护理人员预防与控制手术部位感染最佳临床实践调查研究

Survey of optimal clinical practice for prevention and control of surgical site infections in nursing staff

目的了解我国护理人员在落实手术部位感染预防与控制最佳实践的现状,为卫生行政部门制定相关医院感染预防与控制政策、落实医院感染最佳实践提供科学依据。方法 2015年7月1-30日采用流行病学横断面调查方法,调查医院及护理人员基本情况和调查当日手术部位感染最佳实践的落实情况。结果 15个省市/自治区/直辖市122所医院参与了调查,发放调查问卷3 629份,回收3 520份,回收率为97.00%;三级医院101所占82.7%,公立医院118所占96.7%,综合医院101所占82.7%,参与调查的医院平均开放床位数1 001张,在岗护理人员574名;在围术期护理方面,5.7%的患者备皮方式为剪毛,1.7%的患者使用了含氯己定成分浴液,监测血糖/控制血糖和术中保温纳入医嘱的比例分别为46.3%和3.6%;去除毛发的方式、去毛时间、使用氯己定成分的浴液进行术前沐浴等,在二、三级医院分布差异有统计学意义(P<0.05)。结论围术期护理临床实践与感染控制最佳实践之间存在距离和鸿沟,卫生行政部门应该制定相应的政策和指标体系,从顶层设计上推行和落实护理人员围术期管理,预防与控制手术部位感染。

OBJECTIVE To understand the current status of optimal practice for prevention and control of surgical site infections in nursing staff in China so as to help the health administrative departments to develop related prevention and control policies and provide scientific basis for implementation of the optimal practice.METHODS From Jul 1,2015 to Jul 30,2015,the epidemiological cross-sectional survey was conducted for the basic information of hospitals and nursing staff as well as the status of implementation of the optimal practice for the surgical site infections.RESULTS Totally 122 hospitals from 15provinces/ municipalities/autonomous regions participated in the research;a total of 3 629 questionnaires were issued,and 3 520 questionnaires were collected with the collection rate of 97.00%.There were 100（82.7%）tertiary hospitals,118（96.7%）public hospitals,and 101（82.7）hospitals.The enrolled hospitals opened 1001 beds in average,and 574on-the-job nursing staff were recruited in the study.With the respect to perioperative nursing,shaving was the skin preparation for 5.7% of the patients,1.7% of the patients used the bath lotion containing chlorhexidine;the proportions of monitoring of blood glucose/control of blood glucose and intraoperative warming brining into the doctor＇advice were 46.3% and 3.6%,respectively.There was significant difference in the shaving approach,shaving time,or use of bath lotion containing chlorhexidine for preoperative bath between the secondary hospitals and the secondary hospitals（P〈0.05）.CONCLUSIONS There is a wide gap between the perioperative clinical practice of nursing and the optimal practice of infection control.It is necessary for the health administrative departments to formulate corresponding policies and indicator systems and push forward the perioperative management of nursing staff from the top-level design so as to prevent and control the surgical site infections.