医院实施安全注射制度的效果评价
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摘要
目的 探讨医务人员安全注射情况并提出改进措施,以提高安全注射的依从性。方法 收集安全注射方案实施前2015年1-12月的266例医务人员和1 125例住院患者和安全注射方案实施后2018年1-12月的301例医务人员和1 125例住院患者为研究对象,调查医院医务人员安全注射知识知晓情况,同时调查全院注射相关锐器伤及上报情况,同时调查注射室、治疗室和治疗车的安全注射配置和医疗废弃物处置情况。结果 实施后,全院安全注射设施配置率达到了97.09%(1 300/1 339),洗手池配备干手设施,速干手消毒液配置率和锐器盒配置率分别为96.67%,96.03%和98.81%高于实施前(P<0.05);实施后,治疗车配置率和注射室配置率分别为97.36%和95.35%高于实施前;无菌操作技术、锐器伤防护和医疗废物处置的知识知晓率分别为92.69%、88.04%和97.34%高于实施前(P<0.001);现场督导中注射、输液和采血的安全注射总依从率为91.15%高于实施前(P<0.001),其中注射、输液和采血依从率分别为89.13%,92.38%和90.24%高于实施前(P<0.001);一周内锐器伤实际人次发生率和人次上报率分别为0.89%和70.00%,与实施前比较差异有统计学意义(P<0.05);全年锐器伤人次发生率由实施前的6.42%下降至实施后的4.06%,每千住院日人次发生率由实施前166.97‰下降至实施后104.68‰。结论 通过多部门协作,改善安全注射设施配置,提升医务人员的安全注射知识水平和意识,提升医疗过程中督导的合格率,改善了本医院的安全注射环境。
OBJECTIVE In this study, we explored the situation of safe injection of medical staff and put forward improvement measures to improve the compliance of safe injection. METHODS The knowledge of safe injection in 266 medical staff and 1 125 inpatients from Jan. 2015-Dec. 2015 before implementing the scheme of safe injection and in 301 medical staff and 1 125 inpatients in Jan. 2018-Dec. 2018 after implementing scheme of safe injection was collected, and then the situation of sharp instrument injury and reporting rates in the whole hospital was investigated. At the same time, the safe injection allocation and disposal of medical waste in injection room, treatment room and treatment vehicle were investigated. RESULTS Through comprehensive intervention measures, the allocation rate of safe injection facilities reached 97.09%(1 300/1 339). The allocation rate of hand drying facilities in hand-washing pool, the allocation rate of quick-drying hand disinfectant, the allocation rate of sharp instrument box increased to 96.67%, 96.03% and 98.81% after intervention, and the difference was significant(P<0.05). The allocation rate of treatment vehicle and the allocation rate of injection room increased to 97.36% and 95.35% after intervention, the difference was significant(P<0.05). The awareness rates of aseptic operation technology, sharp instrument injury protection and medical waste disposal increased significantly to 92.69%, 88.04% and 97.34% after intervention, respectively(P<0.001). The total compliance rate of safe injection was 91.15%, significantly higher than that before implementation(P<0.001). The compliance rates of injection, transfusion and blood collection were 89.13%, 92.38% and 90.24% respectively, which were significantly higher than those before implementation(P<0.001). The actual incidence and reporting rate of sharp instrument injuries in one week were 0.89% and 70.00% respectively, with significant differences from those before implementation. The annual incidence of sharp instrument injuries decreased from 6.42% before implementation to 4.06% after implementation. The incidence of sharp instrument injuries per 1 000 hospitalization days decreased from 166.97‰ before implementation to 104.68‰ after implementation. CONCLUSION Through multi-department collaboration, we improved the configuration of safe injection facilities, enhanced the knowledge level of safe injection in medical staff, and enhanced the qualified rate of supervision in the medical process, and thus improved the safe injection environment in this hospital.
