流程再造在多部门参与多重耐药菌感染防控中的效果
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摘要
目的探讨流程再造在提高多部门参与多重耐药菌感染管理中的效果,为医院多部门协作管理提供方法学指导。方法选取2015年7月—2017年6月共672例多重耐药菌感染管理处置相关数据,流程再造前2015年7月—2016年6月370例患者作为对照组,流程再造后2016年7月—2017年6月302例患者作为实验组,应用流程再造完善医院内多重耐药菌发现、报告、合作、处置等各个环节流程,比较应用流程再造前后各项医院感染质量评价指标的差异。结果应用流程再造后,多重耐药菌信息从检验科传送到临床科室的时间由(240±30)min缩短至(8±2)min;多重耐药菌医院感染发生率由2.39‰下降至1.56‰,多重耐药菌检出率由13.42%下降至11.09%,差异均有统计学意义(均P<0.05)。多重耐药菌各项防控措施依从率和知晓率由58.11%~71.89%提高至84.11%~92.05%;抗菌药物使用率从53.18%下降至48.45%,使用强度DDDs值由44.76下降至38.26,治疗性抗菌药物使用前微生物送检率从46.68%上升至53.62%。结论流程再造增强了各部门参与合作程度,发挥了学科间优势互补,提高了医院感染管理效果。
Objective To investigate the effect of business process reengineering(BPR)on improving multisectors' participation in management of multidrug-resistant organism(MDRO)infection,and provide methodological guidance for hospital multisectors' collaborative management.Methods Related data about management and disposal of 672 cases of MDRO infection occurred from July 2015 to June 2017 were selected,370 patients before BPR(from July2015 to June 2016)were as control group,302 patients after BPR(from July2016 to June 2017)were as a trial group,BPR was used to improve the process of detection,report,cooperation,and disposal of MDROs in hospital,various quality evaluation indexes of healthcare-associated infection before and after BPR were compared.Results After the BPR was implemented,time of MDRO information transmitted from laboratory to clinical departments shortened from(240±30)minutes to(8±2)minutes;incidence of MDRO HAI decreased from2.39‰to1.56‰,isolation rate of MDROs decreased from13.42% to 11.09%,differences were all significant(all P<0.05).Compliance rates and awareness rates of various MDRO prevention and control measures increased from58.11%-71.89%to 84.11%-92.05%,usage rate of antimicrobial agents decreased from53.18% to 48.45%,defined daily doses(DDDs)of antimicrobial use density decreased from44.76 to 38.26,specimen submission rate before antimicrobial use increased from46.68%to 53.62%.Conclusion BPR can enhance the cooperation between different departments,give full play to the complementary advantages of interdisciplinary,and improve the efficiency of HAI management.
Objective To investigate the effect of business process reengineering(BPR)on improving multisectors' participation in management of multidrug-resistant organism(MDRO)infection,and provide methodological guidance for hospital multisectors' collaborative management.Methods Related data about management and disposal of 672 cases of MDRO infection occurred from July 2015 to June 2017 were selected,370 patients before BPR(from July2015 to June 2016)were as control group,302 patients after BPR(from July2016 to June 2017)were as a trial group,BPR was used to improve the process of detection,report,cooperation,and disposal of MDROs in hospital,various quality evaluation indexes of healthcare-associated infection before and after BPR were compared.Results After the BPR was implemented,time of MDRO information transmitted from laboratory to clinical departments shortened from(240±30)minutes to(8±2)minutes;incidence of MDRO HAI decreased from2.39‰to1.56‰,isolation rate of MDROs decreased from13.42% to 11.09%,differences were all significant(all P<0.05).Compliance rates and awareness rates of various MDRO prevention and control measures increased from58.11%-71.89%to 84.11%-92.05%,usage rate of antimicrobial agents decreased from53.18% to 48.45%,defined daily doses(DDDs)of antimicrobial use density decreased from44.76 to 38.26,specimen submission rate before antimicrobial use increased from46.68%to 53.62%.Conclusion BPR can enhance the cooperation between different departments,give full play to the complementary advantages of interdisciplinary,and improve the efficiency of HAI management.
引文
[1]邵晓红,刘颖,韩德辉,等.流程再造在新生儿医院感染控制中的效果观察[J].中华医院感染学杂志,2014,24(17):4368-4370.
[2]王文娟,许渝.2012年某医院多重耐药菌医院感染目标性监测与分析[J].中国消毒学杂志,2014,31(3):271-273.
[3]申翠华,徐华,张静,等.多药耐药菌感染监控模式的探讨[J].中华医院感染学杂志,2011,21(6):1203-1204.
