宜宾市263家医疗机构消毒供应经济负担调查分析及区域化集中管理模式可行性探讨

Investigation and analysis of the economic burden of disinfection supply and feasibility discussion on the regional centralized management mode of 263 medical institutions in Yibin City

目的了解宜宾市医疗机构消毒供应经济负担情况,探索宜宾市建立区域化集中管理模式的消毒供应中心的可行性。方法 2018年4月—5月,采用手机APP设计问卷调查的方式对宜宾市八县两区263家医疗机构消毒供应成本核算、费用负担情况进行调查。结果参与调查的医疗机构共263家,61家(23.19%)有消毒供应中心,其中公立医院43家,私立医院18家;202家无消毒供应中心,主要集中在二级以下医院[195家(74.14%),其中公立医院120家,私立医院75家]。医院级别越高,消毒供应中心平均面积越大,差异有统计学意义(χ2=40.009,P<0.001)。医院级别越高,配备专职人员数越多,差异有统计学意义(χ2=31.862,P<0.001),以护理人员为主(66.23%)。三级医院消毒供应中心费用负担均在100万元以上,61.90%的二级医院费用负担在10万元及以上,二级以下医院费用负担均在10万元以下;医院级别越高,总费用负担越高,差异有统计学意义(χ2=37.995,P<0.001)。结论针对医疗机构消毒供应中心经济负担较重、二级以下医疗机构设置不均衡等问题,建立区域化消毒供应中心集中管理模式是未来发展的新方向、新趋势、新模式,有利于提高消毒灭菌质量,降低医疗成本,真正做到合理利用卫生资源,有效地防范医院感染发生,保障医疗安全。

Objective To understand the economic burden of disinfection supply to medical institutions in Yibin City, and explore the feasibility of establishing a regional centralized management model of disinfection supply center in Yibin City. Methods From April to May 2018, 263 medical institutions in the eight counties and two districts of Yibin City were investigated by means of mobile phone application-designed questionnaire, to obtain the information of cost accounting and economic burden of disinfection supply. Results There were 263 medical institutions involved in the survey, in which 61(23.19%) had set up the central sterile supply department(CSSD), including 43 public hospitals and 18 private hospitals;202 medical institutions were without CSSD, which were mainly secondary hospitals [195(74.14%),including 120 public hospitals and 75 private hospitals]. The higher the hospital level was, the larger the average area of the CSSD was;the difference was statistically significant(χ2=40.009, P<0.001). The higher the hospital level was, the more fulltime personnel were employed, and the difference was statistically significant(χ2=31.862, P<0.001), and the care staff were the majority(66.23%). The cost burden of CSSD was more than 1 million yuan in the tertiary hospitals, which was 100 000 yuan or above in 61.90% of the secondary hospitals, and was below 100 000 yuan in hospitals below secondary level. The higher the hospital level was, the higher the total cost burden became;the difference was statistically significant(χ2=37.995,P<0.001). Conclusion In view of the heavy economic burden of CSSD in medical institutions and the unbalanced setting up of medical institutions below secondary level, the establishment of a regional CSSD centralized management model is a new direction, new trend, and new model for future development, which is conducive to improving the quality of disinfection and sterilization, reducing medical care costs, making rational use of health resources, effectively preventing hospital infections, and ensuring the medical safety.