Donabedian质量理论在血液净化中心手卫生持续改进中的应用

Application of Donabedian quality theory in continuous improvement of hand hygiene in blood purification center

目的应用Donabedian质量理论构建血液净化中心工作人员手卫生依从性的结构-过程-结果指标,进行持续质量改进,探讨在质量理论指导下的三维指标能否提高手卫生管理质量。方法对某医学中心血液净化中心全体工作人员手卫生依从性进行持续质量改进,干预前采用常规注重结果指标的持续质量改进方法,干预措施主要在Donabedian质量理论指导下,关注血液净化中心工作人员手卫生依从性的结构-过程-结果三维指标,观察该方法与常规的持续质量改进方法对于手卫生影响的差异。结果与干预前比较,干预后血液净化中心各类工作人员手卫生依从率(医生组:52.38%、75.22%;护理组:69.49%、88.17%;护工组:52.72%、73.93%;清洁工组:12.54%、56.83%)、正确率(医生组:80.91%、94.07%;护理组:87.08%、95.49%;护工组:37.74%、56.20%;清洁工组:57.14%、59.49%)均有所提高,差异均有统计学意义(均P<0.05)。干预前后血液净化中心工作人员手卫生知识考核成绩[(78.12±8.37)分VS(88.82±6.57)分],速干手消毒剂消耗量[(33.33±2.07)瓶VS(53.50±1.81)瓶],手部细菌检测合格率(58.82%VS 91.18%),患者对工作人员手卫生满意度(88.92%VS 96.30%)比较,差异均有统计学意义(均P<0.05)。干预前深静脉导管感染率为2.1例次/1000导管日,干预后未发生深静脉导管感染。结论Donabedian质量理论指导下的工作人员手卫生质量管理,在手卫生依从率、正确率,手卫生知识考核成绩,患者对工作人员手卫生满意度等方面效果显著,是一种值得推广的管理模式。

Objective To construct the structure-process-outcome index of hand hygiene(HH)compliance of staff in blood purification center by Donabedian quality theory,conduct continuous quality improvement,and explore whether the three-dimensional indexes guided by the quality theory can improve the quality of HH management.Methods HH compliance of all staff in blood purification center of a medical center was continuously improved,before the intervention,the routine continuous quality improvement method focusing on outcome indexes was adop-ted,intervention measures were performed under the guidance of Donabedian quality theory,structure-process-outcome three-dimensional index of HH compliance of staff in blood purification center was paid attention to,effect of the method and routine continuous quality improvement method on HH was observed.Results Compared with before intervention,HH compliance rate of all kinds of staff in blood purification center improved after intervention(doctor group:52.38%vs 75.22%;nursing group:69.49%vs 88.17%;attendant group:52.72%vs 73.93%;cleaner group:12.54%vs 56.83%),accuracy rate also improved(doctor group:80.91%vs 94.07%;nursing group:87.08%vs 95.49%;attendant group:37.74%vs 56.20%;cleaner group:57.14%vs 59.49%),diffe-rences were all statistically significant(all P<0.05).Before and after the intervention,scores of HH knowledge check in staff in blood purification center([78.12±8.37]points vs[88.82±6.57]points),consumption of alcohol-based hand rub([33.33±2.07]bottles vs[53.50±1.81]bottles),qualified rate of detection result of hand bacteria(58.82%vs 91.18%),and patients’satisfaction with HH of staff(88.92%vs 96.30%)were all significantly different(all P<0.05).The deep venous catheter infection rate was 2.1 per 1000 catheter-days before intervention,and no deep venous catheter infection occurred after intervention.Conclusion HH quality management of staff under the guidance of Donabedian quality theory has remarkable achievement in HH compliance rate and accuracy rate,HH knowledge examination,as well as patients’satisfaction with HH of staff,which is worthy to be promoted.