PDCA管理循环在结核感染控制中的应用价值

Application value of PDCA circulation in tuberculosis infection control

目的 评价PDCA管理循环（以下简称“PDCA法”）在结核感染控制中的应用价值。方法 搜集2010年1月至2017年12月嘉兴市第一医院诊治的10979例肺结核患者（包括53例机械通气患者）。其中,2010年1月至2012年12月收治的2501例肺结核患者采用传统管理方法进行管理; 2013年1月至2017年12月收治的8478例肺结核患者采用PDCA [计划（plan）、执行（do）、检查（check）、处理（action）]法进行管理。对比分析两种管理方法期间临床医护人员院内结核感染情况。并选取传统管理期间结核病区的24名医护人员和 PDCA法管理期间的27名医护人员进行结核感染控制措施的满意度调查。结果 2010年1月至2012年12月对照组3年间年均临床医护人员1174名,其中10例医护人员感染肺结核;利用PDCA法改进痰液管理后, 2013年1月至2017年12月5年间年均临床医护人员1513名,全院临床医护人员均无院内结核感染发生,差异有统计学意义（χ 2=10.64, P〈0.01）;传统管理期间医护人员满意度评分为（91.92±1.69）分、PDCA法管理期间医护人员满意度评分为（97.07±1.92）分,两者比较差异有统计学意义（t=10.12, P=0.000）。 结论 利用PDCA法管理可降低医护人员院内结核病感染的发生,提高医护人员对感染控制措施的满意度。

Objective To evaluate the application value of management circulation of Plan-Do-Check-Action（PDCA for short） in tuberculosis infection control.Methods A total of 10979 patients with pulmonary tuberculosis patients including 53 patients treated with mechanical ventilation admitted in the first hospital of Jiaxing city, Zhejiang province were collected in this study during January 2010 to December 2017. 2501 patients with pulmonary tuberculosis admitted during from January 2010 to December 2012 were managed by traditional management methods and 8478 patients with pulmonary tuberculosis admitted during from January 2013 to December 2017 were managed by PDCA. The data of nosocomial tuberculosis infection were compared with these two management methods among clinical medical staff during the period. A survey on the satisfaction degree was conducted between 24 medical staff from the period of traditional management methods and 27 medical staff from the period of PDCA administration.Results There were 10 clinical medical staff infected with tuberculosis among the control group of 1174 average annual clinical medical staff during the three years from January 2010 to December 2012. However, there were no staff infected with tuberculosis among the research group of 1513 average annual clinical medical staff after improving sputum management by using PDCA during these five years from January 2013 to December 2017. The difference of nosocomial tuberculosis infection was statistically significant （χ 2=10.64, P〈0.01）. The satisfaction degree of medical staff in traditional management period was 91.92±1.69 and that in PDCA method was 97.07±1.92. The difference was statistically significant （t=10.12, P=0.000）. Conclusion PDCA management can reduce the incidence of tuberculosis infection among clinical medical staff in hospital and improve the satisfaction of clinical medical staff on infection control measures.