基于灾害脆弱性分析的新生儿科医院感染风险评估

Risk assessment of neonatology nosocomial infection based on hazard vulnerability analysis

目的对某院新生儿科医院感染风险事件进行评估,明确需要优先关注的感染预防与控制(以下简称感控)风险事件及改进关键点,降低医院感染风险。方法基于灾害脆弱性分析方法,结合文献回顾与工作实践,某院新生儿科医院灾害脆弱性分析小组采用头脑风暴法进行指标的初步筛选,进而通过问卷对初筛指标逐一评估,结合Kaiser模型的风险值评估表形成新生儿科感控风险评价指标体系,在此基础上制定感控风险值评估问卷。2020年5月,以问卷形式请小组成员对风险指标发生可能性和严重性进行评分,然后计算危害风险值并采用矩阵分析法划分风险带。结果新生儿科感控风险评价指标体系包括管理指标11项,执行指标20项,结果指标7项。危害风险值排序前5的指标依次为:手卫生方法不正确(39.20%)、环境物体表面清洁消毒不到位(39.04%)、奶液未现配现用(38.19%)、医院感染暴发(38.02%)和手卫生依从性低(37.99%)。严重度高而准备度低的指标包括与乳类喂养相关的3项指标以及与物体表面清洁消毒相关的3项指标。矩阵分析结果显示,处于高风险带的指标有9项,处于中风险带者7项,处于低风险带者22项。结论本研究基于灾害脆弱性分析明确了新生儿科的医院感染管理风险事件,管理者应优先关注处于高风险带的指标,对于危害风险值高而准备度低的指标需进行根本原因分析并采取干预措施,从而降低医院感染发生率,避免医院感染暴发。

Objective To assess the nosocomial infection risk events of neonatology experienced by a hospital,for identifying those events deserving high priority in infection prevention and control and critical rooms of improvement,hence minimizing such risks of the hospital.Methods The hazard vulnerability analysis was called into play,along with literature review and clinical practices,while the hazard vulnerability analysis team of neonatology of the hospital preliminarily screened the indexes in brainstorming method.Then the individual indexes from such screening evaluated by means of questionnaires,and the risk evaluation index system for neonatal infection prevention and control was formed in combination with the risk value evaluation table of Kaiser model.On such basis,an evaluation questionnaire for the prevention and control was developed.In May 2020,the team members scored the possibility and severity of these risk indexes in the form of questionnaire,calculated the hazard risk value,and divided the risk zones by matrix analysis.Results The risk assessment index system of neonatology was composed of 11 management indexes,20 implementation indexes and 7 outcome indexes.The top 5 indexes of hazard risk value were:incorrect hand hygiene method(39.20%),inadequate cleaning and disinfection of environmental object surface(39.04%),the formula was not used immediately when ready(38.19%),nosocomial infection outbreak(38.02%),and low hand hygiene compliance(37.99%).The indexes with high severity and low readiness include three indexes related to formula feeding and three indexes related to cleaning and disinfection of object surface.The matrix analysis results showed that there were 9 indexes in the high-risk zone,7 indexes in the medium risk zone and 22 in the low-risk zone.Conclusions This study identified risk management events in hospital infection management in neonatology by means of hazard vulnerability analysis.The neonatology administrators are recommended to prioritize indexes in the high risk zone,make a root cause analysis of those indexes of high risk value and low readiness and take intervention measures in time,hence reducing the incidence of nosocomial infection and avoiding the outbreak of nosocomial infection.