综合性医院非隔离区域新型冠状病毒肺炎疫情防控的精细化管理

目的 总结该院在非隔离区域的新型冠状病毒肺炎疫情防控经验,为国内综合性医院非隔离区域的新型冠状病毒肺炎及其他传染性疾病的防控提供参考。方法 利用精细化管理理念,以专业化为前提,制订非隔离区域的新型冠状病毒肺炎疫情防控标准,系统化落实各项新型冠状病毒肺炎疫情防控措施,网格化稽查,用信息化手段进行团队间及医患间有效沟通,数据化反馈结果促进质量改进。结果 院内员工无继发新型冠状病毒感染,院内全员口罩佩戴率、流行病史筛查率、环境及医疗用品消毒率均为100%,患者及家属的口罩佩戴正确率为73.79%,手卫生正确执行率为40.78%。结论 精细化管理策略防控措施在综合性医院新型冠状病毒肺炎非隔离区域有效,患者及家属的口罩佩戴正确率及手卫生执行率需要进一步提高。     

新型冠状病毒肺炎定点医院非发热诊区疫情防控的应急管理策略

目的总结新型冠状病毒肺炎定点医院非发热诊区疫情防控管理的应急策略,为进一步做好疫情防控提供借鉴.方法基于各区域特征,制订新型冠状病毒肺炎疫情的防控标准和应急管理策略,专人分区进行专项督查,根据数据反馈促进各项防控措施的质量改进.结果院内员工无新型冠状病毒感染发生;医院入口处人员口罩佩戴率为100%,住院患者家属口罩佩戴率为94.62%;各入口体温检测率均为100%;流行病学史筛查率:医院入口为95.93%,门诊、病房入口均为100%;工作人员手卫生执行率为96.14%,手卫生执行正确率为84.78%;患者和家属新冠肺炎防范措施知晓率为95.38%,护工为95.92%;医疗用品、环境消毒率为100%.结论制订的医院非发热诊区新型冠状病毒感染的应急管理策略切实有效.后期医院入口流行病学史筛查率、住院患者家属口罩佩戴率以及各级人员手卫生和防控知识培训仍须进一步加强.     

多部门网格化管理在新型冠状病毒肺炎疫情期间综合医院陪护管理中的应用

目的 总结某三级甲等医院在新型冠状病毒肺炎疫情防控时期普通医疗区实施多部门合作网格化陪护管理经验,为重大疫情期间综合性医院普通医疗区陪护管理提供参考。方法 通过组建由护理部、医务部、安全保卫部、医院感染控制中心、信息中心、财务部、病友服务中心、后勤保障部共同组成的陪护管理团队。利用网格化管理理念,以陪护需求为出发点,制订陪护管理规范,系统化落实各项措施,网格化稽查,用信息化手段进行各部门及医患之间的有效沟通,数据化反馈结果促进质量改进。结果 2020年2月3日—3月31日,共筛查普通医疗区住院患者陪护5 520例,其中体温异常23例,疑似新型冠状病毒肺炎12例,无确诊新型冠状病毒肺炎病例。未发生陪护、院内员工继发新型冠状病毒感染,无投诉,病区陪护流行病学史调查率为100%、特别疫情告知书签署合格率均为98.58%,防护知识知晓率、手卫生设施合格率均为100%,普通病房内陪护口罩佩戴率91.41%,陪护口罩佩戴正确率83.38%。结论 多部门网格化管理策略对新型冠状病毒肺炎疫情期间综合医院普通医疗区的陪护管理有效。     

新型冠状病毒肺炎疫情期间手术室护理人员手卫生执行情况的调查分析

目的了解新型冠状病毒肺炎疫情期间手术室护理人员的手卫生执行情况。方法采用自制调查表调查200名手术室护理人员的手卫生执行情况。结果不同时刻的手卫生执行率从高至低依次为体液暴露后、无菌操作前、接触患者前、接触患者后、接触患者周围环境后。不同职称护理人员接触患者后和接触患者周围环境后手卫生执行率均<60.00%。接触患者后有无救灾经历或参加过救灾培训的护理人员手卫生执行率差异有统计学意义(P<0.05)。结论手术室护士总体手卫生依从率仍较低,管理者应进一步加强没有救灾经历或没有参加过救灾培训的护理人员的手卫生管理。     

