检验科微生物检验不合格标本的原因分析及对策

Causes and Countermeasures of Unqualified Specimens in Laboratory Microbiology Test

目的分析检验科中微生物检验标本质量的影响因素与应对策略。方法选取228例检验科接收微生物检验标本分别纳入对照组与观察组,其中对照组标本检验时期采用常规检验科管理模式进行检验工作管理,观察组标本检验时间采用质量综合改进模式进行检验工作管理。结果接受常规检验科管理模式下的对照组微生物检验标本中痰液标本、粪便标本、分泌物标本、血液标本、尿液标本、无菌体液标本对应不合格率以及综合不合格率分别为3.51%、1.75%、1.75%、0.88%、0.88%、1.75%、10.53%,接受质量综合改进模式下检验科管理的观察组微生物检验标本对应不合格数据分别为0.88%、0.88%、0、0.88%、0.88%、0、3.51%;采集阶段影响微生物标本质量的因素中采集时间不恰当、采集量不足、采集污染的OR值分别为3.542、8.497、9.294,保存与送检阶段影响微生物标本质量的因素中送检时间过长、保存或送检过程污染的OR值分别为5.081、4.204,检验阶段影响微生物标本质量的因素中检验操作过程污染、标本待检时间过长的OR值分别为9.592、7.931,其他部分影响微生物标本质量的因素中患者所致检测结果异常的OR值为4.290(P<0.05)。结论标本污染、标本待检时间过长、采集量不足等是影响检验科微生物检验标本不合格的重要因素,改善措施需要从整体工作链流程、工作人员培训考核、用品物品质量管理等方面综合分析与协调处理,同时结合长期观察监督、质量管理才能提高且稳定检验标本质量。

Objective To analyze the influencing factors and coping strategies of the quality of microbiological test specimens in the laboratory department.Methods Selected 228 cases of microbiological test specimens received by the laboratory department and included them in the control group and the observation group respectively.The routine laboratory management mode was adopted for the inspection period of the specimens in the control group,and the quality comprehensive improvement mode was adopted for the inspection work management of the specimens in the observation group.Results The corresponding unqualified rate and comprehensive unqualified rate of sputum,stool,secretion,blood,urine and sterile body fluid specimens in the control group under the management mode of routine laboratory department were 3.51%,1.75%,1.75%,0.88%,0.88%,1.75%,10.53%respectively,accepted the management of the inspection department under the comprehensive quality improvement mode The corresponding unqualified data of microbial test specimens in the observation group were 0.88%,0.88%,0,0.88%,0.88%,0,3.51%;among the factors affecting the quality of microbial specimens in the collection stage,the OR values of inappropriate collection time,insufficient collection volume,and collection pollution were 3.542,8.497,and 9.294,respectively.Among the factors affecting the quality of microbial specimens in the preservation and inspection stages,the inspection time was too long.The OR values of contamination during the inspection process,preservation or inspection process were 5.081 and 4.204 respectively.Among the factors affecting the quality of microbial specimens during the inspection stage,the OR values of contamination during inspection operation and the specimen waiting for too long were 9.592 and 7.931 respectively.Other factors affected the quality of microbial specimens.Among the quality factors,the OR value of abnormal test results caused by patients was 4.290(P<0.05).Conclusion Specimen contamination,long waiting time for specimens,and insufficient collection are important factors that affect the unqualified specimens for microbiological examination in the laboratory.Improvement measures need to be taken from the overall work chain process,staff training and assessment,and quality management of supplies and items.Comprehensive analysis and coordinated processing,combined with longterm observation and supervision,and quality management,can improve and stabilize the quality of test specimens.