应用根因分析法控制骨科植入类器械清洗消毒效果对患者感染的影响  

Effect of application of root cause analysis to control the effect of disinfection of orthopedic implantation on patient infections

作　　者：谈绍峰[1] 张莉[1] 薛英 马秀玲[1] 陈秋航 TAN Shao-feng;ZHANG Li;XUE Ying;MA Xiu-ling;CHEN Qiu-hang(Qingdao City Eighth People＇s Hospital,Qingdao,Shandong 266100,China)

机构地区：[1]青岛市第八人民医院消毒供应室,山东青岛266100

出　　处：《中华医院感染学杂志》2018年第15期2394-2396,2400,共4页Chinese Journal of Nosocomiology

摘　　要：目的探究应用根因分析法控制骨科植入类器械对器械清洗消毒效果、患者感染情况的影响。方法选取2015年5月-2017年4月于医院接受骨科手术治疗并植入器械患者476例为研究对象,将2015年5月-2016年4月于医院接受治疗的患者227例作为对照组,将2016年5月-2017年4月于医院接受治疗的患者249例作为试验组,于2016年5月开始应用根因分析法评估改进骨科植入类器械清洗消毒质量。对照组患者骨科植入类器械采用常规清洗消毒,试验组患者在对照组的基础上应用根因分析法进行评估改进,检测两组骨科植入类器械的清洗消毒效果并进行比较,同时比较两组患者感染情况,检测感染患者病原菌种类及构成比。结果 476例接受骨科手术治疗并植入器械患者中共有41例感染,感染率为8.61%;41例感染患者共检出病原菌59株,其中革兰阳性菌38株占64.4%、革兰阴性菌18株占30.5%、其他菌种3株占5.1%;对照组患者骨科植入类器械清洗消毒质量:污渍器械9.7%、生锈器械4.0%、返洗器械13.7%和总合格器械86.3%,试验组患者骨科植入类器械清洗消毒质量:污渍器械3.2%、生锈器械1.6%、返洗器械4.8%和总合格器械95.2%,两组器械清洗消毒质量比较差异有统计学意义(P<0.05);对照组患者感染率为12.8%(29/227),高于试验组患者感染率4.8%(12/249)(χ2=5.051,P=0.025)。结论应用根因分析法能够有效提高骨科植入类器械清洗消毒质量,降低器械病菌附着程度,对于降低骨科植入手术患者感染率具有积极影响。OBJECTIVE To explore the effect of application of root cause analysis to control the effect of orthopedic implantation on equipment cleaning and disinfection and patient infections.METHODS A total of 476 patients who underwent orthopedic surgery and implanted equipment from May 2015 to Apr.2017 were selected as the study subjects.Among which,227 cases of patients treated in hospital from May 2015 to Apr.2016 were selected as control group,and 249 cases of patiets treated in the hospital from May 2016 to-Apr.2017 were selected as the observation group.The root cause analysis was used to improve the quality of orthopedic implant cleaning equipment disinfection from May 2016.The orthopedic implants in patients of the control group were treated with routine cleaning and disinfection.The orthopedic implants in the observation group were improved on the basis of the control group.The disinfection effect of the two orthopedic implants was tested and compared,while the infection of the two groups of patients were detected,and the pathogen species and composition ratio of the infected patients were detected.RESULTS Totally 41 cases of infections in 476 patients underwent surgical treatment and and orthopedic implantation,and the infection rate was 8.61%.A total of 59 strains of pathogenic bacteria were detected from 41 infected pateints,including 38 strains of gram-positive bacteria（64.4%）,18 strains of gram-negative bacteria（30.5%）,and 3 strains of other bacteria（5.1%）.The cleaning and disinfection qualities of orthopedic im-plants of the control group of patients were as follows：the implanted device was 9.7%,the rusty instrument was4.0%,backwashing device was 13.7% and the total qualified equipment was 86.3%,and of the observation group were as the following：the implanted device was 3.2%,the rusty instrument was 1.6%,backwashing device was4.8% and the total qualified equipment was 95.2%,and the equipment cleaning and disinfection quality of the two groups had statistically significantly difference（P〈

关 键 词：骨科 植入类器械 感染 根因分析法 影响 

分 类 号：R187[医药卫生—流行病学]