社区医院保洁人员手卫生依从性调查及对策研究

目的 调查社区医院保洁人员手卫生依从性的现状并分析原因,以切断疾病传播途径、切实做好院内感染防控。方法 采用现场访谈法了解影响保洁人员手卫生依从性的相关因素,并采取相应对策。干预前后对我院15名保洁人员进行手卫生依从性观察,了解实施效果。结果 影响保洁人员手卫生依从性的相关因素为缺乏监督管理,手卫生知识知晓率低。干预后手卫生依从性从27.27%提升到69.23%。结论 通过实施监督管理评价、配备足够、便捷的手卫生设施、加强手卫生知识培训,可以有效提高社区医院保洁人员的手卫生依从性。     

The bug stops with me: Prevention of COVID-19 nosocomial transmission during radiographic procedures

IntroductionNosocomial transmission of Coronavirus Disease 2019 (COVID-19) is a preventable risk to the patient population and radiographer workforce. This article aims to describe the prevention of COVID-19 nosocomial transmission during radiographic procedures by the utilization of stringent infection prevention measures at a leading tertiary hospital in Singapore.MethodsThe implemented measures are the appropriate use of personal protective equipment, staff education, infection controls measures such as equipment disinfection, physical distancing and segregation of staff and patients.ResultsDespite the handling of 1637 COVID-19 cases as of July 25, 2020, there has not been a single case of known nosocomial transmission of the disease in the institution.DiscussionThe absence of nosocomial transmission suggests that the implemented measures are adequate. These measures will need to be sustainable for the long term in order to ensure continued success.ConclusionRadiographers are a crucial part of the team in the fight against COVID-19 and are at risk of contracting COVID-19. Strict adherence to appropriate infection control measures is essential for the safety of Radiology staff and their patients, and the successful control of this pandemic.     

品质圈管理在ICU手卫生管理中的应用

目的评价品质圈管理方法在ICU手卫生管理中的应用价值。方法通过品质圈管理活动,以"提高医务人员手卫生依从性"为活动主题,进行医务人员手卫生质量调查与分析。结果经实施品质圈管理,该重症监护室医务人员手卫生知识掌握比例从71.9%提高至92.2%;手卫生执行率从39.9%提高至55.9%。在品质圈范围内,团队精神、沟通协调能力和解决问题的能力均有明显提高。结论实施品质圈活动,提高了医院重症监护室医务人员手卫生依从性和质量,加强了医院感染管理整体水平。     

Staff experiences,perceptions of care,and communication in the intensive care unit during the COVID-19 pandemic in Australia

BackgroundIn 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission.AimThe aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale.MethodsThis was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis.FindingsFour major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods.ConclusionThe results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.     

新型冠状病毒肺炎院内感染防控规范化培训方案的制订与实施

目的 制订综合医院新型冠状病毒肺炎院内感染防控规范化培训方案,并评价其效果。方法 培训对象为医护人员和医辅人员。组建职责明确的工作团队、制订个性化的培训内容,采用线上为主、线下为辅的培训方式,对培训效果进行多种形式的追踪与评估。结果 实施规范化培训方案7 d后,医护人员院内感染防控知识得分从（69.02±13.21）分上升至（88.49±10.57）分; 医辅人员院内感染防控知识得分从（62.38±13.05）分上升至（75.86±12.19）分,差异均有统计学意义（P< 0.05）。督查人员现场提问回答正确率由82.69%提升至92.31%、外科口罩佩戴规范率由85.36%提升至92.86%,手卫生正确率由92.31%提升至96.30%。结论 综合医院新型冠状病毒肺炎院内感染防控规范化培训方案有效提高了医护人员和医辅人员院内感染防控知识、口罩佩戴规范率和手卫生正确率。     

优质护理管理在控制医院感染中的作用

目的：探讨优质护理管理在控制医院感染中的临床效果。方法我院于2012年4月在全院实行控制医院感染的优质护理管理,对优质护理实施前后2年间医院感染率、医院环境卫生合格率、医护人员手卫生的依从性监测指标进行对比分析,了解实施效果。结果优质护理实施后,医院感染率下降0.67％,医院环境卫生合格率提高0.94％,医护人员手卫生执行率提高8.92％。结论优质护理管理在控制医院感染率、提高医疗质量中具有明显的作用。     

