一所三级综合医院安全注射管理效果的多维度评价

Multidimensional evaluation on management effectiveness of safe injection in a tertiary general hospital

摘要:

目的探讨科学有效的安全注射管理方法，为提高安全注射行为依从率、实现安全注射持续改进提供参考。方法制定安全注射专项工作方案，开展基线调查和安全注射相关培训，制定安全注射制度和标准操作规程，加强现场督导检查和考核，比较干预前（2016年5月基线调查）、干预后（2017年）安全注射设施配置合格率、理论考试成绩、行为依从率、锐器伤发生率等量化指标的变化。结果通过综合干预，全院安全注射各项设施配置率均>97%，各项医疗废物规范处置合格率均>93%，速干手消剂全院实际平均消耗量从（5.56±2.13） mL/床·日，增加至（9.95±5.38） mL/床·日；医院工作人员安全注射知识考试平均成绩由干预前的（71.20±12.22）分，上升至干预后的（92.59±5.99）分；干预前医务人员安全注射依从率为62.50%，干预后为88.53%，各组比较，差异均有统计学意义（均P<0.05）。一周内全院锐器伤例次上报率从干预前的15.79%上升至干预后的71.43%；全年各科室锐器伤例次发生率、每百住院日例次发生率分别从干预前的9.98%和0.0276%，下降至干预后的5.31%、0.0168%，差异均有统计学意义（均P<0.05）。结论有效的综合干预措施，可以强化安全注射意识，提高安全注射行为依从率，有效防范因非安全注射导致的医务人员职业伤害事件的发生，阻断医院感染传播。

Abstract:

ObjectiveTo explore scientific and effective management methods for safe injection, provide reference for improving compliance rate of safe injection behavior and achieving continuous improvement in safe injection.MethodsA special safety injection program was formulated, baseline survey and safe injectionrelated training were carried out, safe injection system and standard procedures were formulated, onsite supervision and examination were strengthened, quantitative indexes such as qualified rate of safe injection facilities, theoretical examination result, behavior compliance rate, and occurrence rate of sharp injury before intervention (baseline survey in May 2016) and after intervention (2017) were compared.ResultsThrough comprehensive intervention, facilities allocation rates of safe injection in whole hospital were all>97%, qualified rates of all medical waste disposal were all>93%, actual average consumption of alcoholbased hand rub in the whole hospital increased from (5.56±2.13)  mL/bedday to (9.95±5.38)mL/bedday; the average score of safety injection knowledge examination of health care workers(HCWs) increased from (71.20±12.22) before intervention to (92.59±5.99) after intervention; HCWs’ compliance rate to safe injection increased from 62.50% before intervention to 88.53% after intervention, difference were all statistically significant (P<0.05). Reporting rate of sharp injuries in the whole hospital within a week increased from 15.79% before intervention to 71.43% after intervention; occurrence rate of case incidence of sharp injuries in the whole year and 100day hospitalization decreased from 9.98% and 0.0276% before intervention to 5.31% and 0.0168% after intervention respectively, differences were both statistically significant (both P<0.05).ConclusionEffective comprehensive intervention measures can strengthen the awareness of safe injection, improve compliance rate of safe injection behavior, effectively prevent the occurrence of occupational injuries in HCWs caused by unsafe injection, and prevent the spread of healthcareassociated infection.