医院感染管理风险评估的效果

Effect of risk assessment on healthcare-associated infection management

摘要:

目的 分析医院感染管理风险评估的效果。方法 2016、2019年分别对某院36个部门进行风险评估，将两次评估结果（包括风险评估因素的变化、高风险科室的变化、当前管理体系完整性的变化等）进行比较。另外评价风险评估对医院感染感染管理工作的影响，即各项医院感染相关指标的变化，如医院感染发病率、多重耐药菌（MDRO）医院感染发病率、手卫生依从性、手卫生正确率、呼吸机使用率、中心静脉导管使用率、导尿管使用率、呼吸机相关肺炎（VAP）发病率、静脉导管相关血流感染（CLABSI）发病率、导尿管相关尿路感染（CAUTI）发病率。结果 2019年风险评估显示，心外重症监护病房（ICU）、呼吸ICU、心内科ICU、外科ICU、肾内科、儿外科、老年内科ICU、新生儿ICU、儿童ICU属于高风险科室，其中儿童ICU、新生儿ICU、儿外科和肾内科为2019年新增高风险科室。2016年神经内科、风湿免疫科、血液内科、泌尿外科四个高风险部门风险级别明显降低。与2016年各项监测数据进行比较，2019年各科室当前管理体系完整性提升，医院感染发病率、MDRO医院感染发病率、CAUTI发病率、导尿管使用率明显降低，手卫生依从性及正确率明显提升，差异均有统计学意义（均P<0.05）。结论 通过风险评估可提示下一步重点关注科室和风险因素并实施干预，可有效推动医院感染管理工作，降低医院感染发病率。

Abstract:

Objective To analyze the effect of risk assessment on healthcare-associated infection (HAI) management. Methods Risk assessment on 36 departments in a hospital in 2016 and 2019 was carried out respectively, results of two assessment was compared (including change in risk assessment factors, change in high-risk departments, change in the integrity of current management system and so on). In addition, influence of risk assessment on HAI management was evaluated, that is, the change in HAI-related indicators, such as incidence of HAI, incidence of multidrug-resistant organism (MDRO) HAI, hand hygiene compliance, hand hygiene accuracy rate, ventilator utilization rate, central line catheterization rate, urinary catheterization rate, incidence of ventilator-associated pneumonia (VAP), incidence of central line-associated bloodstream infection(CLABSI) and incidence of catheter-associated urinary tract infection (CAUTI). Results Risk assessment in 2019 showed that cardiac surgery intensive care unit (ICU), respiratory ICU, cardiology ICU, surgery ICU, department of nephrology, pediatric surgery, geriatric ICU, neonatal ICU and pediatric ICU were high-risk departments, among which pediatric ICU, neonatal ICU, pediatric surgery and nephrology were the newly increased risk departments in 2019. Risk levels in four high-risk departments (neurology, rheumatology and immunology, hematology, and urology) in 2016 decrased significantly. Compared with surveyed data of 2016, the integrity of current management system in 2019 was improved, incidence of HAI, incidence of MDRO HAI, incidence of CAUTI and urinary catheterization rate decreased significantly, hand hygiene compliance and accuracy rate improved significantly, difference were all statistically significant (all P<0.05). Conclusion Through the risk assessment, the key departments and risk factors that should be paid attention can be pointed out and intervention can be implemented, which can effectively promote the management of HAI and reduce the incidence of HAI.