基于风险矩阵的重症医学科医院感染风险评估指标体系

Risk assessment system of healthcareassociated infection in intensive care unit based on risk matrix

摘要:

目的建立基于风险矩阵的重症医学科医院感染风险评估体系，明确其医院感染管理重点。方法采用文献回顾与复习的方法形成风险数据库，随后在专家咨询法的基础上明确风险评估量表及得分。在风险矩阵分析法的基础上，通过风险序数、风险矩阵及风险带构建风险评估体系。结果25个重症医学感染风险纳入本次风险评估中。医务人员（R=18.06）、疾病程度（R=15.33）、侵入性操作（R=15.33）、物体表面（R=14.69）是风险等级较高的风险；医务人员（P=4.17）、侵入性操作（P=4.00）、物体表面（P=3.83）等是风险发生概率较高的风险；经器械传播（C=4.83）、“三管”（C=4.67）、经接触传播（C=4.50）等是风险发生严重性较高的风险。25个风险中，12个风险位于高风险带（LR=20），10个风险位于中风险带（LR=16），3个风险位于低风险带（LR=4）。结论医务人员的标准预防措施执行不到位，患者的病情程度复杂，侵入性操作及环境物体表面清洁消毒不合格是重症医学科发生医院感染的较高危风险。

Abstract:

ObjectiveTo establish a risk assessment system for healthcareassociated infection(HAI) in intensive care unit(ICU) based on risk matrix, and clarify the focus of HAI management.MethodsThe risk database was established through literature review, risk assessment scale and score were defined on the basis of expert consultation method. On the basis of risk matrix analysis, the risk assessment system was constructed through risk order, risk matrix, and risk band.Results25 risk factors for infection in ICU were included in this risk assessment. Health care workers (R=18.06), degree of diseases (R=15.33), invasive procedure (R=15.33), and object surface (R=14.69) were high level of risk; health care workers (P=4.17), invasive procedure (P=4.00), and object surface (P=3.83) were high probability of the occurrence of risk; transmission through devices (C=4.83), three catheters (C=4.67), and transmission through contact (C=4.50) were high severity of the occurrence of risk. Among 25 risks, there were 12 risks in the high risk band (LR=20), 10 in the middle risk band (LR=16), and 3 in the low risk band (LR=4).ConclusionThe high risk of HAI in ICU is that the standard preventive measures are not implemented properly by health care workers, patient’s condition is complex, invasive procedure, and disinfection of environmental object surface is not qualified.