OBJECTIVE In this study, we explored the situation of safe injection of medical staff and put forward improvement measures to improve the compliance of safe injection. METHODS The knowledge of safe injection in 266 medical staff and 1 125 inpatients from Jan. 2015-Dec. 2015 before implementing the scheme of safe injection and in 301 medical staff and 1 125 inpatients in Jan. 2018-Dec. 2018 after implementing scheme of safe injection was collected, and then the situation of sharp instrument injury and reporting rates in the whole hospital was investigated. At the same time, the safe injection allocation and disposal of medical waste in injection room, treatment room and treatment vehicle were investigated. RESULTS Through comprehensive intervention measures, the allocation rate of safe injection facilities reached 97.09%(1 300/1 339). The allocation rate of hand drying facilities in hand-washing pool, the allocation rate of quick-drying hand disinfectant, the allocation rate of sharp instrument box increased to 96.67%, 96.03% and 98.81% after intervention, and the difference was significant(P<0.05). The allocation rate of treatment vehicle and the allocation rate of injection room increased to 97.36% and 95.35% after intervention, the difference was significant(P<0.05). The awareness rates of aseptic operation technology, sharp instrument injury protection and medical waste disposal increased significantly to 92.69%, 88.04% and 97.34% after intervention, respectively(P<0.001). The total compliance rate of safe injection was 91.15%, significantly higher than that before implementation(P<0.001). The compliance rates of injection, transfusion and blood collection were 89.13%, 92.38% and 90.24% respectively, which were significantly higher than those before implementation(P<0.001). The actual incidence and reporting rate of sharp instrument injuries in one week were 0.89% and 70.00% respectively, with significant differences from those before implementation. The annual incidence of sharp instrument injuries decreased from 6.42% before implementation to 4.06% after implementation. The incidence of sharp instrument injuries per 1 000 hospitalization days decreased from 166.97‰ before implementation to 104.68‰ after implementation. CONCLUSION Through multi-department collaboration, we improved the configuration of safe injection facilities, enhanced the knowledge level of safe injection in medical staff, and enhanced the qualified rate of supervision in the medical process, and thus improved the safe injection environment in this hospital.
引文
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[15] 朱萍儿,余慧,盛惠娥,等.医务人员锐器伤职业暴露基线调查与分析[J].中华医院感染学杂志,2013,23(3):602-604.
[16] 刘桂芝,李霞,郑晓凤,等.医务人员锐器伤基线调查与分析[J].中华医院感染学杂志,2014,24(1):233-235.
[17] Kakizaki M,Ikeda N,Ali M,et al.Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia[J].BMC Res Notes,2011,4(1):184.
[18] 沈琴.临床护理人员锐器伤低报告率原因调查[J].基层医学论坛,2018,22(15):2030-2032.
[19] 向凤玲,田继书,刘晞照,等.临床护理人员安全注射认知现状调查与对策分析[J].中华医院感染学杂志,2017,27(10):2386-2389.
[20] 张浩军,张肖红,张映华,等.不同地区医疗机构医务人员安全注射现状调查研究[J].中华医院感染学杂志,2017,27(8):1909-1912.
[21] 秦元梅.临床护士及护生锐器伤调查分析[J].中华医院感染学杂志,2010,20(16):2474-2475.
[22] Riddell LA,Sherrard J.Blood-borne virus infection:the occupational risks[J].Int J STD AIDS,2000,11(10):632-639.
[23] Ismail NA,Aboul Ftouh AM,Elshoubary WH,et al.Safe injection practice among health-care workers in Gharbiya Governorate,Egypt.[J].East Mediterr Health J,2007,13(4):893-906.
[24] Kohli E,Ptak J,Smith R,et al.Variability in the hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units[J].Infect Control Hosp Epidemiol,2009,30(3):222-225.
[25] Shi CL,Zhang M,Xie C.[Study on status of needle-stick and other sharps injuries among healthcare workers in a general hospital][J].Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi,2011,29(12):939-943.
[26] 杨远秋,刘泉,陈长蓉,等.一所三级综合医院安全注射管理效果的多维度评价[J].中国感染控制杂志,2018,17(11):1013-1018.
[27] 孔春芽,王飞,王飞筠,等.医务人员锐器伤现状调查与管理[J].中华医院感染学杂志,2015,25(24):5736-5738.
[2] 肖佳庆,杜丽,张馨心,等.医疗安全大背景下安全注射现状调查及对策探讨[J].现代医院管理,2017,15(2):16-18.
[3] Manchikanti L,Malla Y,Wargo BW,et al.Infection control practices (safe injection and medication vial utilization) for interventional techniques:are they based on relative risk management or evidence?[J].Pain Phys,2011,14(5):425-434.
