中华卫生应急电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 146 -151. doi: 10.3877/cma.j.issn.2095-9133.2021.03.005 × 扫一扫
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Xia Jin1, Xiaojie Xia1, Zijun Ge1, Qingtang Zhu1, Lin Li1, Zhanjie Li1, Feng Zang1,†()
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金霞, 夏晓洁, 葛子君, 朱庆堂, 李琳, 李占结, 臧凤. 全员培训模式提高医院感染监测效率的效果评价[J]. 中华卫生应急电子杂志, 2021, 07(03): 146-151.
Xia Jin, Xiaojie Xia, Zijun Ge, Qingtang Zhu, Lin Li, Zhanjie Li, Feng Zang. Efficiency of whole staff training model on nosocomial infection monitoring[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2021, 07(03): 146-151.
探索"四步法"感控全员培训模式对医院感染监测指标的影响效果。
选取2019年6月25日至9月30日对南京医科大学第一附属医院(江苏省人民医院)全院人员采用"四步法"感控全员培训模式进行感染预防与控制知识与技能培训。培训内容包括医院感染基本知识、手卫生、职业暴露预防与处置、消毒灭菌、医疗废物管理、规范送检、多重耐药菌防控、传染病管理等。监测指标包括医院感染率、医院感染例次率、手术切口感染率、ICU患者三管感染率、治疗性抗菌药物使用前微生物标本送检率、手卫生依从性及正确率。
"四步法"感控全员培训实施后全院、内科、外科、老年医学科及ICU病房的医院感染例次率有所降低(P<0.05)，全院手术部位感染率由0.66%降低至0.42%，Ⅰ类、Ⅱ类手术切口感染率也低于培训实施前(P<0.05)，Ⅲ类手术切口感染率培训实施前后差异无统计学意义，重症监护病房(intensive care unit, ICU)患者三管感染率在"四步法"感控全员培训实施后未发生变化，全院患者全部类、限制级、特殊级抗菌药物使用前送检率均有所提高(P<0.05)，全院护士手卫生依从性及正确率均有所提高(P<0.05)，全院医师在培训实施后手卫生依从性虽有所提高，但是正确率未发现统计学差异(P>0.05)。
"四步法"感控全员培训考核模式对医院感染监测指标起到正反馈作用，医院感染预防与控制水平得到显著改善。
To explore the effect of "four step" training mode for all staff in hospital infection control on monitoring indicators of nosocomial infection.
From June 25 to September 30, 2019, the whole staff of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) were trained on the knowledge and skills of infection prevention and control by the "four step" training mode. The training contents include basic knowledge of nosocomial infection, hand hygiene, occupational exposure prevention and disposal, disinfection and sterilization, medical waste management, standardized inspection, multi drug resistant bacteria prevention and control, infectious disease management, etc. Monitoring indicators included hospital infection rate, hospital infection case rate, surgical incision infection rate, three tube infection rate of ICU patients, microbial sample submission rate before the use of therapeutic antibiotics, hand hygiene compliance and accuracy rate.
After the implementation of the "four step" sensing and control full staff training, the incidence of nosocomial infection in the whole hospital, internal medicine, surgery, geriatrics and ICU ward decreased (P<0.05), the infection rate of surgical site in the whole hospital decreased from 0.66% to 0.42%, and the infection rate of class I and class II surgical incision was also lower than that before the implementation of the training (P<0.05). There was no significant difference in the infection rate of class III surgical incision before and after the implementation of the training, The infection rate of three tubes in intensive care unit (ICU) patients did not change after the implementation of "four step" full staff training. The submission rates of all kinds of antibiotics, restricted antibiotics and special antibiotics in the whole hospital were improved (P<0.05), and the hand hygiene compliance and accuracy of nurses were improved (P<0.05), Although the compliance of hand hygiene was improved after the implementation of the training, there was no statistical difference in the correct rate (P>0.05).
The "four step" training and assessment mode for all staff of infection control and prevention has a positive feedback effect on the monitoring indicators of nosocomial infection, and the level of nosocomial infection prevention and control has been significantly improved.