[4]郭丽萍,徐潜,王云亭,等.日本某三级综合医院预防控制MRSA医院感染的多部门协作模式成效实证分析[J].中华医院感染学杂志,2016,26(12):2854-2857.
[5]肖永红,王进,赵彩云,等.2006—2007年Mohnarin细菌耐药监测[J].中华医院感染学杂志,2008,18(8):1051-1056.
[6]Rosenthal VD,Maki DG,Mehta Y,et al.International Nosocomial Infection Control Consortium(INICC)report,data summary of 43 countries for 2007-2012.Device-associated module[J].Am J Infect Control,2014,42(9):942-956.
[7]林金兰,李六亿.多重耐药菌医院感染的现状及研究进展[J].中国护理管理杂志,2010,10(12):76-78.
[8]Quan KA,Cousins SM,Porter DD,et al.Automated tracking and ordering of precautions for multidrug-resistant organisms[J].Am J Infect Control,2015,43(6):577-580.
[9]李六亿,贾会学,贾建侠,等.综合医院多药耐药菌医院感染控制效果的研究[J].中华医院感染学杂志,2011,21(20):4306-4308.
[10]孙吉花,于苏国,邱会芬.等.多部门合作机制在ICU多药耐药菌预防控制中的应用及效果评价[J].中华医院感染学杂志,2013,23(20):5045-5047.
[11]嵇晓红,刘春湘,陈嫣红.多学科协作模式在多重耐药菌医院感染控制中应用的效果观察[J].重庆医学杂志,2013,42(19):2254-2256.
[12]张丽.多重耐药菌医院感染控制中多学科协作模式的应用效果探析[J].中国伤残医学杂志,2015,23(18):187-188.
[13]魏瑛琪,关纯,邱蔓,等.多学科协作与多部门联动预防控制多药耐药菌医院感染[J].中华医院感染学杂志,2011,21(12):2595-2596.
[14]付强,刘运喜.医院感染监测基本数据集及质量控制指标集实施指南[M].北京:人民卫生出版社,2016:143-146.
[15]钟南山.抗菌药物临床应用指导原则[M].北京:人民卫生出版社,2015:145-147.
[16]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[2]王文娟,许渝.2012年某医院多重耐药菌医院感染目标性监测与分析[J].中国消毒学杂志,2014,31(3):271-273.
[3]申翠华,徐华,张静,等.多药耐药菌感染监控模式的探讨[J].中华医院感染学杂志,2011,21(6):1203-1204.
[4]郭丽萍,徐潜,王云亭,等.日本某三级综合医院预防控制MRSA医院感染的多部门协作模式成效实证分析[J].中华医院感染学杂志,2016,26(12):2854-2857.
[5]肖永红,王进,赵彩云,等.2006—2007年Mohnarin细菌耐药监测[J].中华医院感染学杂志,2008,18(8):1051-1056.
[6]Rosenthal VD,Maki DG,Mehta Y,et al.International Nosocomial Infection Control Consortium(INICC)report,data summary of 43 countries for 2007-2012.Device-associated module[J].Am J Infect Control,2014,42(9):942-956.
[7]林金兰,李六亿.多重耐药菌医院感染的现状及研究进展[J].中国护理管理杂志,2010,10(12):76-78.
[8]Quan KA,Cousins SM,Porter DD,et al.Automated tracking and ordering of precautions for multidrug-resistant organisms[J].Am J Infect Control,2015,43(6):577-580.
[9]李六亿,贾会学,贾建侠,等.综合医院多药耐药菌医院感染控制效果的研究[J].中华医院感染学杂志,2011,21(20):4306-4308.
[10]孙吉花,于苏国,邱会芬.等.多部门合作机制在ICU多药耐药菌预防控制中的应用及效果评价[J].中华医院感染学杂志,2013,23(20):5045-5047.
[11]嵇晓红,刘春湘,陈嫣红.多学科协作模式在多重耐药菌医院感染控制中应用的效果观察[J].重庆医学杂志,2013,42(19):2254-2256.
[12]张丽.多重耐药菌医院感染控制中多学科协作模式的应用效果探析[J].中国伤残医学杂志,2015,23(18):187-188.
[13]魏瑛琪,关纯,邱蔓,等.多学科协作与多部门联动预防控制多药耐药菌医院感染[J].中华医院感染学杂志,2011,21(12):2595-2596.
[14]付强,刘运喜.医院感染监测基本数据集及质量控制指标集实施指南[M].北京:人民卫生出版社,2016:143-146.
[15]钟南山.抗菌药物临床应用指导原则[M].北京:人民卫生出版社,2015:145-147.
[16]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.