基于SMART原则的医院感染预防与控制效果评价

Evaluation of the effectiveness of hospital infection prevention and control based on the SMART principle

目的:医院感染在增加患者痛苦和病死率的同时,也造成了巨大的经济损失。采取有效的措施改善医院感染情况,做好医务人员手部清洁、消毒刻不容缓。SMART原则即在目标设置时遵循明确性、可衡量性、可接受性、相关性、时限性原则。本研究在医院感染预防与控制工作中结合SMART原则,围绕手卫生等医院感染问题采取一系列措施,并对实施效果进行评价。方法:本研究为回顾性研究。2020年1至6月,在中南大学湘雅医院国际医疗部运用SMART原则开展了感染预防与控制干预工作,实施感染预防与控制质量改进计划。以指标数据作为目标衡量标准,建立以医院感染预防与控制知识知晓度、手卫生依从率为过程监测,手术部位感染率、导尿管相关尿路感染率为结果监测的评价指标。将干预后(2020年7月至2021年6月)各项评价指标与干预前(2019年1至12月)进行比较。结果:纳入在国际医疗部工作的51名医务人员,其中医师12名,护士39名;男性6名,女性45名;年龄21~57(30.2±7.1)岁。干预后医务人员医院感染预防与控制知识知晓度、手卫生依从率较干预前均明显提升(均P<0.05),但手术部位感染率、导尿管相关尿路感染率干预前后差异均无统计学意义(均P>0.05)。干预后内、外科病房医务人员医院感染预防与控制知识知晓度、手卫生依从率均较干预前有所提高(均P<0.05),外科病房医务人员医院感染预防与控制知识知晓度较低但改进明显,内科病房医务人员手卫生依从率较高且改进明显;干预后男性和女性医务人员医院感染预防与控制知识知晓度、手卫生依从率均较干预前有所提高(均P<0.05),均为男性较女性提升明显;干预后年龄<30岁、30~40岁的医务人员医院感染预防与控制知识知晓度、手卫生依从率均较干预前有所提高(均P<0.05),年龄30~40岁的医务人员医院感染预防与控制知识知晓度较低但2项指标改进均最明显;干预后医生、护士的医院感染预防与控制知识知晓度均较干预前有所提高(均P<0.05),且医生知识知晓度改进较为明显,护士手卫生依从率较干预前有所提高(P<0.05);干预后初级、中级职称医务人员医院感染预防与控制知识知晓度、手卫生依从率均较干预前有所提高(均P<0.05),均为中级职称医务人员改进较为明显。结论:基于SMART原则,结合多种国内外感染预防与控制相关评价标准,实施质量改进计划,可有效提升医务人员感染预防和控制知识知晓度及手卫生依从率,强化医院感染的预防与控制,保障患者的安全。

Objective:Hospital infection not only increases patient suffering and mortality,but also causes huge economic losses.It is urgent to take effective measures to improve the situation of hospital infection and focus on hand hygiene and disinfection.The SMART principle is to follow the principles of specificity,measurability,attainability,relevance,and timeliness when setting goals.This study aims to use the SMART principle in the prevention and control of hospital infection,to take a series of measures on the hospital infection such as hand hygiene,and to evaluate the implementation effect.Methods:This study is a retrospective study.From January to June 2020,the SMART principle was used to carry out intervention for infection prevention and control in the Xiangya International Medical Department,Central South University,and implement the infection prevention and control quality improvement plan.Using indicator data as targeting measurement standard,we established evaluation indicators for hospital infection prevention and control knowledge awareness and hand hygiene compliance rate as the process monitoring,surgical site infection rate and catheter-related urinary tract infection rate as the result monitoring.The evaluation indicators after intervention(July 2020 to June 2021)were compared with those before intervention(January 2019 to December 2019).Results:Fifty-one medical staff working in the Xiangya International Medical Department were included.There were 12 doctors and 39 nurses,and 6 males and 45 females.The age ranged from 21 to 57(30.2±7.1)years.After the intervention,the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff were significantly higher than those before the intervention(both P<0.05),but there were no significant differences in surgical site infection rate and catheter-related urinary tract infection rate before and after intervention(both P>0.05).After the intervention,the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff in the internal and surgical wards were higher than those before the intervention(all P<0.05).The awareness of hospital infection prevention and control knowledge of medical staff in surgical wards was low but improved significantly.The compliance rate of hand hygiene of medical staff in internal wards was high and improved significantly.After the intervention,the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of male and female medical staff were higher than those before the intervention(all P<0.05),both of which were significantly higher in males than in females.After the intervention,the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate for medical staff aged less than 30 years old and 30 to 40 years old were higher than those before the intervention(all P<0.05).Medical staff aged 30 to 40 years had a low awareness of hospital infection prevention and control knowledge,but both indicators improved most significantly.After the intervention,the awareness of hospital infection prevention and control knowledge of doctors and nurses was increased(both P<0.05).The awareness of doctors improved more significantly,and the hand hygiene compliance rate of nurses improved(P<0.05).After the intervention,the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff with primary and intermediate professional titles were higher than those before the intervention(all P<0.05),and the improvement was more significant for medical staff with intermediate professional titles.Conclusion:Based on the SMART principle management method,the implementation of quality improvement plans combined with various domestic and international evaluation standards for infection prevention and control can effectively improve the awareness of infection control knowledge and hand hygiene compliance rate of medical staff,strengthen the prevention and control of hospital infection,and further ensure the safety of patients.