重庆市血液透析室医院感染管理现况调查

摘要

Objective To analyze the status of nosocomial infection prevention in the hemodialysis rooms of 36 hospitals in Chongqing city,and to put forward the normative countermeasures for nosocomial infection prevention. Methods According to the management regulations in the hemodialysis room of medical institutions and the review acceptance standards for hemodialysis room of Chongqing, we assessed the quality of management for nosocomial infection prevention in the hemodialysis rooms of 10 third-class hospitals and 26 second-class hospitals in Chongqing. The basic situation, layout of equipment and environment, dialysate, reuse of dialyser,organization,and management of medical records were all recorded in the assessment including 56 indices and total score 100. Results The total scores between the third-class hospitals and second-class hospitals had no statistical significanceO = 4. 88, P = 7. 720) ,but the layout of equipment and environment and the workflow was not reasonable,auxiliary room was less,and the facilities of hand washing was substandard in all hospitals. The quality monitoring for dialysis water between the third-class hospitals and second-class hospitals showed statistical difference (l = 4. 37,P<0. 001). The reuse of dialyser reuse management between the third-class hospitals and second-class hospitals had statistical difference^ = -A. 05,P<0. 001). Conclusion All hospitals should strengthen the construction and management for the layout of equipment and environment, workflow,and facilities of hand washing, strengthen the quality monitoring for dialysis water,and improve the normative management for nosocomial infection prevention in the hemodialysis room.%目的 分析重庆市36所医院血液透析室医院感染管理的现状,提出规范化管理对策.方法 根据卫生部<医疗机构血液透析室管理规范>和<重庆市血液透析室评审验收标准>,对重庆市10所三级医院和26所二级医院血液透析室预防医院感染管理质量进行现场考核评估,内容包括:基本概况、设备与环境布局、透析液、透析器复用、组织机构、病案管理等10部分,共56项指标,总分100分.结果 三级医院和二级医院总分差异无统计学意义(t=4.88,P=7.720),但均存在血液透析室的环境布局和工作流程不合理、透析室的辅助用房少、洗手设施不符合要求等问题;在透析用水的水质监测方面,三级医院明显优于二级医院(t=4.37,P＜0.001);透析器复用管理方面,部分三级医院仍在使用透析器复用,二级医院普遍取消了透析器复用,两者差异有统计学意义(t=-4.05,P＜0.001).结论 各级医院均应加强血液透析室环境布局、工作流程及洗手设施的合理化建设,规范并加强透析用水的医院感染监测,提高血液透析室预防医院感染的规范化管理.