized pack-ing table, missed inspections, incorrect distribution procedures, inadequate staff training, and insufficient light-ing through the pass-through window between storage and distribution rooms. Among these, lack of a stan-dardized inspection procedure, small packing table size, and missed inspections were statistically significant risk factors (P<0.05). The sealing defect rate decreased from 0.15% pre-RCA implementation to 0.07% post -RCA implementation. Conclusions: Implementing RCA has been shown to effectively enhance the CSSD staff's perception of sealing quality and significantly reduce the incidence of sealing defects in paper-plastic pouches. Thus, RCA serves as an invalu-able tool for quality improvement in sterilization packaging processes.

Objetivo: Investigar los efectos de la intervención basada en el modelo de creencias de salud en los comportamientos de las enfermeras en términos de mantener húmedos los instrumentos quirúrgicos. Método: Se realizaron encuestas previas y posteriores a la capacitación sobre la humectación de instrumentos con las mismas 356 enfermeras de un hospital en China. Ambas encuestas contenían un cuestionario sobre el conocimiento general relacionado con la humectación del instrumento, preguntas basadas en escalas de percepción sobre el mismo tema y un formulario de inspección sobre la implementación de los procedimientos de humectación. Se proporcionó una formación de 3 meses a las enfermeras. Resultados: Después de la capacitación se mejoraron los conocimientos, las actitudes, las creencias y los comportamientos de las enfermeras para la humectación del instrumento. Conclusiones: La intervención basada en el modelo de creencias en salud puede generar una mejora significativa en el cumplimiento de los requisitos de humectación del instrumental quirúrgico por parte de las enfermeras, y las correspondientes mejoras en la limpieza del instrumental y la seguridad del paciente.

OBJECTIVE:We investigated the effects of the Health Belief Model (HBM)-based intervention on nurses' behaviors in terms of keeping surgical instruments moist.MATERIALS AND METHODS:Pre- and post-training surveys about instrument moistening were conducted with the same 356 nurses from a hospital in China. Both of the surveys contained questionnaire concerning general knowledge relating to instrument moistening, perception scale-based questions concerning the same issue, and an inspection form concerning the implementation of moistening procedures. Three months' training was provided for the nurses.RESULTS:After training, the nurses' knowledge, attitudes, beliefs, and behaviors for instrument moistening were improved.CONCLUSIONS:The HBM-based intervention can bring about a significant improvement in nurses' compliance with surgical instrument moistening requirements, and corresponding improvements in instrument cleanliness and patient safety.

Background: Efficient and timely cleaning of surgical instruments is paramount for optimal patient care. Challenges often arise during the collection and processing of instruments utilized in nighttime surgical procedures, impeding effective cleaning. To address these inefficiencies, we employed the Eliminate-Combine-Rearrange-Simplify (ECRS) strategy to improve the quality and efficiency of nighttime surgical instrument cleaning processes.Material/Methods: We optimized the nighttime surgical instrument cleaning process using the ECRS methodology. For the study, 27,308 surgical instruments cleaned between May and June 2021 were categorized as the control group, while 28,471 instruments cleaned between October and November 2021 constituted the observation group. We com-pared the number of quality defects in instrument cleaning, procedure times, and quantities of cleaning agents used before and after the implementation of ECRS.Results: With the ECRS application, the cleaning process was streamlined from 14 steps to 13. The quality defect rate, cleaning time per instrument batch, and average quantity of cleaning agent used per instrument were initial-ly 2.11%, 115 minutes, and 0.278 mL/piece, respectively. Post-ECRS implementation, these measures were sig-nificantly reduced to 0.26%, 91 minutes, and 0.193 mL/piece, correspondingly.Conclusions: The ECRS strategy presents a practical solution to optimize the cleaning process for surgical instruments used during nighttime procedures. This approach not only improves the quality and efficiency of cleaning but also contributes to cost reduction. This underscores the potential of ECRS in enhancing healthcare operation management.

Objetivo: Investigar los efectos de la intervención basada en el modelo de creencias de salud en los comportamientos de las enfermeras en términos de mantener húmedos los instrumentos quirúrgicos. Método: Se realizaron encuestas previas y posteriores a la capacitación sobre la humectación de instrumentos con las mismas 356 enfermeras de un hospital en China. Ambas encuestas contenían un cuestionario sobre el conocimiento general relacionado con la humectación del instrumento, preguntas basadas en escalas de percepción sobre el mismo tema y un formulario de inspección sobre la implementación de los procedimientos de humectación. Se proporcionó una formación de 3 meses a las enfermeras. Resultados: Después de la capacitación se mejoraron los conocimientos, las actitudes, las creencias y los comportamientos de las enfermeras para la humectación del instrumento. Conclusiones: La intervención basada en el modelo de creencias en salud puede generar una mejora significativa en el cumplimiento de los requisitos de humectación del instrumental quirúrgico por parte de las enfermeras, y las correspondientes mejoras en la limpieza del instrumental y la seguridad del paciente.

This study aimed to investigate the effect of the application of the FOCUS-PDCA quality improvement model in terms of reducing the distribution defect rate of the sterile packages processed by the CSSD. The FOCUS-PDCA quality improvement model was applied to analyze the causes of the distribution defects of sterile packages, develop improvement measures, and compare the distribution defect rates before and after the application of the FOCUS-PDCA model. Following implementation of the FOCUS-PDCA quality improvement model, the distribution defect rate of sterile packages decreased from 1.74 to 0.37% (P < 0.05). The FOCUS-PDCA quality improvement model can produce a substantial reduction in the distribution defect rate of sterile packages, ensuring the quality of sterile supplies.