Risk assessment-driven optimization of dressing change nursing in neurosurgery and analysis of the effectiveness of hospital infection prevention and control
风险评估驱动的神经外科换药护理优化与院感防控成效分析

摘要

目的 在神经外科换药护理场景中，根据风险评估来创建护理流程优化方案，并且评价优化前后换药护理合格率和院感、多重耐药菌（MDRO）发生率变化。方法 用科室换药护理抽查表为过程指标来源、科室院感/MDRO月度监测表为结果指标来源，按照优化前（3-6月）和优化后（8-11月）进行对比，12月作为干预后观察期。用两比例χ²检验和计算相对危险度（RR）和95%的置信区间。结果 经过优化后的换药护理合格率从原来的69.81%提高到现在的92.31%，差异有统计学意义（P＜0.001）；院内感染发生率由原来的1.72%降到现在的0.96%，没有达到统计学上的显著性差异（P=0.066），但是12月份降到了0.57%；MDRO发生率由原来的1.09%降到现在的0.62%（P=0.255），12月份为0.57%。结论 在本病区的情境之下，风险评估驱动下的换药护理流程优化和过程指标有明显改善、院感/MDRO指标降低的方向是一致的；由于研究属于前后对照观察，还需要控制混杂因素，并延长随访来证实。

Abstract

Objective To formulate an optimization scheme for nursing processes based on risk assessment in the scenario of dressing change nursing in neurosurgery, and to evaluate the changes in the qualification rate of dressing change nursing as well as the incidence rates of hospital-acquired infection (HAI) and multidrug-resistant organism (MDRO) before and after the optimization.
Methods The random inspection form for dressing change nursing of the department was used as the source of process indicators, and the monthly monitoring form for HAI/MDRO of the department was taken as the source of outcome indicators. A comparative analysis was conducted between the pre-optimization period (March-June) and the post-optimization period (August-November), with December set as the post-intervention observation period. The chi-square test for two proportions was adopted, and the relative risk (RR) and 95% confidence interval (95%CI) were calculated.
Results After optimization, the qualification rate of dressing change nursing increased significantly from 69.81% to 92.31%, with a statistically significant difference (P<0.001). The incidence rate of HAI decreased from 1.72% to 0.96%, without reaching a statistically significant difference (P=0.066), while it dropped to 0.57% in December. The incidence rate of MDRO decreased from 1.09% to 0.62% (P=0.255), and was 0.57% in December.
Conclusion   In the context of this neurosurgery ward, risk assessment-driven optimization of the dressing change nursing process leads to a significant improvement in process indicators, which is consistent with the downward trend of HAI and MDRO indicators. Due to the nature of this study as a before-after controlled observation, it is necessary to control confounding factors and extend the follow-up period to verify the above conclusions.