柏拉图分析法在传染病专科医院保洁员管理中的应用

Application of Pareto analysis in management on hospital cleaners in infectious disease specialty hospital

目的探讨柏拉图分析法在传染病专科医院保洁员管理中的应用效果。方法 2012年某院通过跟班督查的方法检查32名保洁员感染防控措施落实情况,并应用柏拉图分析法对缺陷条目进行分析,寻找需优先解决的关键缺陷问题,通过加强培训,制定和完善规范的操作流程,提供清晰明确的标识,建立能级管理体系等进行质量改进。结果整改前错误执行次数为121例次,主要执行缺失项目为"执行标准预防措施"、"各区域消毒隔离操作"、"消毒剂配制"、"手卫生",4项累积百分比76.03%(92例次)。通过柏拉图分析法和专家头脑风暴,认为造成保洁员医院感染防控措施执行不到位的主要原因为医院感染知识缺乏,操作流程及各类标识不完善,管理层对医院感染工作重视程度不同,监督考核不严。整改后,错误执行次数降至48例次,上述4项措施累积百分比为72.92%(35例次)。整改前后32名保洁员医院感染防控措施执行率比较,差异有统计学意义(P<0.05)。结论柏拉图分析法能迅速找出质量改进的关键问题,提高医院感染防控质量管理效率,对减少医院感染的发生有重要意义。

Objective To explore the effect of Pareto analysis in management on hospital cleaners in infectious dis-ease specialty hospital.Methods The implementation of healthcare-associated infection（HAI）prevention and con-trol measures among 32 cleaners were supervised,defects items were analyzed by Pareto analysis,top priority prob-lems which needed to be dealt with were found out,the quality was improved by strengthening the training,formu-lating and perfecting standard operation procedures,providing clear signs,and establishing competence-based stra-tegic management.Results Before rectification,there were 121 cases of incorrect implementation,the main defects items were “implementation of standard precautions”,“disinfection and isolation procedures in each location”,“preparation of disinfectant”,and “hand hygiene ”,cumulative percentage of these four items was 76.03%（92 cases）.Pareto analysis and expert brainstorm method showed that the main causes of incomplete implementa-tion of HAI prevention and control measures among cleaners were lack of HAI knowledge,incomplete operating process and all kinds of signs,varied attention on HAI management among administrators,and less stringent super-vision.After rectification,incorrect implementation dropped to 48 cases,cumulative percentage of above four meas-ures was 72.92%（35 cases）.The implementation rate of HAI prevention and control measures among 32 cleaners were statistically different before and after rectification （P 〈0.05）.Conclusion Pareto analysis can quickly find out the key problems which need to be solved,improve the efficiency of HAI prevention and control management,and has important significance to reduce the occurrence of HAI.