Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics

Objective:To explore the effect of the Plan-Do-Check-Action(PDCA)cycle on hand hygiene and nosocomial infection quality of or thopedic medical staff.Methods:The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization.Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time,and compare the compliance of hand hygiene before and after implementation,and evaluate the quality of nosocomial infection.Results:The hand hygiene compliance of doctors and nurses in stage P was 82%.The compliance of medical staff in stage D was 93%.The compliance of stage C was 94%and that of stage A was 95%.The quality score of hospital self-examination nosocomial infection was also significantly increased.Conclusions:The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality,which is wor thy of circulatory application in or thopedic nosocomial infection quality control,especially improving the quality of hand hygiene.

Nosocomial Infection Surveillance in a Tuberculosis Specialized Hospital in China

Nosocomial infections（NIs） are a critical issue affecting the quality of healthcare. In this study, we performed a retrospective study to explore the incidence rates, mortality rates, and microbial spectrum of NIs in Beijing Chest Hospital, a tuberculosis（TB） specialized hospital in China. Our data demonstrate that the overall incidence rate of inpatients with NIs slightly decreased from 2012 to 2016, which may be associated with the implementation of hand hygiene measures, while the mortality rates associated with NI did not significantly change. In addition, the species distribution of NIs was quite different from that presented in previous reports, and Klebsiella pneumoniae was the most frequently isolated microorganism.

Analysis of the Influence of Operating Room Nursing Care Management on the Incidence Rate of Nosocomial Infection in Orthopedic Surgery Patients

Objective:To analysis the influence of operating room nursing care management on the incidence rate of nosocomial infection in orthopedic surgery patients.Methodology:Fifty six orthopedic surgery patients who admitted into the hospital between January to December 2018 were enrolled into this study and randomly divided into two groups,which were the control group(under general management)and the observation group(under the operating room nursing care management).Further,the incidence rate of nosocomial infections,the incidence rate of irregular nursing care phenomena,the satisfaction score of nursing care management,and the quality of life score were observed and recorded.Result:The incidence rate of nosocomial infection,the incidence rate of irregular nursing care management,the satisfaction score of nursing care management,and the quality of life score of the observation group were compared to that of the control group,and the result showed P<0.05,indicates the statistical significance between the data indicators.Conclusion:The use of operating room nursing care management in patients with orthopedic surgery has shown a significant effect.

Analysis of the Effect of Infection Control in Hospital Operation Room

Objective:To explore the implementation effect of nursing management in operating room for hospital infection control.Methods:100 cases of patients who received surgical treatment in our hospital from 2019 to 2020 were selected and divided into observation group and control group according to different nursing management methods in operating room.Patients in the control group received routine nursing management services,while patients in the observation group received systematic and highquality comprehensive management services based on routine nursing management services.Results:The air colony count and hand colony count of the observation group were significantly better than those of the control group.At the same time,the incidence probability of infection in the observation group was also significantly lower than that of the control group,with significant difference between the groups,with statistical value(P<0.05).Conclusions:In view of the occurrence of nosocomial infection,the implementation of high-quality operating room nursing service can effectively control it,reduce the probability of occurrence,and ensure the safety of patient treatment,which is worthy of clinical application.

Model of Healthcare-Associated Infection Control in Primary Health Care Institutions:A Structural Equation Modeling

The purpose of this study was to construct the model of organization system,managemcnt,training and surveillance in healthcare-associated infection prevention and control(IC)of primary health care institutions and identify its efleet on patient safety and decreasing economic burden by standardizing IC.A cross-sectional survey was conducted with questionnaires.Data were collected from 268 primary health care institutions in Hubei province,China.Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling.The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels:root mean square error of approximation(RMSEA)=0.071;comparative fit index(CFI)=0.965;tucker lewis index(TLI)=0.956:weighted root mean square residual(WRMR)=1.014.The model showed that organization system had a direct effect on management(β=0.311.P<0.01),and training(β=0.365,P<0.01).Management and training played an intermediary role that partially promoted organization system impact on surveillance.Results also showed that institutional factors such as the number of physicians、the ninnber of nurses,the designated capacity of beds,the actual number of open beds and surgery trips had positive impacts on management(β=0.050,P<0.01;β=0.181,P<0.01;β-0.111.P<0.01;β=0.064,P<0.01;β=0.084,P=0.04);nd training(β=0.21,P=0.03;β=0.050,P=0.02;β=0.586.P=0.01;0=0.995,P=0.02;β=0.223.P=0.03).In conclusion.the model of organization system,managemcnt,training and surveillancc in IC of primary health care institutions is valuable tor guiding IC practice.

