Medical institutions, the last defense line for the medical treatment of coronavirus disease 2019, are crucial to avoid cross-infection in hospitals. And how to reasonably arrange patient visits and achieve early detection, early reporting, early isolation, and early treatment of patients with coronavirus disease 2019 and suspected cases at the same time is an important proposition. After the outbreak of coronavirus disease 2019, West China Hospital of Sichuan University continued to supplement and improve implementation details based on the three-level pre-examination and triage of infectious diseases, and established a three-level pre-inspection and triage management mechanism more suitable for coronavirus disease 2019, and successfully applied it. This article introduces the process and results of this outpatient three-level pre-examination and triage management optimization practice, aiming to provide an experience reference for the outpatient three-level pre-examination and triage in medical institutions.
Objective To construct a quality evaluation index system for healthcare-associated infection (HAI) management, and conduct an empirical evaluation on the quality of HAI management in clinical departments. Methods The literature research method and panel discussion method were adopted to initially form the framework of HAI management quality evaluation index system, and the Delphi method and the analytic hierarchy process were used to establish the index system and determine the weights from January to December 2018. Eight comprehensive evaluation methods, such as osculating value method and technique for order preference by similarity to an ideal solution method, were used to evaluate the quality of HAI management in clinical departments of West China Hospital, Sichuan University in 2018. Kendall’s coefficient of concordance (W) was used to assess the consistency of the results. The clinical departments were ranked by the standardized total scores, which were the means of the normalized scores of the eight methods. Results A quality evaluation index system for HAI management with 3 first-level indicators and 15 second-level indicators was established finally. The results of the eight comprehensive evaluation methods for the quality evaluation of HAI management in 39 clinical departments of West China Hospital, Sichuan University were consistent (W=0.952, χ2=259.800, P<0.001). The standardized total score of Department 18 was 100, which ranked the first place. Conclusion The HAI management quality evaluation index system constructed in this study could be used in clinical departments to evaluate the quality of HAI management in combination with comprehensive evaluation methods.
ObjectiveTo investigate the risk factors for surgical site infection (SSI) in patients after colorectal surgery, in order to provide a basis for regulation and implementation of preventive measures against SSI. MethodsFrom February to December 2012, a targeted surveillance on surgical site infection of "colon resection" and "rectum resection" surgery patients in the Department of Gastrointestinal Surgery was carried out. We analyzed the monitoring data, and explored the occurrence of postoperative SSI. At the same time, by case-control study, both single and multiple regression logistic analyses were performed on the 12 variables such as hypertension, diabetes mellitus duration during operation, America Society of Anesthesiologists score, grade of incision and so on to analyze the risk factors for SSI. ResultsAmong the 535 patients who underwent colorectal resections, 44 had SSI with an infection rate of 8.22%. Multiple logistic regression analysis showed that the length of hospital stay[OR=1.070,95%CI(1.033,1.109), P<0.001]and emergency surgery[OR=6.320,95%CI(1.932,20.669),P=0.002] were independent risk factors for SSI after colorectal resections. ConclusionThere are many risk factors for SSI after colorectal surgery. Through the implementation of targeted surveillance, we can find the main risk factors, which provides a basis for the regulation and implementation of intervention measures against SSI.
ObjectiveTo analyze the status quo, problems and weak points of cleaning compliance in the Intensive Care Unit (ICU), and assess the intervention effects by evaluating the object surface cleaning quality in the ICU. MethodsBetween September 1st and December 1st, 2014, fluorescence marker was used to mark the surfaces of medical instruments and objects in the ward which were supposed to be cleaned by the nursing and cleaning staff. The assessment of cleaning compliance was performed through observing the residual fluorescence. Then, targeted intervention was carried out for situations with a low cleaning compliance. ResultsBefore the intervention, the thorough cleaning rates of medical instruments in the Comprehensive ICU, Neurological ICU (NICU), and Chest ICU were respectively 43.3%, 31.4%, and 23.8%, and the thorough surface cleaning rates for those units in order were 67.1%, 60.5%, and 48.4%, respectively. After the first intervention, the cleaning rate of medical instruments in the Comprehensive ICU was 47.1%, which had no significant change (P=0.345), but the rate in the NICU and Chest ICU reached respectively 65.3% and 35.1%, which was significantly improved (P<0.05). The object surface cleaning rates were 73.3% and 58.1% in the Comprehensive ICU and Chest ICU after the first intervention, and there was no significant difference compared with those before the intervention (P>0.05), but the object surface cleaning rate in the NICU was significantly improved to 85.5% (P<0.05). After the second intervention, the medical equipment cleaning rates were 66.9%, 83.3%, and 57.4%, respectively for those three units, and compared with those before intervention, all the three were significantly improved (P<0.05). The object surface cleaning rates for NICU and Chest ICU were significantly raised to 85.6% and 84.2% (P<0.05), while it was 65.7% in the Comprehensive ICU and was not significantly improved (P=0.767). ConclusionObservation and supervision through a feedback system can raise the cleaning compliance, which is helpful in controlling and preventing nosocomial infection.