The Risk Study Of Secondary General Hospitals On Acute Respiratory And Intestinal Infectious Diseases Control

BackgroundsPrevention and control of communicable diseases is an important part of public health, which is also related to the security of people and the whole society. The qualified ability of general hospitals, especially the secondary ones, guarantees that we can deal with acute respiratory and intestinal infectious diseases successfully. The secondary hospitals are mostly responsible for the identification, diagnosis, isolation and treatment of these diseases since the patients will go there for help probably. When amounts of patients get together, the risk of nosocomial infections and the spread of diseases will increase. Once the severity of these communicable diseases goes beyond the capacity of specialist hospital, the secondary general hospitals will also admit these patients. At the same time, the secondary general hospitals are where the critically ill patients are taken care of as well as the research is conducted. However, there is no comprehensive understanding of risks on prevention and control of acute respiratory and intestinal infectious diseases yet, and how to assess and supervise the risks systematically has been a problem of the health administrative department.We will do a cross-sectional survey among the whole secondary general hospitals, and want to analyze the risks in prevention and control of acute respiratory and intestinal infectious diseases by Failure Mode and Effects Analysis (FMEA), and make recommendations on its supervision.MethodsFMEA is used to make assessment on risk in prevention and control of acute respiratory and intestinal infectious disease and work out the risk assessment table. The table is improved by weight assignment according to references. Survey is done among25secondary general hospitals in Hangzhou, and risk analysis is made on the basis of the results.Results1、The risk assessment table on prevention and control of acute respiratory and intestinal infectious disease in secondary general hospitals contains5main indicators which are organization and rules making, sources of infection separating, routes of transmission cutting off, susceptible populations protecting, related training and exercises. And there are16secondary indicators and56tertiary indicators.2、The weight assigned according to references are as follows:sources of infection separating equals0.38, organization and rules making equals0.19, susceptible populations protecting equals0.167, routes of transmission cutting off equals0.162, related training and exercises equals0.105.3、Results of the survey show that the percentage of25hospitals which meet organization and rules making, sources of infection separating, routes of transmission cutting off, susceptible populations protecting, related training and exercises are73.68%,75.57%,90%,80.3%and83.4%, While the top10tertiary indicators are as follows:(1) There is no independent department of infectious diseases;(2) There is no guarantee that susceptible populations are kept away from these disease;(3) The infectious diseases clinic does not meet the requirements;(4) The proportion of infectious diseases staff is unbalanced;(5) No infectious diseases exercises were done last year;(6) There are no adequate methods which aim to protect the staff;(7) There is no dynamic monitoring of disinfection efficacy;(8) There is no disinfection of the patients’excrement and vomit;(9) The laboratory testing ability is incapable;(10)There is no disinfection of rooms related to infectious diseases.4、The average score of112A-level hospitals is83.22(SD=4.57), while the score of142B-level hospitals is74.03(SD=5.03). The difference between them is statistically significant. On organization and rules making, the difference between the average scores is statistically significant with17.31(SD=2.30) of2A-level and12.15(SD=3.46) of2B-level, for most2B-level hospitals do not have independent departments of infectious diseases. On sources of infection separating, the average score of2A-level hospitals is29.68(SD=1.05), while the score of2B-level hospitals is27.57(SD=2.53). The difference between them is statistically significant for many2B-level hospitals do not meet the requirements of the infectious diseases clinic. There are no statistically significant differences on routes of transmission cutting off, susceptible populations protecting, related training and exercises between2A-level and2B-level hospitals.ConclusionsThis study focuses on prevention and control of acute respiratory and intestinal infectious diseases in secondary general hospitals by the means of risk analysis. We establish the evaluation method, assess the risk among secondary general hospitals in Hangzhou, and analyze the existed problems so as to propose the measures that we can take for supervision. The conclusions are as follows:1、FMEA is useful in risk analysis on prevention and control of acute respiratory and intestinal infectious diseases in secondary general hospitals as well as other medical cases.2、To decrease the risk, what we can do first is to improve the ability of preparation, and patients’ diagnosis and separation as early as possible is also important. Besides, we should improve the ability of organization and rules making as well.3、When we refer to supervision, the most important thing is to take more care of2B-level hospitals and those with high risk. Furthermore, we should monitoring the issues as follows:(1) There is no independent department of infectious diseases;(2) There is no guarantee that susceptible populations are kept away from these disease;(3) The infectious diseases clinic does not meet the requirements;(4) The proportion of infectious diseases staff is unbalanced;(5) No infectious diseases exercises were done last year;(6) There are no adequate methods which aim to protect the staff;(7) There is no dynamic monitoring of disinfection efficacy;(8) There is no disinfection of the patients’ excrement and vomit;(9) The laboratory testing ability is incapable;(10)There is no disinfection of rooms related to infectious diseases.