广州市2021—2022年噪声接触人员纯音听阈测试质量控制考核影响因素分析

Analyzing the influencing factors of quality control assessment of pure tone audiometry among noise exposed personnel in Guangzhou City from 2021 to 2022

目的探讨广州市职业健康检查(OME)机构纯音听阈测试(PTA)质量控制考核情况及相关影响因素。方法采用随机抽样方法,选择2021—2022年广州市41家次OME机构为研究对象,对其进行现场质量考核和噪声接触人员PTA质量控制考核。结果2021年—2022年考核的41家次OME机构共检出整改项205项;其中,不符合组织架构要求、质量管理体系要求、OME工作质量控制要求、健康检查信息报送要求的OME机构分别有19、28、30和28家次。噪声接触人员OME报告考核正确率为74.9%(820/1095)。多因素logistic回归分析结果显示,不符合质量管理体系组OME机构出现PTA质量控制考核不合格和PTA结果不合格的风险均高于符合质量管理体系组(P值均<0.05),备案年限<1年组OME机构出现PTA结果不合格的风险高于备案年限≥1年组(P<0.05),不符合OME工作质量控制组OME机构出现OME结论不合格的风险高于符合OME工作质量控制组(P<0.05),不符合健康检查信息报送组OME机构出现疑似职业病结论不合格的风险高于符合健康检查信息报送组(P<0.05),不符合质量管理体系组OME机构出现职业禁忌证结论不合格的风险高于符合质量管理体系组(P<0.05)。结论广州市OME机构PTA质量有待提高;完善OME的质量管理有利于提高PTA的质量。

Objective To explore the status of quality control assessment of pure tone audiometry(PTA)and to analyze its influencing factors in occupational medical examination(OME)institutions in Guangzhou City.Methods A total of 41 OME institutions in Guangzhou City were selected as the research subjects from 2021 to 2022 using random sampling method,and its status of on-site quality and PTA quality for individuals exposed to noise were assessed.Results A total of 205 rectification items were identified among the 41 OME institutions from 2021 to 2022.Among them,19,28,30,and 28 OME institutions did not meet the requirements of organizational structure,quality management system,quality control of OME,and health examination information reporting,respectively.A total of 1095 OME reports for individuals exposed to noise were assessed,with 820 reports having correct results and conclusions,resulting in an accuracy rate of 74.9%.The results of the multiple logistic regression analysis showed that OME institutions without meeting the requirements for the quality management system had a higher risk of failing the PTA quality control assessment and having inaccurate hearing test results compared with those meeting the requirements(all P<0.05).OME institutions with a filing period less than one year had a higher risk of having inaccurate hearing test results than those with a filing period of one year or more(P<0.05).OME institutions not meeting the requirements for quality control of OME had a higher risk of having abnormal OME conclusions than those meeting the requirements(P<0.05).OME institutions not meeting the requirements for health examination information reporting had a higher risk of having abnormal conclusions in suspected occupational disease than those meeting the requirements(P<0.05).OME institutions not meeting the requirements for the quality management system had a higher risk of having abnormal conclusions of occupational contraindications than those meeting the requirements(P<0.05).Conclusion The quality of PTA in OME institutions in Guangzhou City needs to be improved.And a well-established quality management system for OME is beneficial for improving the quality of PTA.