目的 构建并应用疫情常态化下病区陪护封闭式管理的有效方案,在保障患者陪护需求基础上有效预防院内交叉感染。方法 通过分析疫情管控中存在的问题,制订针对性方案。启用人脸录入、电子陪客证、双向门禁系统及出入扫码登记系统对陪护进行封闭式闭环管理,辅以院前教育、住院期间监管、后勤物资支持及出院服务落实。统计方案实施前及实施后3个月、6个月的陪护率、日均陪护外出率、人均外出时间、出入闭环率、单日陪护管理时数,对比实施前后效果;同时比较实施前、后11个月的患者满意度及病房环境质控得分。结果 方案实施后3个月陪护率下降15.72%;双陪护率下降77.8%;日均外出率下降36.6%;人均外出时间缩短19.7 min;陪护出入闭环率提升30.1%;单日陪护管理时数缩减17.6 min,与实施前相比差异无统计学意义（P<0.05）。方案实施6个月陪护率下降9.90%;双陪护率下降为0;日均外出率下降44.8%;人均外出时间缩减13.0 min;闭环率为100%;单日陪护管理时数缩减26.6 min,与实施前相比差异均具有统计学意义（P<0.05）。未出现院内交叉感染事件。病房环境和患者满意度在实施前后差异无统计学意义（P>0.05）。结论 疫情常态化下,病区实施陪护封闭式闭环管理方案切实可行,能有效降低陪护率、减少陪护流动、预防院内交叉感染。
Objective To explore the best caregivers management scheme of general wards under the normalization of the epidemic situation,and to effectively prevent nosocomial cross-infection on the basis of ensuring the caregivers needs of patients. Methods We formulated the targeted plan by analyzing the problems existing in the epidemic control. Face input,electronic caregivers card,double access control system and access scanning and registration system were used to carry out closed closed-loop management of caregivers,supplemented by pre-hospital education,supervision during hospitalization,logistics and material support and discharge services implementation. Compared the caregiver rate,average daily caregivers rate,per capita exit time,access closed-loop rate,daily caregiver management hours before and 3 month,6 month after implementation. Compared the patient satisfaction and the quality control score of ward environment 11 months before and after implementation of the plan. Results The caregivers rate decreased by 15.72%,the double caregivers rate decreased by 77.8%,the average daily caregivers rate decreased by 36.6%;the per capita caregivers exit time decreased by 19.7 min,the closed loop rate increased by 100%,daily caregivers management time decreased by 17.6 min 3 month after the implementation of the scheme. There were significantly differences before and after implementation（P< 0.05）. After 6 month of the program,the caregivers rate decreased by 9.90%,the double caregivers rate decreased by 0,the average daily caregivers rate decreased by 44.8%;the per capita caregivers exit time decreased by 13.0 min;the closed-loop rate was 100%;the daily caregivers management time decreased by 26.6 min compared with those before implementation（P< 0.05）. No nosocomial cross-infection events occurred. Ward nursing environment scores and patient satisfaction had no statistical differences before and after the implementation（P> 0.05）. Conclusion The implementation of the closed caregivers closed-loop management scheme in the general ward under the normal epidemic situation is feasible,which can effectively reduce the caregiver rate,reduce the flow of caregivers,prevent the hospital cross-infection.
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