A Blockchain-Based Life-Cycle Environmental Management Framework for Hospitals in the COVID-19 Context

During the coronavirus disease 2019 (COVID-19) emergency, many hospitals were built or renovated around the world to meet the challenges posed by the rising number of infected cases. Environmental management in the hospital life cycle is vital in preventing nosocomial infection and includes many infection control procedures. In certain urgent situations, a hospital must be completed quickly, and work process approval and supervision must therefore be accelerated. Thus, many works cannot be checked in detail. This results in a lack of work liability control and increases the difficulty of ensuring the fulfillment of key infection prevention measures. This study investigates how blockchain technology can transform the work quality inspection workflow to assist in nosocomial infection control under a fast delivery requirement. A blockchain-based life-cycle environmental management framework is proposed to track the fulfillment of crucial infection control measures in the design, construction, and operation stages of hospitals. The proposed framework allows for work quality checking after the work is completed, when some work cannot be checked on time. Illustrative use cases are selected to demonstrate the capabilities of the developed solution. This study provides new insights into applying blockchain technology to address the challenge of environmental management brought by rapid delivery requirements.

Management strategies in a thoracic surgery ward during COVID-19 pandemic: Experience from West China Hospital

The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In response to the pandemic,the management division of West China Hospital oversaw the implementation of hospital-wide emergency measures.In accordance with these measures,the hospital's thoracic surgery ward implemented a new management system by reformulating staff training plans,patient admission procedures,and other systems for managing the ward and protecting perioperative patients.Overall,the ward was successful in restoring normal working order,protecting all staff from occupational exposures,and ensuring the safety of inpatients and their families.

PDCA循环结合危险因素管理在提高儿科院内感染控制质量中的应用效果

目的探讨PDCA循环结合危险因素管理在儿科院内感染控制中的应用效果。方法选取萍乡市人民医院儿科2020年7月至2020年12月住院患儿共851例为对照组,2021年1月至2021年6月的住院患儿共916例为PDCA组。对照组实施常规感染管理,PDCA组实施PDCA循环结合危险因素管理。观察2组患儿院内感染发生率、消毒合格率、医护人员不合规事件发生率。结果PDCA组患儿的院内感染发生率、医护人员不合规事件总发生率均显著低于对照组(P<0.05)。PDCA组物体表面、医护人员手和空气消毒合格率均显著高于对照组(P<0.05或P<0.001)。结论PDCA循环管理结合危险因素管理可有效提高儿科消毒合格率,降低医护人员的不合规事件发生率和住院患儿院内感染发生率。

六西格玛理念下分级管理模式对降低实习护生针刺伤发生率的影响

目的:探讨六西格玛理念下分级管理模式对降低实习护生针刺伤发生率的效果。方法:选取2021年8月—2023年6月在我院实习的60名实习护生随机分为对照组和研究组,各30人。对照组实行常规管理,研究组实行六西格玛理念下的分级管理,比较两组各环节针刺伤发生率、针刺伤基本知识知晓情况、实习效果及实习满意度。结果:与对照组比较,研究组各环节针刺伤发生率更低(P<0.05),针刺伤基本知识知晓情况、实习效果及实习满意度更高(P<0.05)。结论:将六西格玛理念下分级管理模式应用于实习护生中,可降低针刺伤发生率,提升针刺伤基本知识知晓率、实习效果和实习满意度。

