基于德尔菲法构建综合性医院感染风险评价体系

Construction of risk assessment index system in general hospital based on Delphi method

目的对上海市浦东新区多家综合性医疗机构进行医院感染风险评估,建立及验证医院感染风险量化评估方法。方法使用德尔菲法进行专家函询,识别医院感染风险,赋值权重系数,评估指标后果严重性,筛选风险量化评估体系指标。结果该体系共识别出配置、管理、过程和结果4项一级指标及78项二级指标。其中“开设的感染性门诊是否均设立合理规范的三区划分”“院内有独立的医院感染科,床位比(院感专职人数/床位数)是否达1:200”“各科室是否至少指定1名医务人员作为科室兼职感控人员”“环境物品医疗器械清洁消毒设备是否定期维护保养”4项二级指标的权重系数最高。将体系用于不同医疗机构进行风险评价,提示“开设的感染性门诊面积是否符合诊疗需要”“院内核定床位开放率”和“医院感染科人员构成多样化”3项指标在不同医疗机构均为高风险指标。结论基于德尔菲法构建的医院感染风险评价体系可定量识别高风险环节,为医院感染预防控制提供有效参考。

Objective To construct and validate a quantitative assessment index system of hospital infection risk by conducting risk assessments on multiple comprehensive medical institutions in Pudong New Area.Methods Delphi method was applied in the assessment index system.Risk identification was the first step,followed by weight coefficient assignment and assessment of index severity to acquire the quantitative assessment index system.Results The system identified 4 first-level indexes including allocation,management,process and result indexes and 78 second-level indexes.Among all of the indexes,the weight coefficients of 4 secondary indicators ranked highest,including “whether all of the established infectious clinics had reasonable and standardized three zone division”,“whether independent hospital infection prevention and control department was established in the hospital,and whether the bed ratio(number of full-time hospital infection prevention and control staffs/number of patient beds) reached 1:200”,“whether one medical staff at least was responsible for the part-time hospital infection prevention and control in each department ",and " whether cleaning and disinfection instruments were regularly maintained”.Risk assessment of 3 medical institutions suggested that “whether the area of infectious outpatient clinics meet the needs of diagnosis and treatment”,“the opening rate of approved beds in the hospital” and “the diversity of personnel in the hospital's infection prevention and control department,including clinical doctors,public health doctors,health technical personnel,nurses,etc.” played as common high-risk indicators in different institutions.Conclusions The assessment index system can quantitative identify the high-risk factors and provide effective reference for hospital infection prevention and control.