浅谈手卫生与儿童重症监护病房医院感染率及三管感染率的相关性

目的探讨手卫生与儿童重症监护病房(PICU)医院感染率及三管感染率的相关性。方法选择2017年4月至2019年9月我院儿内二科PICU医护人员与所有患儿为研究对象。观察调查期间各季度医院感染、三管感染发生情况及医护人员手卫生依从率、正确率与合格率;分析医护人员手卫生与PICU医院感染率、呼吸机相关肺部感染率的相关性。结果我院2017年4月至2019年9月PICU医院感染率在0~9.91%,2017年第三季度、2018年第一季度医院感染率最突出;呼吸机相关肺部感染在2017年第三季度明显增加;PICU医护人员手卫生依从率在68.57%~92.83%,正确率在81.98%~92.95%,合格率在79.07%~91.67%。相关性分析结果显示,医护人员手卫生依从率与PICU医院感染率、呼吸机相关肺部感染率均有显著的负相关性(P<0.001)。结论医护人员手卫生依从性与PICU医院感染率、呼吸机相关肺部感染率有显著的负相关性,严格执行手卫生可明显降低医院感染率与三管感染率。     

应用PDCA模式对改善儿科护理人员洗手依从性及医院感染发生率的影响

目的 探讨应用PDCA模式对改善儿科护理人员洗手依从性以及医院感染发生率的影响。 方法 2014年8月-2015年7月将PDCA循环模式应用于儿科护理人员手卫生管理,比较实施前后儿科护理人员洗手依从性和医院感染发生率。 结果 实施PDCA模式后,儿科护理人员的手卫生知识考试及格率,接触患儿前后、脱手套后、无菌操作前后的洗手率明显高于实施前;接触患儿体液前后的洗手率比较,差异无统计学意义;护理人员洗手依从性逐渐提高,医院感染发生率逐渐下降。 结论 应用PDCA模式可提高儿科护理人员的洗手依从性,降低医院感染的发生率。     

动态环境卫生学监测在多重耐药菌预防与控制工作中的应用

目的评价动态环境卫生学监测在多重耐药菌预防与控制工作中的应用,以提高医院感染的管理。方法通过对各种动态环境卫生学采样结果进行分析,对手卫生设施、手卫生依从性、手卫生细节、接触隔离、减少设备共用、环境清洁等方面进行干预。结果有效改善了手卫生设施,提高了医务人员手卫生的依从性及预防与控制多重耐药菌各项措施的执行。结论正确恰当的使用动态环境卫生学监测,能更好的融洽管理者与被管理者的关系,太大提高医务人员的执行力,是医院感染管理工作的一个有益探索。     

An observational study of hand hygiene compliance in paediatric wards

Aims and objectives. To measure healthcare workers’, children’s and visitors’ hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Background. Children are especially vulnerable to healthcare‐associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. Design. This was an observational study. Method. We measured hand hygiene compliance over an eight‐hour period in two hospital wards using the ‘five moments of hand hygiene’ observation tool. We monitored a total of 407 hand hygiene opportunities. Results. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p < 0·001), with compliance before child contact 90% (140/155); after child contact 78% (89/114); after body fluid exposure 75% (3/4); and after surroundings contact 36% (15/42). For healthcare workers and visitors, there was no evidence of an association between time of day and their hand hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p < 0·05). Conclusion. Owing to the nature of the clinical environments, we are unable to draw conclusions about children’s hand hygiene compliance; however, visitors’ compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Relevance to clinical practice. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers.     

ICU和非ICU护士手卫生现状的调查分析

目的:了解我院ICU及非ICU护士手卫生现状及影响因素,为研究防治对策提供科学依据。方法:采用问卷调查法对32名ICU护士和33名非ICU护士进行消毒灭菌定义、标准预防、接触隔离、六步洗手法、卫生洗手要点、快速手消毒剂、手卫生指征等相关知识进行调查,并随机抽查部分ICU护士手卫生质量。结果:医院护士手卫生知识知晓率普遍偏低,洗手时机的掌握程度不够,医院护士洗手质量监测结果均达不到院感质控要求,但ICU护士对手卫生知识的掌握程度要好于非ICU护士。结论:手卫生的认知不够影响医院护士洗手的依从性。     

