根因分析法对抑制颅脑外科院内感染的价值研究  

Value of root cause analysis in suppressing nosocomial infections in craniocerebral surgery

作　　者：申健 杨琦 田维琴[1] SHEN Jian;YANG Qi;TIAN Wei-qin(Beijing Chaoyang Hospital,Capital Medical University,Supply Room,Beijing 100020,China;不详)

机构地区：[1]首都医科大学附属北京朝阳医院供应室,北京100020 [2]首都医科大学附属北京朝阳医院手术室,北京100020

出　　处：《现代预防医学》2020年第17期3257-3260,共4页Modern Preventive Medicine

摘　　要：目的探讨根因分析法(RCA)对颅脑外科手术显微器械病原菌分布的影响及预防院内感染的价值。方法回顾性分析自2017年4月-2018年4月间行神经外科手术治疗患者270例病例资料,抽选2018年6月-2019年6月间行270例患者为观察组。比较各组一般资料,采用根因分析法评估后院内感染发生率、手术器械清洗消毒质量、不合格显微器械病原菌分布和手术室空气质量改善情况。结果两组研究对象性别、年龄、手术类型等差异无统计学意义(P>0.05),实施RCA前神经外科颅脑感染发生率高于实施后,差异有统计学意义(χ^2=14.128,P<0.001)。实施RCA后手术显微器械清洗目测法、试剂法合格率高于实施前,差异有统计学意义(χ^2=6.383,P=0.011;χ^2=5.741,P<0.05)。细菌培养结果显示,RCA实施前检出革兰氏阴性菌(G-)17株,革兰氏阳性菌(G+)35株、真菌2株,实施后检出革兰氏阴性菌(G-)8株,革兰氏阳性菌(G+)5株,但未检出真菌,差异无统计学意义(χ^2=4.237,P=0.120),RCA评估指导制定相关措施后,实施后术前、手术10min、术毕时空气菌落数低于实施前,差异有统计学意义(F=9.650,P<0.001;F=14.882,P<0.001;F=36.214,P<0.001)。结论根因分析法能够提高手术器械清洗消毒合格率和室内空气清洁度,有效预防颅脑手术感染率。Objective To investigate the influence of root cause analysis(RCA)on the distribution of pathogens in microsurgical instruments and the value of preventing nosocomial infections.Methods The data of 270 patients who underwent neurosurgery from 2017/4 to 2018/4 were retrospectively analyzed.270 patients who underwent neurosurgery from 2018/6 to 2019/6 were selected as the observation group.The general data of each group were compared.Root cause analysis was used to evaluate the incidence of infection in backyard,cleaning and disinfection quality of surgical instruments,distribution of pathogenic bacteria of unqualified microscopic instruments and improvement of air quality in operating room.ResultsThere was no significant difference in gender,age and type of surgery between the two groups(P>0.05).The incidence of craniocerebral infection in neurosurgery before RCA was higher than that after RCA(χ^2=14.128,P<0.001).The qualified rate of cleaning and visual inspection method and reagent method for surgical microscopic instruments after RCA was higher than that before RCA(χ^2=6.383,P=0.011;χ^2=5.741,P<0.05).The results of bacterial culture showed that 17 Gram-negative bacteria(G-)and 35 Gram-positive bacteria(G+)and 2 fungi were detected before RCA was implemented.After RCA was implemented,8 Gram-negative bacteria(G-)and 5 Gram-positive bacteria(G+)were detected,but no fungi were detected.The difference was not statistically significant(χ^2=4.237,P=0.120).After RCA evaluation guided the formulation of relevant measures,the number of air colonies before and 10min after the operation and at the end of the operation was lower than that before the implementation,and the difference was statistically significant(F=9.650,P<0.001;F=14.882,P<0.001;F=36.214,P<0.001).Conclusion The root cause analysis method can improve the cleaning and disinfection rate of surgical instruments and indoor air cleanliness,and effectively prevent the infection rate of brain surgery.

关 键 词：颅脑手术 显微器械 空气菌落数 病原菌 感染率 

分 类 号：R197.3[医药卫生—卫生事业管理]