Evaluation on the risk management effect of cluster infectious disease in schools of Jingzhou
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摘要:
目的 评价学校传染病聚集性疫情防控风险管理效果，为进一步完善风险管理重点、策略和方法提供科学依据。 方法 对荆州市沙市区92所学校开展为期2年的传染病聚集性疫情防控风险管理，通过健全组织管理和规章制度、强化学校日常卫生管理、督导传染病防控措施落实，加强培训及指导等方式，分别于风险管理前、后进行现场调查，将荆州市未开展风险管理的其他7个县区学校作为外对照，评估风险管理效果。 结果 实施风险管理2年后，学校传染病聚集性疫情防控的组织管理、日常卫生管理、防控措施各方面的落实率均较风险管理前提高6.5~45.7百分点；中、低风险学校所占比例分别上升19.6，5.4百分点，高风险学校所占比例下降25.0百分点(Z=7.41，P < 0.01)；沙市区92所学校传染病聚集性疫情的年发生率下降23.9百分点，与同期未开展风险管理的荆州市其他县市区相比，所占比例下降趋势明显(χ趋势2=18.17，P＜0.01)。 结论 有针对性地开展风险管理能有效提高学校传染病聚集性疫情防控措施落实率，降低风险等级，减少聚集性疫情发生。 Abstract:Objective To evaluate the effect of risk management on cluster infectious disease prevention and control in schools, and to provide a scientific basis for the further development of its methods and strategies. Methods A two-year risk management program of cluster infectious disease control and prevention in 92 schools was carried out in urban area of Jingzhou. In the process of intervention, comprehensive measures were implemented, such as improving organizational management and rules, strengthening routine hygiene management, supervising the implementation of epidemic prevention and control measures, increasing training and guidance. On-site investigation was conducted to evaluate the risk management effects before and after the risk management, with the other 7 counties of Jingzhou having got no risk management chosen as the control group. Results Through two-year risk management, the implementation rate covering all aspects regarding cluster infectious disease prevention and control were 6.5-45.7 percentage point higher than that before. The proportion of low and medium risk school increased by 19.6 and 5.4 percentage point, respectively, while the proportion of high-risk schools decreased by 25.0 percentage point(Z=7.41, P < 0.01). The annual incidence of clustered infectious diseases in 92 schools decreased by 23.9 percentage point. Compared with other counties in Jingzhou City, the trend of decline was significant(χ2=18.17, P < 0.01). Conclusion Risk management can effectively improve the implementation rate of prevention and control measures regarding epidemic disease in schools, reduce risk severity, and decrease the incidence of cluster infectious diseases. -
表 1 传染病聚集性疫情防控风险管理措施实施前后不同学段学校落实率比较/%
Table 1. Comparison of the implementation rate of risk management measure about cluster infection diseases before and after risk management in different schools/%