Hand Hygiene in Emergency Medical Services

Abstract

Background. Hospital-acquired infections (HAIs) affect millions of patients annually (World Health Organization. Guidelines on Hand Hygiene in Healthcare. Geneva: WHO Press; 2009). Hand hygiene compliance of clinical staff has been identified by numerous studies as a major contributing factor to HAIs around the world. Infection control and hand hygiene in the prehospital environment can also contribute to patient harm and spread of infections. Emergency medical services (EMS) practitioners are not monitored as closely as hospital personnel in terms of hand hygiene training and compliance. Their ever-changing work environment is less favorable to traditional hospital-based aseptic techniques and education. Methods. This study aimed to determine the current state of hand hygiene practices among EMS providers and to provide recommendations for improving practices in the emergency health services environment. This study was a prospective, observational prevalence study and survey, conducted over a 2-month period. We selected participants from visits to three selected hospital emergency departments in the mid-Atlantic region. There were two data components to the study: a participant survey and hand swabs for pathogenic cultures. Results. This study recruited a total sample of 62 participants. Overall, the study revealed that a significant number of EMS providers (77%) have a heavy bacterial load on their hands after patient care. All levels of providers had a similar distribution of bacterial load. Survey results revealed that few providers perform hand hygiene before (34%) or in between patients (24%), as recommended by the Centers for Disease Control and Prevention guidelines. Conclusion. This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly. Since EMS providers treat a variety of patients and operate in a variety of environments, providers may be exposed to potentially pathogenic organisms, serving as vectors for the exposure of their patients to these same organisms. Proper application of accepted standards for hand hygiene can help reduce the presence of microbes on provider hands and subsequent transmission to patients and the environment.     

精神科住院部新型冠状病毒肺炎疫情防控期间的护理管理

目的 探索医院精神科住院部应对新型冠状病毒肺炎疫情防控的护理管理。方法 精神科住院部在2020年1月21日—2月29日新型冠状病毒肺炎疫情期间,采取严格掌握患者入院指征和严格执行陪护探视制度控制人员聚集;通过体温监测和流行病学筛查关卡设置防止疫情输入;对住院患者进行分区收治、分级防护防范院内交叉感染;制定精神科住院患者疫情排查处置流程、通过首次排查和每日排查进行动态疫情防控;调整住院患者外出转运带送、专科治疗用药、院内外康复管理等工作流程落实防控措施;采取多种形式的疫情防控健康教育和心理支持,严格执行精神科护理风险管理、巡视制度、分级护理等护理核心制度,确保患者安全。结果 精神科住院部日均在床住院患者421例,累计开展新入院及在院患者新型冠状病毒肺炎每日排查16 840例次,排查率为100%,带送患者外出转运506例次,未发现新型冠状病毒肺炎疑似和确诊病例、无院内交叉感染,未发生住院患者自杀自伤、肇事肇祸、擅自离院等护理安全事件。结论 精神科住院部应对新型冠状病毒肺炎疫情防控的护理管理成效明显,具有可操作性。     

《医务人员手卫生规范》实施效果考察

目的调查《医务人员手卫生规范》实施后,本医院医务人员手卫生执行情况。方法采用随机抽样的方法,对本医院临床医务人员手卫生执行率和洗手方法的正确性及其效果进行了调查。结果经过与贯彻手卫生规范前后比较,本医院医务人员手卫生依从性从30.49%提高到51.08%,医务人员六步洗手法正确率从38.18%提高到70.91%,医务人员手卫生质量监测合格率从85.83%提高到94.17%。结论通过贯彻手卫生规范和实施干预措施,医务人员手卫生质量有了明显的提高,医院手卫生设施得到改善,手卫生执行率明显提高。     

新建医院体检中心医院感染预防管理

目的分析新建医院体检中心医院感染的危险因素,探讨预防和管理措施。方法2012年4月-12月对某新建医院体检中心医院感染的危险因素进行分析,制定一系列医院感染防控措施：开展医务人员的知识培训、加强对针刺伤的管理、严格执行消毒灭菌、加强环境卫生管理和实施医疗废物规范分类管理。结果医护人员正确执行无菌技术操作、手卫生依从性提高、医院环境卫生学监测合格、医疗废物分类规范、无1例医院感染和职业暴露发生。结论采取合理的预防和管理措施,可以提高体检中心医务人员医院感染防控意识,有效地预防医院感染的发生。     

医务人员手卫生现状

目的了解本院医务人员手卫生依从性及相关因素的情况,以便改进和提高医务人员手卫生质量。方法采用问卷调查和现场查看的方法,对本院医护工人员手卫生现状进行了调查。结果本医院的医务人员的洗手依从率尚不足50%。临床医生在洗手依从性及洗手正确率等方面明显低于护士。影响医务工人员洗手依从性的原因主要是工作负荷大和手卫生设施不足或使用不便。结论本医院的医务人员洗手依从性较低,需要加强相关法规和技术培训,以提高医务人员手卫生质量。