医院感染风险管理研究热点的可视化分析

目的分析医院感染风险管理研究相关文献的增长规律、研究热点和前沿,探索其发展方向。方法检索中国知网(CNKI)1999年1月1日至2022年5月15日的核心期刊文献,共纳入852篇文献,利用Excel软件进行文献增长规律及来源期刊分析;利用CiteSpace 6.1.R2软件通过文献关键词共现、聚类及热点突变等网络分析方法识别医院感染风险管理研究热点和趋势;通过文献被引频次分析反映该领域的关键点和学科前沿。结果研究经历了起步期(1999年-2010年)、增长期(2011年-2020年)和发展期(2021年以来)3个阶段;发表刊物以医院感染控制专业期刊和医院管理专业期刊为主;“危险因素”是研究的核心主题,中心性为0.12(>0.1);“危险因素”和“风险评估”是研究的核心内容;研究热点及发展趋势分为3个阶段:从医院感染的干预、对策研究过渡为医院感染的风险评估和建立风险预警体系,最新的研究热点为建立前瞻性风险管理预测模型和对病原菌、肝硬化等具体的对象进行研究;信息化在研究领域中关注度不足,未来有很大的研究空间。结论医院感染风险管理研究是医院管理中的重要组成部分,依然是未来研究的热点和重点。

口腔修复门诊实施院内感染清单式管理的效果分析

目的分析口腔修复门诊实施院内感染清单式管理的效果。方法针对院内感染监测发现的问题,于2021年8月—2022年12月在医院口腔修复门诊实施包括诊室空气质量、医疗器械、口腔印模、医护人员手卫生的清单式管理。经过3次诊室空气培养,器械表面、印模表面及医护人员手部采样和细菌学检测,详细记录监测结果,对比实施前后口腔修复门诊院内感染控制质量监测数据的差异,分析实施效果。结果清单式管理实施后,口腔科门诊空气菌落计数较清单式管理实施前下降(P<0.01);医护人员手部、口腔印模表面、医疗器械表面菌落计数较清单式管理实施前下降(P<0.01);口腔科门诊空气、医护人员手部、托盘消毒储存监测合格率较清单式管理实施前提升(P<0.01);患者院内感染发生率较实施前下降(P<0.01)。结论口腔修复门诊实施院内感染清单式管理可有效减少诊室空气粉尘、器械表面、印模表面、医护人员手部的细菌学检出率,降低院内感染风险。

湖北省476所医疗机构医院感染管理专职人员及医院感染信息化监测现状调查

目的了解湖北省医疗机构医院感染管理专职人员配备情况及医院感染信息化监测能力,为全省医院感染管理质控工作的开展提供基础。方法2023年7月,由湖北省医院感染管理质量控制中心向该省地市县区质控中心发布调研通知,对湖北省各地市州辖区内二级及以上医疗机构基本情况、医院感染管理专职人员情况及医院感染监测情况开展问卷调查。结果共调查476所医疗机构,其中328所(68.91%)医疗机构医院感染管理专职人员配备达标。214所(44.96%)医疗机构采用医院感染信息系统开展监测。13项医院感染质量控制指标的获取能力调查中,采用医院感染信息系统开展监测的医疗机构高于手工监测方式。结论湖北省医院感染专职人员队伍建设有待进一步加强,医院感染信息化监测能力有待进一步提高,已实现医院感染信息化监测的医疗机构应注重医院感染监测系统的更新迭代,不断完善监测功能。

检验科医源性感染的原因分析以及预防措施

在现代医院的管理体系中,医源性感染已成为威胁患者及医护人员健康安全的重大危险因素,是医学界重点关注的课题。检验科作为医院感染最主要科室之一,其工作人员需要接触各种生物样本,稍有不注意就会发生医源性感染,造成严重后果。所以从生物安全与医院管理的角度来说,做好检验科医源性感染的管理与控制是一个非常紧迫的工作。文章通过综述我国临床医学检验行业中普遍存在的医源性感染问题,并进行深入的分析,从中找到相关的解决方式,着重探讨相关医源性感染的预防措施,以此促进医学检验技术发展和检验质量管理水平提升。

