甘肃省60所医疗机构医院感染管理现状调查
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摘要
目的了解甘肃省不同地区医疗机构医院感染管理现状,为制定甘肃省医院感染管理对策提供依据。方法采用多阶段分层整群随机抽样方法,根据地理位置、自然和人文特点选取甘肃省60所医疗机构对其2017年7月-2018年7月期间医院感染管理机构设置、专职人员配备、专职人员参加相关培训、医院感染管理工作开展等情况进行问卷调查及实地调研并对调查结果进行分析。结果二级和三级医疗机构设立医院感染管理委员会、配备感染管理专职人员、专职人员床位配比不足各占92.16%和100%、70.59%和100%、47.06%和66.67%;二级和三级医疗机构医院感染管理专职人员年龄构成、专业及学历分布差异均具有统计学差异(P<0.05);二级医疗机构无出省培训机会占72.56%,三级医疗机构只有科室负责人有出省培训机会占44.44%,差异有统计学意义(P<0.05);二级和三级医疗机构医院感染管理专职人员参与感染性疾病会诊分别占3.92%和33.33%,差异有统计学意义(P<0.05);二级和三级医疗机构开展医院感染全面监测分别为76.47%和100%,采用信息化监控手段分别为19.61%和11.11%;基础感控措施落实方面二级医院和三级医疗机构差异有统计学意义(P<0.05)。结论甘肃省三级医疗机构感染管理组织相关机构设置较合理,二级医疗机构医院感染管理组织机构需要逐步完善。医院感染管理专职人员数量仍不足,感染管理科专职人员中参与感染性疾病会诊医师严重不足,医院感染监测基本停留于手工阶段,信息化管理滞后,难以将医院感染管理进行深层次拓展的循证感控和精准感控。
OBJECTIVE To understand the current situation of nosocomial infection management in medical institutions in different regions of Gansu province,and to provide the basis for formulating the countermeasures of nosocomial infection management in Gansu province.METHODS Using multi-stage stratified cluster random sampling method,60 medical institutions in Gansu province were selected according to geographical location,natural and human characteristics.The setting of nosocomial infection management institutions,full-time staffing,training of full-time staff,and implementation of nosocomial infection management from Jul.2017 to Jul.2018 were surveyed and investigated.The survey and investigation results were analyzed.RESULTS The proportions of insufficiency in setting of nosocomial infection management committees,full-time staff for nosocomial infection managenment and beds for full-time staff in Grade II and Grade III institutions were 92.16%and 100%,70.59%and 100%,47.06%and 66.67%respectively.There were significant differences in the age composition,specialty and educational background distribution of full-time staff in Grade II and Grade III medical institutions(P <0.05).72.56% of the Grade II medical institutions did not have training opportunities outside the province,whereas 44.44% of the Grade III medical institutions had training opportunities in other provinces only for heads of departments,and the difference was significant(P<0.05).3.92% and 33.33% of the full-time staff of nosocomial infection management in Grade II and Grade III medical institutions participated in consultation of infectious diseases,respectively(P<0.05).76.47%and 100%of Grade II and Grade III medical institutions carried out overall monitoring of nosocomial infection,whereas 19.61% and 11.11% of them carried out information-based monitoring.There were significant differences in the implementation of basic infection control measures between Grade II hospitals and Grade III medical institutions(P<0.05).CONCLUSIONThe establishment of infection management organizations in the Grade III medical institutions in Gansu province is reasonable,and the organization of nosocomial infection management in the Grade II medical institutions needs to be improved step by step.The number of full-time staff for nosocomial infection management is still insufficient,and there is a serious shortage of doctors participating in consultation of infectious diseases among full-time staff in the department of infection management.The monitoring of nosocomial infection basically stays at the manual stage,and the information management lags behind,causing difficulty in expanding the evidence-based and accurate control of nosocomial infection management.
