医院感染管理中培育医院执行力文化的实践与思考

Practice and consideration of fostering hospital execution culture for healthcareassociated infection management

摘要:

目的探讨医院执行力文化在医院感染管理中的应用价值。方法选取2013年1月1日—2014年12月31日某院所有科室为研究对象，2014年1月1日开始将医院执行力文化的理念与培育方法应用于医院感染管理工作中，比较培育前后医务人员在医院感控方面的工作积极性、工作能力及工作绩效相关指标。结果2013、2014年均分别调查全院科室53个。工作积极性指标：参加院级培训的科室数由24个（45.28%）增加至49个（92.45%），开展二次培训的科室数由21个（39.62%）增加为48个（90.57%），而主动开展感控自查的科室也由10个（18.87%）增加为43个（81.13%），差异均有统计学意义（均P＜0.001）。工作能力指标：医务人员手卫生和多重耐药菌防控措施知识知晓率由49.05% (103/210)、37.14% (78/210)，分别提高至96.30% (208/216)、97.22% (210/216)；2013年仅2个（3.77%）科室对日常工作进行定期整改，执行力培育后增加至19个（35.85%），差异均有统计学意义（均P＜0.001）。工作绩效指标：医务人员手卫生操作合格率由8.57% (18/210)提高至87.04% (188/216)；多重耐药菌隔离措施落实率由50.00%提高至80.08%，治疗性使用抗菌药物病原学送检率由28.85%提高至51.30%，差异均有统计学意义（均P＜0.001）。结论医院执行力文化的培育，提高了参与医院感染管理工作的积极性和工作能力，同时也推动医院感染管理工作的落实，是促进医院感染管理工作的有力工具。

Abstract:

ObjectiveTo explore the application value of hospital execution culture in healthcareassociated infection(HAI)  management. MethodsAll departments in a hospital from January 1, 2013 to December 31, 2014 were studied.  From January 1, 2014, ideas and fostering methods for  hospital execution culture  were applied in HAI management, the working enthusiasm, working ability, and working achievements of health care workers (HCWs) on HAI  control before and after the application of execution culture  were compared. Results53 departments in the hospital were surveyed annually in  2013 and 2014. Working enthusiasm: the number of departments participating in hospitalwide training increased from 24 (45.28%) to 49 （92.45%）, the number of departments that carried out subsequent training increased from 21（39.62%）to 48（90.57%），departments that initiatively carried out selfinspection increased from 10（18.87%）to 43（81.13%）, differences were all significant (all P<0.001). Working ability: percentage of HCWs knew knowledge about hand hygiene as well as prevention and control measures for multidrug resistance bacteria increased from 49.05% (103/210)  and 37.14% (78/210) to 96.30% (208/216) and  97.22% (210/216) respectively; while in 2013, only 2 departments (3.77%) performed regular rectification on daily work, which increased to 19 departments （35.85%）after training，differences were all significant (all P<0.001). Working achievements: the qualified rate of correct hand hygiene among HCWs increased from 8.57%(18/210)  to 87.04%(188/216); implementation rate of multidrug resistance bacteria isolation increased from 50.00% to 80.08%，pathogenic detection in patients receiving therapeutic  antimicrobial agents increased from 28.85% to 51.30%, differences were all significant（all P＜0.001）. ConclusionFostering of hospital execution culture has improved the enthusiasm and work ability of HCWs to participate in HAI management, promoted the implementation of HAI management, and is a  powerful tool for the management of HAI.