管理措施 托幼机构(n=48) 小学(n=29) 中学(n=15) 干预前 干预后 干预前 干预后 干预前 干预后 组织管理 成立传染病防控领导小组 62.5 85.4 72.4 86.2 53.3 86.7 有专(兼)职保健老师 31.2 47.9 41.3 65.5 46.7 66.7 制定并完善“两案九制” 16.7 62.5 27.6 72.4 33.3 80.0 日常卫生管理 有足够数量方便洗手的水龙头 60.4 85.4 37.9 69.0 33.3 66.7 学生养成良好洗手习惯 47.9 68.8 31.0 41.4 46.7 60.0 每学期更换直饮水滤芯 29.2 58.3 33.3 55.6 20.0 60.0 食堂有“三防”设施 77.1 87.5 72.0 88.0 71.4 92.9 防控措施落实 严格落实晨午检 77.1 93.8 44.8 79.3 26.7 66.7 发现疑似聚集性疫情及时报告 52.1 81.3 34.5 69.0 33.3 66.7 教室每日开窗通风 58.3 72.9 31.0 55.2 40.0 73.3 学生呕吐物先消毒后清扫 25.0 64.6 27.6 58.6 33.3 53.3 严格落实预防接种证查验 79.2 87.5 37.9 69.0 — — 完成全程接种儿童比例 87.5 93.8 79.3 86.2 — — 培训及指导 保健老师每年接受传染病防治培训至少1次 35.4 81.3 27.6 79.3 46.7 80.0 定期对学生开展传染病防治知识健康教育 37.5 83.3 51.7 86.2 53.3 86.7 定期对家长开展传染病防治知识健康教育 14.6 58.3 17.2 51.7 26.7 46.6 注：每学期更换直饮水滤芯、食堂有“三防”措施分别抽样38，87份。 
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表 2 传染病聚集性疫情防控风险管理措施实施前后不同地区学校落实率比较/%
Table 2. Comparison of the implementation rate of risk management measure about cluster infection diseases before and after risk management in schools of different regions/%
管理措施 城市(n=62) 乡镇及郊区(n=30) 总体(n=92) 干预前 干预后 干预前 干预后 干预前 干预后 χ2值 P值 组织管理 成立传染病防控领导小组 72.6 88.7 46.7 80.0 64.1 85.9 11.59 ＜0.01 有专(兼)职保健老师 46.8 71.0 16.7 26.7 37.0 56.5 7.07 0.01 制定并完善两案九制 24.2 72.6 20.0 60.0 22.8 68.5 38.64 ＜0.01 日常卫生管理 有足够数量方便洗手的水龙头 54.8 80.6 36.7 70.0 48.9 77.2 15.77 ＜0.01 学生养成良好洗手习惯 46.8 64.5 33.3 46.7 42.4 58.7 4.89 0.03 直饮水滤芯每学期更换 33.3 63.3 12.5 37.5 28.9 57.9 6.48 0.01 食堂有“三防”设施 80.7 93.0 63.3 80.0 74.7 88.5 4.53 0.03 防控措施落实 严格落实晨午检 64.5 88.7 46.7 76.7 58.7 84.8 15.44 ＜0.01 发现疑似聚集性疫情及时报告 46.8 79.0 36.7 66.7 43.5 75.0 18.93 ＜0.01 教室每日开窗通风 48.4 72.6 43.3 56.7 46.7 67.4 8.01 0.01 学生呕吐物先消毒后清扫 32.3 64.5 16.7 53.3 27.2 60.9 21.19 ＜0.01 严格落实预防接种证查验 60.0 80.0 70.4 81.5 63.6 80.5 5.45 0.02 完成全程接种儿童比例 84.0 90.0 85.2 92.6 84.4 90.9 1.50 0.22 培训及指导 保健老师每年接受传染病防治培训至少1次 40.3 82.3 23.3 76.7 34.8 80.4 39.26 ＜0.01 定期对学生开展传染病防治知识健康教育 46.8 85.5 40.0 83.3 44.6 84.8 32.57 ＜0.01 定期对家长开展传染病防治知识健康教育 19.4 59.7 13.3 43.3 17.4 54.3 27.31 ＜0.01 注：每学期更换直饮水滤芯、食堂有“三防”措施分别抽样38，87份。
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表 3 不同学段学校传染病风险管理前后聚集性疫情风险等级分布比较
Table 3. Comparison of risk level distribution of cluster infection disease before and after risk management in different schools
学段 干预前后 低 中 高 Z值 P值 托幼机构 干预前 7(14.6) 20(41.7) 21(43.8) 4.43 ＜0.01 (n=48) 干预后 20(41.7) 21(43.7) 7(14.6) 小学 干预前 4(13.8) 8(27.6) 17(58.6) 5.04 ＜0.01 (n=29) 干预后 6(20.7) 9(31.0) 14(48.3) 中学 干预前 1(6.7) 5(33.3) 9(60.0) 3.21 ＜0.01 (n=15) 干预后 4(26.7) 8(53.3) 3(20.0) 注： ()内数字为构成比/%。
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表 4 不同地区学校传染病风险管理前后聚集性疫情风险等级分布比较
Table 4. Comparison of risk level distribution of cluster infections disease risk before and after risk management in different areas
地区 干预前后 低 中 高 Z值 P值 城市 干预前 8(12.9) 25(40.3) 29(46.8) 6.11 ＜0.01 (n=62) 干预后 20(32.3) 24(38.7) 18(29.0) 乡镇及郊区 干预前 4(13.3) 8(26.7) 18(60.0) 4.22 ＜0.01 (n=30) 干预后 10(33.3) 14(46.7) 6(20.0) 合计 干预前 12(13.0) 33(35.9) 47(51.1) 7.41 ＜0.01 (n=92) 干预后 30(32.6) 38(41.3) 24(26.1) 注： ()内数字为构成比/%。
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