ICU护士照护多重耐药菌感染患者真实体验的质性研究

目的深入了解ICU护士照护多重耐药菌感染患者的真实体验,为临床优化护理策略、完善多重耐药菌感染控制方案提供实证支持。方法采用现象学研究方法,通过目的抽样法于2023年10-11月选取广西壮族自治区南宁市、柳州市、桂林市、百色市的16名ICU护士进行半结构式深度访谈,运用Colaizzi七步分析法对访谈内容进行分析、归纳并提炼主题。结果共提炼出4个主题及14个亚主题:复杂的情感体验(自信感与危机感、责任感与愧疚感、同情感与无力感、恐惧感与担忧感、疲惫感与耗竭感、自我价值与职业认同的挑战);存在多方面需求(排班与人力资源管理、学习与培训、沟通与合作、环境与设备);对专业认知的持续深化(职业使命感得到强化、体会到感控工作重在细节);对自我成长的不断反思(保持慎独精神、心理的自我调适)。结论ICU护士在照护多重耐药菌感染患者时,存在着复杂的多维度情感体验和多方面需求,管理者应当采取针对性措施,提高护士的心理资本,满足其专业需求,推动其专业成长和自我提升,提高护理服务质量水平。

基于项目化管理模式以提高医院感染诊断相关病原学送检率的应用研究

目的调查某院医院感染诊断相关病原学送检情况,采取项目化管理模式以提高医院感染诊断相关病原学送检率。方法选取重庆市某三级甲等医院2022年1月—12月医院感染病例送检情况为对照组,2023年1月—12月医院感染病例送检情况为干预组,比较两组医院感染诊断相关病原学送检率、微生物标本不合格率及无菌性标本构成比的差异。结果干预组医院感染诊断相关病原学送检率(90.32%)高于对照组(82.77%),微生物标本不合格率(0.98%)较对照组(1.33%)下降,无菌性标本构成比(40.66%)高于对照组(37.75%),差异均具有统计学意义(P<0.05)。结论项目化管理模式可有效提升医院感染诊断相关病原学送检率及微生物标本送检质量,但未来还需进一步加强信息化建设。

2021—2022年某三甲医院多重耐药菌分布情况监测分析

目的 分析某三甲医院2021-2022年多重耐药菌在不同科室、不同人群、不同感染状态下的分布情况。方法 选取2021年1月-2022年12月赤峰市医院住院患者送检检出的多重耐药菌,根据科室类别、性别和感染情况进行分组,分析分布情况。结果 2021年1月-2022年12月共检出多重耐药菌883例,其中检出最多的为产超广谱β-内酰胺酶细菌(extended spectrum beta-lactamase,ESBLs),占31.37%。不同类别科室的多重耐药菌分布不同(χ2=220.448,P <0.001)。内科病房、外科病房主要以ESBLs类细菌为主,重症科室主要是耐碳青霉烯类抗菌药物鲍曼不动杆菌(carbapenem resistant Acinetobacter baumannii,CR-AB)分布最多,差异有统计学意义(P<0.05)。不同性别人群多重耐药菌分布也不同(χ2=57.994,P <0.001),男性患者主要是CR-AB分布居多,检出181例,女性患者则以ESBLs类细菌为主,检出131例,差异有统计学意义(P <0.05)。不同感染类型人群多重耐药菌分布亦不同,差异有统计学意义(χ2=74.391,P <0.001)。社区感染的患者中ESBLs类细菌占比最多,而院内感染患者中则以CR-AB为主。结论 多重耐药菌分布广泛,且分布各有不同,应加强预防控制工作,采取有针对性的措施预防控制多重耐药菌的院内感染。

