基于美国医疗机构评审国际联合委员会标准的烧伤科医院内感染管理实践  

Practice of nosocomial infection management in burn department based on the American hospital evaluation standard of the Joint Commission International

作　　者：陈华清 沈鸣雁[1] 邵华伟[1] 韩春茂[1] Chen Huaqing;Shen Mingyan;Shao Huawei;Han Chunmao(Department of Burns,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院烧伤科,杭州310009

出　　处：《中华烧伤杂志》2020年第6期488-492,共5页Chinese Journal of Burns

基　　金：浙江省医药卫生科技计划(2019KY081)。

摘　　要：目的探讨基于美国医疗机构评审国际联合委员会(JCI)标准的医院持续质量改进措施在浙江大学医学院附属第二医院烧伤科(以下称笔者科室)医院内感染预防和控制中的作用。方法2013-2018年,基于JCI标准中涉及感染预防与控制的11项标准及笔者科室现状,笔者科室50余位医师、护士、护理员共同参与,不断完善笔者科室医院内感染三级管理体系、重点落实多药耐药菌感染患者管理、优化仪器与布类的感染控制管理等,对手卫生执行率等5个指标进行目标管理,对医院内感染预防与控制中的11个项目进行稽查及质量管理和改进。监测笔者科室医护人员2013-2018年手卫生执行率及2016-2018年手卫生正确率,烧伤重症监护病房(ICU)中心静脉导管相关血流感染(CRBSI)、导尿管相关尿路感染(CAUTI)、呼吸机相关肺炎(VAP)发生率。监测2013-2018年改进前后笔者科室医院内感染漏报率、重度烧伤患者强化胰岛素治疗期间高血糖发生率、CRBSI防范措施执行率、留置导尿管体表固定规范率、VAP防范措施执行率、悬浮床使用期间床体温度准确率、住院医师规范化培训医护人员手卫生执行率。对数据行χ^2检验。结果2013-2018年,笔者科室医护人员手卫生执行率为88.0%~89.5%;2016-2018年,笔者科室医护人员手卫生正确率为95.10%~97.35%,均达到目标值。烧伤ICU 2015年CRBSI发生率、2017年VAP发生率和2013、2014、2017年CAUTI发生率未达到目标值,经质量改进后达到目标值;其余年份各指标均达到目标值。2013-2018年,笔者科室改进后医院内感染漏报率、重度烧伤患者强化胰岛素治疗期间高血糖发生率明显低于改进前(χ^2=24.50、4.74,P<0.05或P<0.01),CRBSI防范措施执行率、留置导尿管体表固定规范率、VAP防范措施执行率、悬浮床使用期间床体温度准确率明显高于改进前(χ^2=13.78、6.50、20.37、13.92,P<0.05或P<0.01),住院医师规�Objective To explore the role of continuous quality improvement measures based on the American hospital evaluation standard of the Joint Commission International(JCI)in prevention and control of nosocomial infection in Burn Department of the Second Affiliated Hospital of Zhejiang University School of Medicine(hereinafter referred to as the author′s department).Methods From 2013 to 2018,based on 11 JCI standards related to infection prevention and control and the current situation of the author′s department,more than 50 doctors,nurses,and nursing assistants from the author′s department participated in continuous improvement of the three-level management system of nosocomial infection in the author′s department,focusing on implementing of management of patient with multidrug resistant bacteria infection,optimizing the infection control management of instrument and cloth,and implementing target management on 5 indicators such as hand hygiene implementation rate,and carrying out inspection,quality management,and improvement on 11 items of prevention and control of nosocomial infection.The implementation rate of hand hygiene from 2013 to 2018 and the accuracy rate of hand hygiene from 2016 to 2018 of medical staff in the author′s department,and incidences of catheter-related bloodstream infection(CRBSI)of central venous,catheter-associated urinary tract infection(CAUTI),and ventilator associated pneumonia(VAP)of burn intensive care unit in the author′s department from 2013 to 2018 were monitored.The following 7 indicators were monitored from 2013 to 2018,including false negative rate of nosocomial infection,incidence of hyperglycemia during intensive insulin treatment for severely burned patients,the implementation rate of CRBSI preventive measures,the specification rate of surface fixation of indwelling catheter,the implementation rate of VAP preventive measures,the accuracy rate of bed temperature during the use of suspended bed,and the implementation rate of hand hygiene of standardized training medical

关 键 词：烧伤病房 感染控制 质量控制 

分 类 号：R644[医药卫生—外科学] R63[医药卫生—临床医学] Q344+.14[生物学—遗传学]