精细化管控提升重症监护病房的医院感染管理质量

Delicacy Management Improves Healthcare Acquired Infection Prevention Quality in ICU

摘要: 目的：借助质量管理工具，探索适用于重症医学病房院感质量持续改进的方法，为临床预防和控制医院感染提供最佳实践经验。方法：于2016年1月开始跟踪某三甲教学医院重症监护病房感染的患者，同时利用重庆某研发机构的管理工具执行管理监控和分析，调整干预措施和工作流程等。并于2017年12月收集上述患者资料共计49例，用于感染的流行病学特征分析。结果：第二年新发感染人数和感染例次较第一年有显著差异(p < 0.05)。VAP，CAUTI在2017年的千日发病率较2016年的数据有显著差异(p < 0.05)。通过质量管理改进，正确使用锐器盒的合格率从83.8%上升到92.8% (p = 0.01)，正确处理呼吸机管道冷凝水的正确率从96.4%上升到98.4% (p < 0.01)，正确处理静脉置管敷贴的正确率从88%上升到95.6% (p = 0.02)。结论：利用有效的工具结合多部门协作，质量持续改进进程管理，加强教育培训，可形成灵活高效的感染干预和控制方案。

Abstract: Objective: To explore the best practice for multi-department collaboration and continuous quality improvement with management tools, providing the best practice experience for the intervention and management of nosocomial infections. Methods: In January 2016, we started tracking patients in intensive care unit in a local teaching hospital. Meanwhile, we used management tools developed by a company in Chongqing to perform monitoring and analysis, producing interventions and workflow strategies, as well as education & training. 49 patients’ clinical records were collected in December 2017 for epidemiological analysis of infections. Results: The number of new infections and cases of infection in the second year were significantly different from the first year (p < 0.05). The incidence rate of VAP and CAUTI in 2017 had a significant decrease from the 2016 (p < 0.05). Through the improvement of quality management, the correct rate of using sharps cartridges increased from 83.8% to 92.8% (p = 0.01), the correct rate of correctly treating the condensate water in ventilator pipes increased from 96.4% to 98.4% (p < 0.01), and the correct rate of treatment for venous catheter application increased from 88% to 95.6% (p = 0.02). Conclusion: Using effective tools in combination with multi-department collaboration, continuous quality im-provement process management, and enhanced education and training can lead to practical and efficient infection intervention and control program.