基于循证理论构建MDT网格化血管导管感染管控体系

目的构建多学科诊疗(multi-disciplinary treatment,MDT)网格化血管导管相关感染(vessel catheter-associated infection,VCAI)管控体系。方法在循证理论的基础上,使用德尔菲专家函询法构建MDT网格化VCAI管控体系,比较应用此体系前后临床医护人员对VCAI相关知识的掌握情况。结果经过两轮专家函询构建和完善预防VCAI的理论知识、实践能力、专业发展能力三级管理构架的管控体系;使用该管控体系对医护人员进行培训显著提高医护人员对VCAI相关知识的掌握情况(P<0.05)。结论基于循证理论构建的MDT网格化VCAI管控体系可有效保障患者安全。

目标管理理论在医养结合医院院内感染防控中的应用

目的评价目标管理理论在康复专科医院院内感染防控中的应用效果。方法选取2021年1月至2022年12月在广西壮族自治区荣誉军人康复医院入住的康养患者作为研究对象,2021年1月1日至12月31日的402例患者为对照组,接受常规护理,2022年1月1日至12月31日的427例患者为干预组,在对照组基础上,按目标管理理论,设定目标及实施针对性的干预措施。比较两组医护人员手卫生依从性、环境卫生监测合格率和院内感染的发生率。结果干预组护士手卫生依从率为88.54%,高于对照组(69.79%),差异有统计学意义(P<0.01);干预组环境卫生监测合格率为96.87%,高于对照组(82.29%),差异有统计学意义(P<0.01);干预组患者院内感染的发生率为5.39%,低于对照组(10.94%),差异有统计学意义(P<0.05)。结论将目标管理理论应用于康复机构住院患者院内感染防控,可以有效控制院内感染的发生,值得临床推广应用。

手术室护理管理对骨科手术患者医院感染发生率的影响研究

目的分析手术室护理管理对骨科手术患者医院感染发生率的影响。方法研究选取泉州市第一医院2022年1月至2023年1月临床收治骨科手术患者100例为研究对象,随机分组方式将其划分为对照组(常规管理,50例)和观察组(常规管理+手术室护理管理,50例),比较不同管理模式下,两组医院感染率、护理管理评估、患者满意度、焦虑自评表(SAS)、抑郁自评量表(SDS)得分及生活质量水平。结果护理后,观察组医院感染发生率以及SAS、SDS评分均低于对照组(均P<0.05);观察组患者各项护理管理评分、SF-36评分以及护理满意度均高于对照组(均P<0.05)。结论手术室护理管理能显著降低临床骨科手术患者院内感染发生率,提升临床手术室管理质量及患者满意度,且患者心理状态更优、患者生活质量水平更高。

新生儿医院感染管理质量评价指标体系的构建

目的构建新生儿医院感染管理质量评价指标体系,客观、科学地评价新生儿医院感染管理质量。方法采用文献资料检索和半结构式访谈法,以“结构-过程-结果”三维质量模式为指导,初步编制新生儿医院感染管理质量评价指标体系框架。2023年11月至12月采用电子函询表进行两轮专家函询,最终确定新生儿医院感染管理质量指标评价体系及指标权重,并进行信度和效度分析。结果初始新生儿医院感染管理质量评价指标体系框架,包括一级指标3个、二级指标18个、三级指标70个。两轮函询的专家积极系数均为100.00%,专家参与积极性非常高;专家权威系数分别为0.854、0.873,专家具有较高的权威性,结果可信;Kendall’s W值分别为0.668、0.610(P<0.01),专家协调程度较高,结果可靠;指标重要性赋值均数为4.214~4.929,变异系数为0.053~0.175,专家意见比较集中。最终新生儿医院感染管理质量评价指标体系包含一级指标3个、二级指标6个、三级指标22个。一致性信度Cronbach’sα系数为0.827,重测信度r=0.832(P<0.01);结构效度KMO值为0.778,Bartlett’s球形检验χ2=1413.694(P<0.01)。结论本研究构建了一套新生儿医院感染管理质量评价指标体系,信度和效度较好,为客观、科学地评价新生儿医院感染管理质量提供参考依据。