江门市基层医疗机构消毒管理的风险评估
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杨玉芳

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R181.3+2

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江门市科学技术局2016年度江门市第五批科技计划项目(20160513)


Risk assessment on disinfection management in primary medical institutions in Jiangmen City
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    摘要:

    目的了解基层医疗机构消毒管理现状,为加强基层医疗机构医院感染防控体系建设提供科学依据。方法采用分层抽样法,抽取江门市蓬江区、江海区70所开展静脉注射和/或口腔诊疗的基层医疗机构。2016年4—9月,采用实地考察、问卷调查方法,对70所基层医疗机构的医院感染管理现状进行基线调查。2016年2—12月,对70所基层医疗机构和11所市级医疗机构的重点科室进行消毒效果监测。采用头脑风暴法、专家评议法进行风险评估,采用风险评估矩阵法得出各个风险因素的风险等级水平。结果70所基层医疗机构分别包括7所县级医院、12所社区卫生服务中心、14所乡镇卫生院/卫生站和37所个体诊所。70所基层医疗机构中仅17.14%(12/70)的医疗机构有健全的医院感染管理规章制度或流程。手卫生设施配备不足,仅55.71%(39/70)的机构使用快速手消毒剂。84.29%(59/70)的机构规范安装紫外线灯,但仅17.14%(12/70)的机构能定期监测紫外线灯管辐照强度。仅有12.86%(9/70)的医疗机构安装了污水处理设备。具备医疗污水和消毒效果自检能力的机构分别占2.86%(2/70)、11.43%(8/70)。70所基层医疗机构消毒效果监测共采样816份,总合格率为96.20%(785/816)。室内空气、使用中消毒剂、医疗器材和透析用水的合格率均达到100%;合格率最低的是医疗污水(61.54%)。基层医疗机构物体表面消毒合格率低于市级医疗机构,差异有统计学意义(P<0.05)。风险评估结果提示,灭菌器和透析用水是极高风险项目,手卫生、环境消毒和医疗器械是高风险项目。结论江门市基层医疗机构消毒管理工作存在多个薄弱环节,风险评估方法可为疾病预防控制中心确定医疗机构消毒管理的风险管理重点,提升监测工作效能。

    Abstract:

    ObjectiveTo understand current situation of disinfection management in primary medical institutions, and provide scientific basis for strengthening the prevention and control system of healthcareassociated infection(HAI) in primary medical institutions.MethodsA stratified sampling method was used to select 70 primary medical institutions in Pengjiang District and Jianghai District of Jiangmen City, these institutions performed intravenous injection and/or oral diagnosis and treatment. From April to September 2016, baseline investigation on HAI management status in these medical institutions were performed field trip and questionnaire survey. From February to December 2016, disinfection efficacy in key departments in 70 primary medical institutions and 11 municipal medical institutions was monitored. Brainstorming and expert evaluation were used for risk assessment, risk assessment matrix method was adopted to get the risk level of each risk factor.Results70 primary medical institutions included 7 countylevel hospitals, 12 community health service centers, 14 township health centers/health stations, and 37 private clinics. Of 70 primary medical institutions, only 17.14% (12/70) had adequate HAI management regulations or procedures. Hand hygiene facilities was insufficient, only 55.71% (39/70) of institutions used alcoholbased hand rub. 84.29% (59/70) of institutions installed ultraviolet light, only 17.14% (12/70) of institutions could monitor the intensity of ultraviolet light irradiation regularly. Only 12.86% (9/70) of institutions installed sewage treatment equipment. 2.86% (2/70) and 11.43% (8/70) of institutions respectively had the ability of selfchecking for medical sewage and disinfection efficacy. A total of 816 specimens were conducted disinfection efficacy detection, overall qualified rate was 96.20% (785/816). The qualified rates of indoor air, inuse disinfectant, medical device, and dialysis water all reached 100%; and the lowest rate was medical sewage (61.54%). The qualified rate of object surface disinfection in primary medical institutions was lower than that of municipal medical institutions, difference was statistically significant (P<0.05). Risk assessment results indicated that sterilizer and dialysis water were very high risk projects, hand hygiene, environmental disinfection, and medical devices were high risk projects.ConclusionThere are a lot of deficiencies in the disinfection management of medical institutions in Jiangmen City, risk assessment method can help center for disease prevention and control find the key points of disinfection management of medical institutions, improve the efficiency of surveillance work.

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引用本文

杨玉芳,练丽祯,黄凤娟,等.江门市基层医疗机构消毒管理的风险评估[J]. 中国感染控制杂志,2018,17(9):792-796. DOI:10.3969/j. issn.1671-9638.2018.09.008.
YANG Yufang, LIAN Lizhen, HUANG Fengjuan, et al. Risk assessment on disinfection management in primary medical institutions in Jiangmen City[J]. Chin J Infect Control, 2018,17(9):792-796. DOI:10.3969/j. issn.1671-9638.2018.09.008.

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  • 收稿日期:2017-11-10
  • 最后修改日期:2018-01-09
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  • 在线发布日期: 2018-09-28
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