天津市基层医疗卫生机构疫情防控风险评估与控制研究

COVID-19 prevention and control in primary health care institutions in Tianjin:Risk assessment and control

目的建立天津市基层医疗卫生机构疫情防控风险评估体系,并进行风险评估,为实现疫情精准防控提供参考依据。方法基于医疗失效模式与效应分析法对天津市11个区的基层医疗卫生机构进行调查,建立评估体系,对疫情防控风险进行定量风险评估,查找需要重点干预控制的风险点,制定精准控制措施,并对控制效果进行评价。如此循环进行,持续改进。结果天津市基层医疗卫生机构疫情防控风险体系包括院感管理规范、人员防护及培训、预检分诊管理、隔离技术规范4个部分。第一轮督导共查找风险点23个,确定其中需采取重点干预控制措施的风险点4个。改进结束后,再次进行风险评估,重点干预的4个风险点控制后的RPN值均<125,改进效果良好。结论基于医疗失效模式与效应分析(HFMEA)建立基层医疗卫生机构疫情防控风险评估体系并定期进行风险评估,可及时发现基层医疗卫生机构疫情防控风险隐患,实现基层医疗卫生机构的疫情精准防控与及时阻断,防患于未然。

Objective To establish a risk assessment system for epidemic prevention and control in primary health care institutions in Tianjin and to conduct risk assessment so as to provide evidence for the precise COVID-19 prevention and control.Methods The Healthcare Failure Mode and Effects Analysis(HFMEA)were used to conduct a survey of primary health care institutions in 11 districts of Tianjin.An assessment system was established to conduct quantitative risk assessment of COVID-19 prevention and control risks,identify risk points requiring interventions and control,develop precise control measures,and evaluate the control effectiveness.This strategy was repeated several rounds.Results The epidemic prevention and control risk system of primary medical institutions in Tianjin contained four aspects including in-hospital infection management protocols,personnel protection and training,pre-examination and triage,and technical specifications of isolation.A total of 23 risk points were identified,among which four required major interventions.A second round of risk assessment was performed after the implementation of improvement measures,and all the RPN values were below 125 in four risk points after major interventions,indicating good improvement effectiveness.Conclusions The HFMEA-based epidemic prevention and control assessment system and regular risk assessment in primary medical institutions enable the timely identification of risk points and accurate prevention and blockage of the epidemic.