北京市血液净化质量控制中心医院感染质量控制策略与现状分析

Strategy and status of nosocomial infection control in hemodialysis centers:experience from Beijing Blood Purification Quality Control and Improvement Center

目的构建适宜北京市血液透析室的医院感染质量控制体系,评估北京市血液透析室医院感染防控关键点的薄弱环节,为进一步完善质量控制中心医院感染质量控制能力与水平提供帮助。方法在肾内科专家、医院感染控制专家及医政管理专家共同参与下,根据国家卫生管理部门制定的医院感染管理规范及血液透析标准操作规程,确定调查内容与环节并形成现场医院感染质量控制体系,其核心内容包括8个关键维度:机构与人员资质;透析室布局与结构;管理制度;职业防护及手卫生规范;重点血液传播性疾病的管理;感染控制措施的落实;各功能区感染防控管理;安全复用,共计43个感染控制检查专项,其中包含91个感染控制风险行为(点),采用调阅档案、现场考试与现场观察相结合的方法,于2017年11月~2018年1月对北京市辖区内血液透析室进行调查与分析。结果(1)共调查北京市辖区内122家血液透析室,总体医院感染检查得分为94.6分,其中三级医疗机构中的血液透析室得分为95.0分;二级医疗机构中的血液透析室得分为93.4分;一级医疗机构中的血液透析室得分为90.8分。(2)在上述8个维度中得分排名较低的3位分别为:透析室布局与结构(89.3分)、感染控制措施的落实(91.3分)、机构与人员资质(92.8分)。(3)医院感染防控最薄弱环节的检出率前3位为:消毒隔离的风险行为(点)(29.5%)、基础设施不完善的风险行为(点)(26.2%)、治疗准备室区域的风险行为(点)(26.2%)。结论血液透析室的布局与结构、感染控制措施的落实、各功能区域感染防控管理等3个维度是北京市血液透析室中医院感染风险行为(点)的高发环节,血液净化质量控制中心在未来质量控制以及各血液透析室日常管理过程中应强化这3个维度的督导与管理。

Objectives To establish the strategy for and to understand the present status of nosocomial infection control among hemodialysis units in Beijing.Methods The newly customized strategy was built based on the national policy of nosocomial infection control and the standard operating procedure for blood purification under the cooperation of nephrologist,specialists for nosocomial infection control,and experts in medical administration.The investigation consisted of the following 8 fields(including control of 91 risk behaviors):quality certification for units and professionals,structural configuration of hemodialysis units,establishment and implement of management system for infection control,occupational protection and hand hygiene,management for blood borne diseases,implement of infection control measures,infection control for different functional areas,and standardized management for dialyzer re-use.With this system,the status of nosocomial infection control was evaluated by investigating files,examination of staffs on spot,and observing operating procedures among hemodialysis units in Beijing between November 2017 to January 2018.Results(1)A total of 122 hemodialysis units were investigated.The total score for this inspection was 94.6(95.0 score for units in grade three hospitals,93.4 score for units in grade two hospitals,and 90.8 score for units in grade one hospitals).(2)Among the 8 fields inspected in this study,the leading three of lower score were structural configuration of hemodialysis units(scored 89.3),establishment and implement of management system for infection control(scored 91.3),and quality certification for units and professionals(scored 92.8).(3)In this inspection system,the top three risk behaviors of nosocomial infection control were defect implement of disinfection and isolation procedures(29.5%),inadequate basic installation(26.2%),and risk behaviors in areas of treatment preparation room(26.2%).Conclusions Structural configuration of hemodialysis units,establishment and implement of management system for infection control,and infection control for different functional areas are the highest risk fields of nosocomial infection control in hemodialysis units in Beijing.Our study also implies that Blood Purification Quality Control and Improvement Center has to focus on these three fields during inspection and management of quality control and infection control in hemodialysis units.