ICU患者多重耐药菌感染防控护理质量评价 指标体系的构建

Construction of the Evaluation Index System for the Quality of Nursing Care in the Prevention and Control of Multidrug-Resistant Organism Infections in ICU Patients

摘要: 目的：构建ICU患者多重耐药菌(Multidrug⁃Resistant Organism, MDRO)感染防控护理质量评价指标体系并确定条目权重。方法：以COSO内部控制框架为理论框架，在文献回顾基础上，构建ICU患者MDRO感染防控能力评价指标条目池。选取17名相关专家进行两轮德尔菲函询对条目池进行优化。采用层次分析法、百分权重法、乘积法确定条目权重。结果：(1) 17名专家两轮函询的专家积极系数均为100%，专家权威程度系数分别为0.829、0.865，指标条目总体Kendall协调系数为0.180，具有统计学意义(P < 0.001)。表明专家意见协调性高，结果可靠。两轮函询后，最终构建的指标体系包含5项一级指标、13项二级指标、52项三级指标。(2) 采用层次分析法得出一级指标的权重赋值分别为：控制环境(0.2787)、风险评估(0.2787)、控制活动(0.1883)、信息与沟通(0.1094)、监督与评价(0.1449)；二级指标的组合权重为0.0057~0.0283；通过百分权重法得出三级指标的组合权重为0.0006~0.0146。各判断矩阵CR均 < 0.1，说明指标体系的层级排序一致性程度高，权重合理。结论：ICU患者MDRO感染防控能力评价指标体系形成过程科学、严谨，实用性较好，可用于评价ICU患者MDRO预防质量。

Abstract: Objective: Establish a quality evaluation index system for the prevention and control of Multidrug-Resistant Organism (MDRO) in ICU patients and determine the weights of each item. Methods: Based on the COSO internal control framework as the theoretical framework, and on the basis of literature review, an index pool for evaluating the infection prevention and control capabilities of ICU patients with MDRO was constructed. 17 relevant experts were selected for two rounds of Delphi consultation to optimize the index pool. Analytic hierarchy process, percentage weight method and product method were adopted to determine the weight of index items. Results: (1) The expert participation coefficients in both rounds of the questionnaire survey of the 17 experts were 100%. The expert authority coefficient was 0.829 and 0.865 respectively. The overall Kendall coordination coefficient of the index items was 0.180, which was statistically significant (P < 0.001). This indicates that the coordination of expert opinions is high and the results are reliable. After the two rounds of questionnaire surveys, the final constructed index system includes 5 first-level indicators, 13 second-level indicators, and 52 third-level indicators. (2) The weight assignment for the primary indicators was determined using the Analytic Hierarchy Process as follows: Control Environment (0.2787), Risk Assessment (0.2787), Control Activities (0.1883), Information and Communication (0.1094), and Supervision and Evaluation (0.1449); the combined weights of the secondary indicators range from 0.0057 to 0.0283; the combined weights of the tertiary indicators were derived using the percentage weight method and range from 0.0006 to 0.0146. The CR values of each judgment matrix are all less than 0.1, indicating that the consistency of the hierarchical ranking of the indicator system is high and the weights are reasonable. Conclusion: The formation process of the evaluation index system for MDRO infection prevention and control in ICU patients is scientific and rigorous, with good practicability. It can be used to assess the quality of prevention of MDRO in ICU patients.