PDCA管理模式在神经外科重症监护病房医院感染管理中的应用及其效果评价

The Application and Effective Evaluation of PDCA Management Mode in Nosocomial Infection Management of Neurosurgical Intensive Care Unit

目的:分析PDCA管理模式在神经外科重症监护病房(NICU)医院感染中的应用效果。方法:2013年1~12月在某三级甲等综合医院NICU医院感染管理中应用PDCA管理模式,通过前瞻性目标性监测对其效果进行了观察。结果:本年度共32人发生37例次医院感染,总的医院感染发生率为8.36%,例次发病率9.66%,日感染发病率11.19‰,日感染例次发病率12.94‰;总体来看NICU不同季度医院感染呈下降趋势,第2季度医院感染率最高(11.00%),第4季度医院感染发病率最低(4.60%);第1季度患者病情程度得分(428)最高,第4季度得分(368)最低;本年度调整感染发病率为2.02%,调整日感染发病率2.71‰;调整后第2季度患者感染发病率2.75%、调整日感染发病率3.90‰;调整后第4季度患者感染发病率1.11%、调整日感染发病率1.38‰;医院感染发生部位中,下呼吸道构成比最高(占54.06%),其次为细菌性脑膜炎(占32.43%);第1季度尿道插管使用率最高(99.44%),第2季度中心静脉插管使用率最高(62.84%),第1季度呼吸机使用率最高(6.42%);器械感染发生率较低,其中第3、4季度器械相关感染发病率为0。结论:PDCA管理模式能及时发现NICU医院感染存在的问题,分析原因,立刻整改,从而有效地降低NICU医院感染发生率。

Objective： To analysis the effect of PDCA in nosocomial infection management of neurosurgical intensive care unit（NICU）. Methods： PDCA management mode was applied in nosocomial infection control of an NICU in a three-level first class hospital during January to December 2013. This was a perspective study. Results： 37 infection cases happened among 32 patients in total. The overall incidence of nosocomial infection was 8. 36%. The incidence of infection cases was 9. 66%. The daily incidence of infection was 11.90%. Generally,NICU nosocomial infection rate declined in every quarter. The highest nosocomial infection rate was in the second quarter（11%）,while the lowest rate of nosocomial infection was in the fourth quarter（4. 60%）. The illness severity scored the highest（428）in the first quarter,the lowest（368） in the fourth quarter. The adjusted annual incidence of infection was 2. 02%. Adjusted daily infection incidence was 2. 71‰. The adjusted infection incidence of the second quarter was 2. 75%,and the adjusted daily infection incidence was 3. 90‰. The adjusted infection incidence of the fourth quarter was 1. 11%,and the adjusted daily infection incidence was 1. 38‰. The most common organ of hospital infection was lower respiratory tract（54. 06%）,followed by bacterial meningitis（32. 43%）. The highest rate of urethral catheterization usage was in the first quarter（99. 44%）. The highest rate of central venous catheter was in the second quarter（62. 87%）. The highest rate of using breathing machine was in the first quarter（6. 42%）. The incidence of medical device relat-ed infection was low,especially in the third and fourth quarter（0 case）. Conclusion： By application of PDCA management mode,problems in nosocomial infection of NICU could be found in time,and be analysed and corrected immediately,in order to reduce the incidence of NICU nosocomial infection in effectively.