OBJECTIVE To understand the current situation of nosocomial infection management in medical institutions in different regions of Gansu province,and to provide the basis for formulating the countermeasures of nosocomial infection management in Gansu province.METHODS Using multi-stage stratified cluster random sampling method,60 medical institutions in Gansu province were selected according to geographical location,natural and human characteristics.The setting of nosocomial infection management institutions,full-time staffing,training of full-time staff,and implementation of nosocomial infection management from Jul.2017 to Jul.2018 were surveyed and investigated.The survey and investigation results were analyzed.RESULTS The proportions of insufficiency in setting of nosocomial infection management committees,full-time staff for nosocomial infection managenment and beds for full-time staff in Grade II and Grade III institutions were 92.16%and 100%,70.59%and 100%,47.06%and 66.67%respectively.There were significant differences in the age composition,specialty and educational background distribution of full-time staff in Grade II and Grade III medical institutions(P <0.05).72.56% of the Grade II medical institutions did not have training opportunities outside the province,whereas 44.44% of the Grade III medical institutions had training opportunities in other provinces only for heads of departments,and the difference was significant(P<0.05).3.92% and 33.33% of the full-time staff of nosocomial infection management in Grade II and Grade III medical institutions participated in consultation of infectious diseases,respectively(P<0.05).76.47%and 100%of Grade II and Grade III medical institutions carried out overall monitoring of nosocomial infection,whereas 19.61% and 11.11% of them carried out information-based monitoring.There were significant differences in the implementation of basic infection control measures between Grade II hospitals and Grade III medical institutions(P<0.05).CONCLUSIONThe establishment of infection management organizations in the Grade III medical institutions in Gansu province is reasonable,and the organization of nosocomial infection management in the Grade II medical institutions needs to be improved step by step.The number of full-time staff for nosocomial infection management is still insufficient,and there is a serious shortage of doctors participating in consultation of infectious diseases among full-time staff in the department of infection management.The monitoring of nosocomial infection basically stays at the manual stage,and the information management lags behind,causing difficulty in expanding the evidence-based and accurate control of nosocomial infection management.
引文
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[2]张新.52所医疗机构医院感染管理现状调查[D].山西:山西医科大学,2012.
[3]中华人民共和国卫生部.医院感染监测规范[S].北京,2009.
[4]中华人民共和国卫生部.医院感染管理办法[S].北京,2006.
[5]张京利,王力红,马文晖,等.构建动态绩效考核指标体系持续提升医院感染管理水平[J].中华医院感染学杂志,2016,26(18):4245-4247.
[6]刘思娣,李春辉,李六亿,等.中国医院感染管理组织建设30年调查[J].中国感染控制杂志,2016,15(9):648-653
[7]李卫光,朱其凤,李红军,等.山东省医院感染管理专职人员现状调查[J].中华医院感染学杂志,2011,21(20):4270-4272.
[8]World Health Organization.Practical guidelines for infection control in health care facilities[S].World Health Organization,2004.4-9.
[9]侯建林,柯杨.国际视角下对我国医师多点执业政策的思考[J].中国卫生经济,2016,35(2):51-54.
[10]徐敏,易文婷.美国医院感染管理运行机制及启示[J].中华医院感染学杂志,2013,23(7):1638-1640.
[11]AicherB,PeilH,PeilB,et al.Pain measurement:visual analogue scale(VAS)and verbal rating scale(VRS)in clinical trials with OTC analgesics in headache[J].Cephalalgia,2012,32(3):185-197.
[12]Zingg W,Holmes A,Dettenkofer M,et al.Hospital organization,management,and structure for prevention of health careassociated infection:a systematic review and expert consensus[J].Lancet Infect Dis,2015,15(3):263.
[13]Council of Colleges of Acupuncture and Oriental Medicine.Clean needle technique manual[M].7th ed,Gig Harbor:CCAOM,2016.
[14]张文福.感染与消毒-新世纪的挑战[J].中国消毒学杂志,2012,29(1):1-4.
[15]Liu X,Liang J,Jiang Y,et al.Molecular characteristics of community-acquired methicillin-resistant Staphylococcus aureus strains isolated from outpatients with skin and soft tissue infections in Wuhan,China[J].Pathog Dis,2016,74(4):ftw026.