某院静脉用药调配中心医院感染风险因素分析及防控策略实施

Analysis of Risk Factors and Implementation of Prevention and Control Strategies forNosocomial Infection of Pharmacy Intravenous Admixture Service in a Hospital

目的降低医院静脉用药调配中心(PIVAS)医院感染发生风险。方法调取医院PIVAS工作系统2022年1月至6月(防控策略实施前)发生的医院感染的资料,根据PIVAS工作环节分析和排查潜在的医院感染影响因素;2022年7月至12月(防控策略实施后)制订并实施PIVAS环境动态监测与针对性感染防控策略。比较实施前后PIVAS医院感染风险事件发生情况、空气培养菌落数量及医疗人员综合能力。结果防控策略实施前后分别进行现场抽查30次,分别配置成品输液107151,114166袋;风险因素为工作人员操作不当、配置环境空气消毒不合格、工具消毒不合格、工作人员手消毒不合格、药品存放顺序不合格,发生总频次由实施前的86次降至实施后的11次(P<0.05),且与实施前比较,防控策略实施后上述风险事件发生率均显著降低(P<0.05)。与实施前比较,防控策略实施后,生物安全柜表面、物体摆放车表面、工作人员手部、配置仓的空气培养菌落数量均显著减少(P<0.05),实施1,3,6个月后,工作人员的药品配置、药品管理、环境管理能力评分均显著升高(P<0.05)。结论工具消毒不合格、药品存放顺序不合格、配置环境空气消毒不合格等是PIVAS医院感染发生的主要风险因素,实施PIVAS环境动态监测与针对性感染防控策略可降低PIVAS医院感染的发生风险,减少空气培养菌落数量,提升工作人员的综合能力。

Objective To decrease the risk of nosocomial infection in hospital pharmacy intravenous admixture service(PIVAS).Methods The data of nosocomial infection in the hospital PIVAS work system from January to June 2022(before implementation of prevention and control strategies)were collected to identify the potential factors affecting nosocomial infection based on the PIVAS work process.PIVAS environmental dynamic monitoring and targeted infection prevention and control strategies were formulated and implemented from July to December 2022(after implementation of prevention and control strategies).The incidence of nosocomial infection risk events,count of air bacterial colonies and comprehensive ability of medical staff in PIVAS before and after implementation was compared.Results A total of 60 on-site inspections were conducted before and after implementation,with 30 times in each time period,and 107151,114166 bags of finished infusion products were dispensed respectively.The risk factors included unqualified operation of medical staff,unqualified air disinfection of dispensing environment,unqualified tool disinfection,unqualified hand disinfection and unqualified drug storage sequence.The total frequency of the above risk events decreased from 86 times before implementation to 11 times after implementation(P<0.05),and the incidence of the above risk events significantly decreased after implementation(P<0.05).After implementation,the count of air bacterial colonies in the biosafety cabinet surface,object placement vehicle surface,medical staff′s hands and dispensing warehouse significantly decreased(P<0.05).After one,three and six months of implementation,the scores of medical staff′s abilities in drug dispensing,drug management and environmental management significantly increased(P<0.05).Conclusion The major risk factors of nosocomial infection in PIVAS are unqualified tool disinfection,unqualified drug storage sequence and unqualified air disinfection of dispensing environment.The implementation of PIVAS environmental dynamic monitoring and targeted infection prevention and control strategies can decrease the risk of nosocomial infection in PIVAS,decrease the count of air bacterial colonies,and improve the medical staff′s comprehensive ability.