运用风险评估方法降低重症医学科医院感染发病率
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摘要
目的探讨风险评估方法对高风险科室医院感染发病率的影响。方法选取某院为研究对象,通过开展全院及科室层面的医院感染管理风险评估,筛出高风险科室及其高风险环节,针对性进行干预。2017年4—6月收治的患者作为对照组,2017年7—9月收治的患者作为干预组,比较两组患者医院感染发病率。结果通过全院层面风险评估,重症医学科为风险最高的科室,通过科室层面评估,筛选出重症医学科高风险环节为接触隔离患者诊疗时未穿隔离衣、置管时未采用无菌大铺单、手卫生正确率低。针对性进行干预,接触隔离患者隔离衣配备率由0上升至100%,医护人员穿隔离衣执行率由0上升至97.62%;深静脉置管使用无菌大铺单执行率由72.50%上升至100%;手卫生正确率由85.00%上升至96.59%。医院感染例次发病率由5.90%下降至2.64%,差异有统计学意义(P<0.05)。结论医疗机构实施医院感染风险评估管理,针对高危科室高危环节有效指导医院感染防控,可提升医院感染管理水平。
Objective To explore the effect of risk assessment method on the incidence of healthcare-associated infection(HAI) in high-risk departments.Methods A hospital was selected as the research object, risk assessment of HAI management at the hospital and department level was carried out, high-risk departments and high-risk links were screened out, targeted intervention was performed. Patients hospitalized in April-June 2017 were as control group and those hospitalized in July-September 2017 were as intervention group, incidence of HAI between two groups was compared.Results Through risk assessment at the hospital level, department of critical care medicine was the department with the highest risk, risk assessment at the department level showed that without wearing isolation clothes when contacting isolated patients during diagnosis and treatment, without using sterile sheeting when catheterization, and low correct rate of hand hygiene were high-risk links in department of critical care medicine. Targeted intervention was performed, isolation clothing allocation rate for contacting isolated patients increased from 0 to 100%, compliance rate to wearing isolation clothing among medical staff increased from 0 to 97.62%, implementation rate of using sterile sheet for deep vein catheterization increased from 72.50% to 100%; hand hygiene correct rate increased from 85.00% to 96.59%. Incidence of HAI decreased from 5.90% to 2.64%, difference was statistically significant(P<0.05).Conclusion Implementing risk assessment management of HAI in medical institutions can effectively guide the prevention and control of HAI in high-risk departments, and improve the level of HAI management.
Objective To explore the effect of risk assessment method on the incidence of healthcare-associated infection(HAI) in high-risk departments.Methods A hospital was selected as the research object, risk assessment of HAI management at the hospital and department level was carried out, high-risk departments and high-risk links were screened out, targeted intervention was performed. Patients hospitalized in April-June 2017 were as control group and those hospitalized in July-September 2017 were as intervention group, incidence of HAI between two groups was compared.Results Through risk assessment at the hospital level, department of critical care medicine was the department with the highest risk, risk assessment at the department level showed that without wearing isolation clothes when contacting isolated patients during diagnosis and treatment, without using sterile sheeting when catheterization, and low correct rate of hand hygiene were high-risk links in department of critical care medicine. Targeted intervention was performed, isolation clothing allocation rate for contacting isolated patients increased from 0 to 100%, compliance rate to wearing isolation clothing among medical staff increased from 0 to 97.62%, implementation rate of using sterile sheet for deep vein catheterization increased from 72.50% to 100%; hand hygiene correct rate increased from 85.00% to 96.59%. Incidence of HAI decreased from 5.90% to 2.64%, difference was statistically significant(P<0.05).Conclusion Implementing risk assessment management of HAI in medical institutions can effectively guide the prevention and control of HAI in high-risk departments, and improve the level of HAI management.
引文
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[9] 徐艳, 杨怀, 张曼, 等.外科系统医院感染管理的风险评估研究[J].中华医院感染学杂志, 2017, 27(8):1890-1892.
[10] 徐丹慧, 吴安华, 胡必杰, 等.全国多中心ICU医务人员手卫生正确性分析[J].中华医院感染学杂志, 2015, 25(21):5025-5027.
[11] 贾会学, 李玲, 任军红, 等.提高医务人员手卫生正确率的干预效果分析[J].中华医院感染学杂志, 2013, 23(7):1648-1650.
[12] 张满, 杨怀, 徐艳, 等.2014年贵州省医疗机构住院患者医院感染和社区感染现患率调查[J].中国感染控制杂志, 2017, 16(1):23-27.
[2] Esatoˇglu AE, Agirbas I, Onder OR, et al. Additional cost of hospital-acquired infection to the patient: a case study in Turkey[J]. Health Serv Manage Res, 2006, 19(3): 137-143.
[3] 董卫国, 陈静, 史登平.建立医院感染风险评估机制预防控制医院感染[J].中华医院感染学杂志, 2015, 25(12):2865-2867.
[4] 李六亿, 徐艳.医院感染管理的风险评估[J].中国感染控制杂志, 2016, 15(7):441-445.
[5] 文进, 谢瑜, 高晓凤.美国飓风风险管理的循证评价及其对我国医疗风险管理的启示—医疗风险系列研究之三[J].中国循证医学杂志, 2006, 3(6):209-217.
[6] 中华人民共和国卫生部.突发事件公共卫生风险评估管理办法[S].北京, 2011.
[7] 李六亿, 徐艳, 贾建侠, 等.医院感染管理的风险评估分析[J].中华医院感染学杂志, 2016, 26(11):2607-2610.
[8] 徐艳, 杨怀, 牟霞, 等.医院感染风险管理方法的实施与运用[J].中华医院感染学杂志, 2017, 27(12):2824-2833.
[9] 徐艳, 杨怀, 张曼, 等.外科系统医院感染管理的风险评估研究[J].中华医院感染学杂志, 2017, 27(8):1890-1892.
[10] 徐丹慧, 吴安华, 胡必杰, 等.全国多中心ICU医务人员手卫生正确性分析[J].中华医院感染学杂志, 2015, 25(21):5025-5027.
[11] 贾会学, 李玲, 任军红, 等.提高医务人员手卫生正确率的干预效果分析[J].中华医院感染学杂志, 2013, 23(7):1648-1650.
[12] 张满, 杨怀, 徐艳, 等.2014年贵州省医疗机构住院患者医院感染和社区感染现患率调查[J].中国感染控制杂志, 2017, 16(1):23-27.
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