四川省医疗机构的医院感染管理资源配置现状比较

Current status of resource allocation of healthcare-associated infection management in medical institutions of Sichuan province

目的探索四川省二、三级医疗机构医院感染管理部门设置、经费划拨及人员配备现状。方法在四川省医院感染现患率调查基础上,由省医院感染质量控制中心人员设计统一的调查表,发放至各医疗机构网络填报。调查的方法和形式以及数据的收集与填报均与医院感染现患率调查一致。结果共117家医院进行调研,其中三级医院30家,二级及以下医院87家。仍有少数医院将医院感染管理职能挂靠于医务科或护理科,主要是二级及以下医院(8.75%);各级医院划拨的医院感染管理工作经费均较少,中位数3.33元/床位,四分位数间距40.87元,但医院感染所导致的患者额外住院费用却相对较高,中位数3723.43元,四分位数间距11523.24元;医院感染管理部门专兼职人员结构均以护士为主(78.24%),人员结构失衡的状态在二级及以下医院较为严重;三级医院人员数量配置不足,而二级及以下医院人员数量充足但培训力度不足。结论四川省二、三级医疗机构医院感染管理资源配置虽有各自特点,但总体上趋于一致,且或多或少存在资源配置不足的情况,需要卫生行政部门从顶层设计分层级有针对性地规范医院感染管理的发展模式。

OBJECTIVE To explore the establishment of healthcare-associated infection（HAI）management departments,funding allocation and staffing status in secondary and tertiary medical institutions in Sichuan province.METHODS Based on the investigation of the prevalence of HAIs in Sichuan Province,a unified questionnaire was designed by provincial HAI control personnel and sent to the medical institutions online for investigation.The methods and forms of survey and the collection and reporting of data were consistent with the investigation of prevalence.RESULTS A total of 117 hospitals were investigated,including 30 tertiary hospitals and 87 secondary hospitals.There were still a few hospitals that linked HAI management functions to medical departments or nursing departments,8.75% of them were secondary hospitals or lower scale hospitals.The funds allocated for HAI management at all levels of hospitals were relatively low,with a median of 3.33 yuan per bed,the interquartile range was 40.87 yuan,but the extra hospitalization cost caused by HAIs was relatively high,with a median of 3,723.43 yuan and an interquartile range of 11,523.24 yuan;the structure of the part-time and full-time staff of the HAI management departments was mainly based on nurses（78.24%）,the unbalanced state of the staffing structure was more serious in secondary or lower scale hospitals;the number of staffing was insufficient in the tertiary hospitals,while the number of staffing was adequate in the secondary or lower scale hospitals,but the training was inadequate.CONCLUSION Although the secondary and tertiary medical institutions of Sichuan Province have their own characteristics in the allocation of HAI management resources,they tend to be consistent in general,and there are more or less insufficient allocations.Itwasnecessary for the health administrative departments to specifically regulate the development model of HAI management from the top level design.