综合医院发热门诊医院感染风险评估与控制  

Risk assessment and control of nosocomial infection in fever clinic of general hospital

作　　者：赵霞[1] 王力红[1] 张京利[1] 赵会杰[1] 马文晖[1] 韩叙[1] 王允琮 ZHAO Xia;WANG Li-hong;ZHANG Jing-li;ZHAO Hui-jie;MA Wen-hui;HAN Xu;WANG Yun-cong(Xuanxvu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院医院感染管理处,北京100053

出　　处：《中华医院感染学杂志》2021年第16期2546-2550,共5页Chinese Journal of Nosocomiology

基　　金：北京市属医院科研培育计划基金资助项目(PG2019018)。

摘　　要：目的建立综合医院发热门诊医院感染风险评估体系,通过风险评估实现风险精准控制,降低医患双方医院感染的发生风险。方法基于医疗失效模式与效应分析法(Healthcare failure mode and effect analysis,HFMEA),对某三级甲等综合医院发热门诊进行定量医院感染风险评估,建立评估体系,定期进行风险评估,查找需重点干预控制的风险点,针对性制定精准控制措施,并对控制效果进行评价,循环进行,持续改进。结果发热门诊风险评估体系包括建筑布局与设施是否符合传染病防控要求、医院感染防控相关制度与流程是否完善、人员管理及防护是否恰当、物品管理是否合法合规、环境清洁与消毒是否规范、医疗流程是否符合医院感染防控要求等;新型冠状病毒肺炎疫情初期对发热门诊进行第一轮风险评估,查找风险点44个,其中需采取措施重点干预控制的风险点8个。经过实施针对性改进措施,改进周期结束后,进行第二轮风险评估,对控制效果进行评价,风险控制效果良好。结论基于HFMEA建立综合医院发热门诊定量风险评估体系并定期进行风险评估,可及时发现发热门诊潜在医院感染风险,实现发热门诊医院感染的精准防控,大大降低传染病医院内交叉感染风险,防患于未然。OBJECTIVE To establish the risk assessment system of nosocomial infection in fever outpatient department of general hospital,and to realize the accurate risk control to reduce the occurrence of nosocomial infection in doctors and patients.METHODS Based on the healthcare failure mode and effect analysis(HFMEA),the quantitative risk assessment was carried out in the fever clinic in a general hospital to establish the risk system.Regular evaluation was performed to find out the key risks that should be controlled.Accurate measures were implemented and re-evaluated were performed and then adjusted.The cycle of the process will be conducted in a row to get the improvement.RESULTS The risk assessment system of fever clinic included the building layout and facilities whether meet the requirements of the infectious diseases prevention and control,whether the system of prevention and control of hospital infection was complete,whether the personnel management and protection was proper,whether the item management,environment cleaning and disinfection were legal compliance and whether the medical process can meet the demands of the hospital infection prevention and control,etc.At the beginning of COVID-19 epidemic,the first round of risk assessment was carried out on fever clinics,and 44 risk points were identified,among which 8 risk points needed to be controlled by key intervention measures.Targeted improvement measures were performed,then the second round of risk assessment was conducted to evaluate the control effect,which showed good risk control effect.CONCLUSION The quantitative risk assessment system established based on HFMEA was used to regularly evaluate the risk to find out the potential nosocomial infection,to timely detect the potential nosocomial infection risk in fever outpatient clinics,to achieve accurate prevention and control of nosocomial infection in fever outpatient clinics,which can greatly reduce the risk of cross-infection of infectious diseases in hospitals and nip it in the bud.

关 键 词：发热门诊 医院感染 风险评估 医疗失效模式与效应分析 

分 类 号：R197.323[医药卫生—卫生事业管理]