基于风险管理的器官移植病房医院感染管理策略  

Management strategies for nosocomial infection in organ transplantation wards based on risk management

作　　者：谈宜斌[1] 梁科[1] 王彦峰[2] 李源[1] 吴松杰[1] 王莹[1] TAN Yi-bin;LIANG Ke;WANG Yan-feng;LI Yuan;WU Song-jie;WANG Ying(Zhongnan Hospital,Wuhan University,Wuhan,Hubei 43007l,China)

机构地区：[1]武汉大学中南医院医院感染管理办公室,湖北武汉430071 [2]武汉大学中南医院医院肝胆疾病研究院,湖北武汉430071

出　　处：《中华医院感染学杂志》2023年第21期3337-3342,共6页Chinese Journal of Nosocomiology

基　　金：西部绿色建筑国家重点实验室开放研究基金资助项目(LSKF202104);武汉大学科技创新培育基金药护技和管理专项基金资助项目(CXPY2022064)。

摘　　要：目的探索风险管理方法在器官移植病房医院感染管理控制中的应用,建立并实施以风险管理程序为体系的器官移植病房医院感染防控策略.方法回顾性选取2015年1月1日-2018年12月31日武汉大学中南医院器官移植病房4505例患者为评估前分组,将2019年1月1日-2019年12月31日1823例患者为评估后分组,分析医院感染管理质量控制特征,采用现场访谈、文献计量学分析及临床实证研究等方式,通过筛选,修正与确认,建立医院感染风险管理体系,在实施过程中持续进行验证、纠偏及效果评估.结果器官移植病房形成6个维度、6个一级、21个二级风险指标的防医院感染风险管理体系,医院感染风险控制关键点为医院人员手卫生、感染控制措施执行、三种导管相关感染控制、物理环境.标本送检阳性率、医院感染病例漏报率、多重耐药菌感染检出率、医务人员手卫生依从率、抗菌药物治疗前病原学送检率在实施前后差异有统计学意义(P<0.001).结论基于建筑布局、环境设备、人员管理、消毒隔离、院感监测、重点部位感染预防控制六大医院感染风险管理程序的防控策略运用效果较好,不仅精准识别器官移植病房全程医院感染风险点,更可科学判别优先干预序次并针对性制定感染防控措施,提升器官移植学科医疗安全体系.OBJECTIVE To explore the application of risk management method in management and control of nosocomial infection in organ transplantation wards and put forward the prevention and control strategies for nosocomial infection in organ transplantation wards based on risk management procedures.METHODS A total of 4505 patients who were treated in organ transplantation wards of Zhongnan Hospital,Wuhan University from Jan l,2015 to Dec 31,2018 were retrospectively enrolled in the study and were assigned as the pre-assessment group,and 1823 patients who were treated from Jan 1,2019 to Dec 31,2019 were chosen as the post-assessment group.The quality control characteristics of nosocomial infections were analyzed,the nosocomial infection risk management system was established through screening,correction and confirmation by onsite interview,bibliometric analysis and clinical empirical research;continuous verification,correction of deviations and assessment of ffect were carried out during the implementation process.RESULTS A nosocomial infection risk management system with 6 dimensions,6 first-grade and 21 second-grade risk indexes was established.The hand hygiene of health care workers,implementation of infection control measures,control of three types of catheters-associated infections and physical environment were the key points for risk control of nosocomial infection.There were significant differences in the positive rate of submitted specimens,missed report rate of nosocomial infection cases,detection rate of MDROs infection,hand hygiene compliance rate of health care workers and etiological submission rate before antibiotic treatment before and after the management strategies were implemented(P<O.001).CONCLUSION The prevention and control strategies that are developed based on the six risk management procedures,architectural layout,environmental unit,personnel management,disinfection and isolation,monitoring of nosocomial infection and prevention and control of key sites of infection,can achieve remarkable effect.whic

关 键 词：风险管理 器官移植病房 风险评估 医院感染控制 策略 

分 类 号：R617[医药卫生—外科学]