天津市中小学校传染病防控风险评估与控制

孙华君; 兰琨熠; 张馨月; 马乐萌; 魏可帅; 张雅欣; 杜汋

doi:10.16835/j.cnki.1000-9817.2022.04.032

天津市中小学校传染病防控风险评估与控制

doi: 10.16835/j.cnki.1000-9817.2022.04.032

1.
天津医科大学公共卫生学院/天津市基本公共卫生服务质量控制中心, 天津 300070
2.
天津医科大学护理学院
3.
天津医科大学眼科医院病案管理科

基金项目: 天津市哲学社会科学规划智库项目

详细信息

作者简介:
孙华君(1998-), 男, 天津市人, 在读硕士, 主要研究方向为卫生政策与医疗机构、公共卫生与预防医学

通讯作者:
杜汋, E-mail: duyue@tmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R183 G478 R179
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-17
- 修回日期: 2021-10-18
- 网络出版日期: 2022-04-25
- 刊出日期: 2022-04-25

Risk assessment and control of infectious disease prevention and control in elementary and secondary schools in Tianjin

1.
School of Public Health, Tianjin Medical University/Tianjin Basic Public Health Service Quality Control Center, Tianjin (300070), China

摘要

摘要: 目的建立天津市中小学校传染病防控风险评估体系，通过风险评估与控制，降低传染病防控风险，为中小学校传染病防控工作提供科学的参考依据。方法基于失效模式和效应分析方法，对天津市45所中小学校进行传染病防控风险定量评估，查找风险点，优化督导方式，并对控制效果进行评价，以此实现中小学校传染病防控工作质量持续改进。结果天津市中小学校传染病防控发生率最高的3个风险点依次为未按规定配备卫生专业技术人员(82.22%)、洗手池无洗手液或消毒剂(35.56%)、未索取涉水产品卫生许可批件(28.89%)。天津市中小学校传染病防控风险评估结果表明，风险优先指数(risk priority number, RPN)最高的3个风险点依次为未按规定配备卫生专业技术人员(144)、未按规定进行晨午检(126)、晨午检内容不全面(126)。对可探测度≥7分的风险点优化督导措施后，再次进行定量风险评估，发现全部风险点优化督导措施后的RPN值均下降至125以下，说明控制效果良好。结论基于失效模式和效应分析方法，建立中小学校传染病防控风险评估体系并定期进行风险评估，可及时发现传染病防控风险，精准防控，保障中小学校师生身体健康。
- 卫生人员 /
- 传染病控制 /
- 结果评价(卫生保健) /
- 消毒
Abstract: Objective To establish a risk assessment system for the prevention and control of infectious diseases in primary and secondary schools in Tianjin and reduce the risk of infectious disease prevention and control through risk assessment and control. Methods Based on the failure modes and effect analysis method, a quantitative risk assessment of infectious disease prevention and control in 45 primary and secondary schools in Tianjin was carried out. Risk-based supervisory process was assessed, while control effect was evaluated for contined improvement in the prevention and control of infectious diseases in the primary and secondary schools. Results The top three risk aspects found in the infectious disease prevention and control system in primary and secondary schools in Tianjin included failure to provide sanitation professionals (82.22%) in accordance with regulations, no hand sanitizer or disinfectant (35.56%) in wash basins, and drinking water-related products without approval (28.89%). The results of the risk assessment indicated that the three risk aspects with the highest risk priority number (RPN) included failure to provide health professionals(n=144), no morning and afternoon inspection arrangement(n=126), and low quality of morning and afternoon inspections(n=126). After optimizing the supervision measures for the risk aspects with a detectable degree≥7 points, a quantitative risk assessment was carried out again, the RPN values of all risk points fell below 125, indicating reasonable control effect. Conclusion Based on the failure mode and effect analysis method, the establishment of a risk assessment system for the prevention and control of infectious diseases in primary and secondary schools and regular risk assessments can timely detect risk aspects in the infectious disease prevention and control, to promote effective prevention of infectious diseases in schools.
- Health personnel /
- Communicable disease control /
- Outcome assessment(health care) /
- Disinfection
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 天津市中小学校传染病防控风险发生情况(n=45)

Table 1. The occurrence of infectious disease prevention and control risks in primary and secondary schools in Tianjin(n=45)

