静脉用药调配中心医院感染管理的现状与模式探讨

Exploration of current situation and mode of nosocomial infection management in pharmacy intravenous admixture service

目的总结医院静脉用药调配中心(PIVAS)医院感染管理的有关情况,探讨新时期长效的院感管理模式。方法通过比较2013年6月-2016年12月PIVAS清洁卫生质量考核合格率、微生物学、空气微粒等检测合格率及输液致院感发生情况,分析2016年PIVAS实行系统管理、过程管理、指标管理"三位一体"院感管理新模式对院感的防控效果。结果 2016年医院强化清洁卫生质量考核并纳入过程管理范畴后,员工着装整洁、操作台面整洁、地面消毒清洁以及容器消毒清洁的合格率分别为92.5%、91.6%、95.8%、94.5%,同比2015年均有显著提升(P<0.05),2014-2016年清洁卫生质量考核总体合格率分别为85.6%、87.3%、93.6%,结果提示该过程管理项目成效显著(P<0.05);2013-2016年沉降菌和物体表面微生物检测合格率均为100.0%;空气微粒等第三方年检合格率分别为100.0%、100.0%、77.8%和100.0%;新时期,PIVAS院感管理面临较大压力,但结果提示,2016年实施院感管理新模式后,清洁卫生质量考核、手卫生、第三方年检等合格率均有显著提升(P<0.05);4年中PIVAS未记录有输液致院感情况。结论建立和完善系统管理、过程管理、指标管理"三位一体"管理模式可促进PIVAS医院感染的有效防控并为其科学管理提供新思路。

OBJECTIVE To summarize the relevant situation of the Pharmacy Intravenous Admixture Service （PIV-AS） of our hospital and to discuss long-term nosocomial infection management mode under new circumstance.METHODS By comparing the cleaning and hygiene inspection qualified rate,the qualified rate of microbiology and air particle,and the nosocomial infections caused by transfusion from Jun.2013 to Dec.2016,the prevention and control effects of nosocomial infections by PIVAS implementation of system management,process management,and index management were analyzed.RESULTS After strengthening the quality of cleaning and hygiene assessment and being included in the scope of process management in 2016,the qualified rates of neat staff dress,clean operating table,clean ground and clean container were 92.5%,91.6%,95.8% and 94.5%,which were significantly improved compared with those in 2015（P〈0.05）.From 2014 to 2016,the cleaning and hygiene inspection qualified rates were 85.6%,87.3% and 93.6%,and the results suggested that the process management project had achieved significantly results （P〈0.05）.From 2013 to 2016,the qualified rates of colony forming unit and the monitoring of microorganism of objecfs surface were both 100%.The qualified rates of air particle detected by the third party were 100%,100%,77.8% and 100%,respectively.In new era,the nosocomial infection of PIV-AS was faced with great pressure.The results above suggested that carrying out the new mode,the qualified rates of cleaning and hygiene inspection,hand hygiene and the annual inspection detected by the third party were all improved significantly （P〈0.05）.There was no record of nosocomial infection caused by transfusion in four years.CONCLUSION Setting up and improving three in one management mode of system management,index management and process management can promote the prevention and provide a new idea for the scientific PIVAS infection management system.