[4] 杨莉,赖晓全,梁艳芳.基层医疗机构安全注射现状调查[J].中国感染控制杂志,2017,16(1):50-53.
[5] 陈敏珍.护理人员血源性职业暴露防护现状调查与对策[J].中华医院感染学杂志,2012,22(10):2158-2159.
[6] Pepin J,Abou Chakra CN,Pepin E,et al.Evolution of the global burden of viral infections from unsafe medical injections,2000-2010[J].PLoS One,2014,9(6):e99677.
[7] Hutin YJ,Chen RT.Injection safety:a global challenge[J].Bull World Health Organ,1999,77(10):787-788.
[8] Miller MA,Pisani E.The cost of unsafe injections[J].Bull World Health Organ,1999,77(10):808-811.
[9] Akinnifesi FK,Chirwa PW,Ajayi OC,et al.Analysis on Current status of safe injection of grass-roots inoculating units in Sichuan province[J].Pract Prevent Med,2009,31(10):3282-3291.
[10] Yan Y,Zhang G,Chen Y,et al.Study on the injection practices of health facilities in Jingzhou district,Hubei,China[J].Indian J Med Sci,2006,60(10):407-416.
[11] Gyawali S,Rathore DS,Shankar PR,et al.Strategies and challenges for safe injection practice in developing countries[J].J Pharmacol Pharmacother,2013,4(1):8-12.
[12] Perz JF,Thompson ND,Schaefer MK,et al.US outbreak investigations highlight the need for safe injection practices and basic infection control[J].Clin Liver Dis,2010,14(1):137-151.
[13] Steinglass R,Boyd D,Grabowsky M,et al.Safety,effectiveness and ease of use of a non-reusable syringe in a developing country immunization programme[J].Bull World Health Organ,1995,73(1):57-63.
[14] 索瑶,范珊红,高晓东,等.陕西省11所医院医务人员锐器伤调查与分析[J].中华医院感染学杂志,2011,21(12):2505-2507.
[15] 朱萍儿,余慧,盛惠娥,等.医务人员锐器伤职业暴露基线调查与分析[J].中华医院感染学杂志,2013,23(3):602-604.
[16] 刘桂芝,李霞,郑晓凤,等.医务人员锐器伤基线调查与分析[J].中华医院感染学杂志,2014,24(1):233-235.
[17] Kakizaki M,Ikeda N,Ali M,et al.Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia[J].BMC Res Notes,2011,4(1):184.
[18] 沈琴.临床护理人员锐器伤低报告率原因调查[J].基层医学论坛,2018,22(15):2030-2032.
[19] 向凤玲,田继书,刘晞照,等.临床护理人员安全注射认知现状调查与对策分析[J].中华医院感染学杂志,2017,27(10):2386-2389.
[20] 张浩军,张肖红,张映华,等.不同地区医疗机构医务人员安全注射现状调查研究[J].中华医院感染学杂志,2017,27(8):1909-1912.
[21] 秦元梅.临床护士及护生锐器伤调查分析[J].中华医院感染学杂志,2010,20(16):2474-2475.
[22] Riddell LA,Sherrard J.Blood-borne virus infection:the occupational risks[J].Int J STD AIDS,2000,11(10):632-639.
[23] Ismail NA,Aboul Ftouh AM,Elshoubary WH,et al.Safe injection practice among health-care workers in Gharbiya Governorate,Egypt.[J].East Mediterr Health J,2007,13(4):893-906.
[24] Kohli E,Ptak J,Smith R,et al.Variability in the hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units[J].Infect Control Hosp Epidemiol,2009,30(3):222-225.
[25] Shi CL,Zhang M,Xie C.[Study on status of needle-stick and other sharps injuries among healthcare workers in a general hospital][J].Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi,2011,29(12):939-943.
[26] 杨远秋,刘泉,陈长蓉,等.一所三级综合医院安全注射管理效果的多维度评价[J].中国感染控制杂志,2018,17(11):1013-1018.
[27] 孔春芽,王飞,王飞筠,等.医务人员锐器伤现状调查与管理[J].中华医院感染学杂志,2015,25(24):5736-5738.