Study On The Existing Problem And Countermeasures Of Nosocomial Infection Management In Hemodialysis Room (Center) At The Chongqing Districts

Objective:The purpose of this study is to conduct an empirical investigation in Chongqing on the implementation of national standards and norms about building layout,establishment of the nosocomial infection systems,hand hygiene management,the disinfection and isolation management,nosocomial infections monitoring and prevention and medical waste management of the hemodialysis room(center),to find out the existing problems in the nosocomial infection management at the hemodialysis room(center)and analyze the deep-reason for causing this problem and solve it to promote healthy development of hemodialysis services in Chongqing,ensuring the safety quality of medical services.Method:1.Documentation method: Journal articles,books,government work documents,policy reports and standard guideline related to the weak links of nosocomial infection management in hemodialysis rooms(centers)were collected,analyzed,and summarized.2.Field investigation Method: Through the way of stratified cluster sampling method,a site survey was conducted on 37 hemodialysis rooms(centers)at the Chongqing districts to find out the problems on the implementation of national standards and norms about building layout,establishment of the nosocomial infection systems,hand hygiene management,the disinfection and isolation management,nosocomial infections monitoring and prevention and medical waste management.3.Qualitative Interview Method: Through the interviews with the director or head nurse of the hemodialysis room(center),the staff of the infection section of the medical institution and the staff of the health administrative agency,the possible reasons for the non-compliance of each standard and norm,and the difficulties existing in the supervision work and the direction of solution are understood.Result:1.Building layout: The overall qualified rate of each index was from 75.68% to 94.59%.The qualified rate of the three-zone division,zone identification and special dirt channel setting were the lowest,which all accounted for 75.68%.The qualified rate of the bed distance setting was the highest,which accounted for 94.59%.There was no statistically difference between public and private medical institutions in the qualified rate of each index.2.Establishment of the nosocomial infection systems: All of the establishment rates of nosocomial infection management related work system reached 100%,but the enforceability of some hemodialysis room(center)systems were poor.3.Hand hygiene management: There were 23 hemodialysis rooms(centers)whose hand hygiene facilities(62.16%)equipped,according to the requirements.The overall qualified rate of each facility index was from 81.08% to 97.30%.The qualified rate of the sink setting was the lowest,which accounted for 81.08%.The qualified rate of the preparation of Quickdrying Hand Disinfectant was the highest,which accounted for 97.30%.There was no statistically difference between public and private medical institutions in the qualified rate of each facility index.The qualified rate of strictly following the requirements of hand hygiene and aseptic technique and correctly using the gloves in public medical institutions was 76.92%,which was significantly higher than 27.27% in private medical institutions(P=0.008).4.Disinfection and isolation management: There were 35 hemodialysis rooms(centers)that receive patients with HBV,HCV,syphilis and HIV infectious diseases.And all of them set up isolation dialysis areas according to standards.The overall qualified rate of each disinfection index was from 78.38% to 97.30%.The qualified rate of the article only for one person was the lowest,which accounted for 78.38%.The qualified rate of the correct disinfection of dialysis machine was the highest,which accounted for 97.30%.There was no statistically difference between public and private medical institutions in the qualified rate of each disinfection index.5.Nosocomial infection monitoring and prevention: The overall qualified rate of each index was from 43.24% to 100.00%.The qualified rate of the regular assessment and continuous improvement was the lowest,which accounted for 43.24%.The qualified rate of developing the high quality education training,with planned,recorded,and assessed in public medical institutions was 72.97%,which was significantly higher than 36.36% in private medical institutions(P=0.003).The qualified rates of other indexes were not different between public and private medical institutions.6.Medical waste management: The overall qualified rate of each index was from 86.49% to 100.00%.The qualified rate of the Warning sign setting had the lowest,which accounted for 86.49%.There was no statistically difference between public and private medical institutions in the qualified rate of each index.Conclusion:There are some problems about the nosocomial infection management on hemodialysis rooms(centers)at the districts,such as unreasonable building layout,the low enforceable at the nosocomial infection system,the weakness of hand hygiene management and aseptic operation consciousness,the incomplete measures of the disinfection and isolation,low quality in the nosocomial infection monitoring and irregularity management on the medical waste.It is suggested to improve the system,strengthen supervision,arouse attention and fully learn,so as to ensure that the prevention and control measures of nosocomial infection can be carried out effectively.