潜在失效模式	风险点	发生数量	发生率评分	严重度评分	可探测度评分	风险优先指数
健康教育制度落实不到位	未按规定对学生进行健康教育	0	1	1	7	7
	未按规定对教师进行健康教育	0	1	1	7	7
	未按规定对学生家长进行健康教育	0	1	7	7	7
晨午检制度落实不到位	未按规定进行晨午检	5(11.11)	2	9	7	126
	晨午检内容不全面	5(11.11)	2	9	7	126
	晨午检发现异常未及时报告	0	1	9	10	90
因病缺课登记、追踪制度落实不到位	未按规定对因病缺课学生进行登记	3(6.67)	1	9	8	72
	未按规定对因病缺课学生进行追踪	0	1	9	8	72
健康管理制度落实不到位	未按规定做好学生体检	0	1	2	7	14
	体检项目不全	0	1	2	7	14
	学生体检结果未评价或反馈	0	1	2	7	14
	学生体检机构无资质	1(2.22)	1	2	7	14
	教职员工在传染期内从事教职工作	0	1	10	10	100
生活饮用水卫生管理制度落实不到位	未每层设饮水处	1(2.22)	1	1	5	5
	饮水处水嘴不足	0	1	1	6	6
	未索取涉水产品卫生许可批件	13(28.89)	3	6	3	54
	未进行水质检测	1(2.22)	1	6	7	42
	未定期对涉水产品水嘴清洗消毒	3(6.67)	1	4	7	28
	未定期对涉水产品水箱内部清洗消毒	2(4.44)	1	5	7	35
	未定期更换滤芯	1(2.22)	1	5	7	35
	生活饮用水水源与厕所间距不足	6(13.33)	2	6	5	60
厕所卫生管理制度落实不到位	未每层设厕所	0	1	1	5	5
	厕所蹲位或小便槽数量不足	0	1	1	6	6
	洗手池数量不足	0	1	5	6	30
	洗手池无洗手液或消毒剂	16(35.56)	4	4	5	80
	洗手池使用公用毛巾	1(2.22)	1	4	5	20
	厕所未设污水池	0	1	6	5	30
	厕所未安置排气管道	0	1	6	5	30
物资储备制度落实不到位	物资储备数量不足	0	1	2	4	8
	物资储备种类不全	0	1	2	3	6
	物资超过有效期限	1(2.22)	1	2	3	6
	消毒产品未索取评价报告	1(2.22)	1	6	3	18
通风消毒制度落实不到位	未按规定进行通风换气	10(22.22)	3	3	8	72
	未按规定进行清洗消毒	11(24.44)	3	3	8	72
	消毒方法有误	1(2.22)	1	4	8	32
卫生室建设不达标	未按规定配备卫生专业技术人员	37(82.22)	9	2	8	144
	卫生专业技术人员或保健教师培训不足	0	1	2	7	14
	卫生室建设面积不足	0	1	2	6	12
	卫生室基本设备缺乏	0	1	2	5	10
	卫生室未设在首层	1(2.22)	1	2	5	10
	卫生室违规处方药品	4(8.89)	1	10	6	60
注：( )内数字为发生率/%；发生数量以发现的风险点为准，由于一些风险点具有隐蔽性，实际发生的风险点数量可能高于实际发现的风险点数量。

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表 2 天津市中小学校传染病防控风险控制效果评价

Table 2. Evaluation of the effect of risk control on infectious disease prevention and control in primary and secondary schools in Tianjin

风险点	优化督导前		优化督导后
风险点	可探测度评分	风险优先指数	可探测度评分	风险优先指数
未按规定对学生进行健康教育	7	7	3	3
未按规定对教师进行健康教育	7	7	3	3
未按规定进行晨午检	7	126	3	54
晨午检内容不全面	7	126	3	54
晨午检发现异常未及时报告	10	90	3	27
未按规定对因病缺课学生进行登记	8	72	3	27
未按规定对因病缺课学生进行追踪	8	72	3	27
未定期对涉水产品水嘴清洗消毒	7	28	3	12
未按规定进行通风换气	8	72	3	27
未按规定进行清洗消毒	8	72	3	27
消毒方法有误	8	32	3	12
未按规定配备卫生专业技术人员	8	144	3	54

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