县级医疗卫生机构流感大流行防控策略研究

发布时间：2018-07-10 04:13

本文选题：感 + 防控　；参考：《华中科技大学》2009年硕士论文

【摘要】：研究目的: 本研究在总结分析发达国家突发公共卫生事件应急管理体系实践经验的基础上,通过对县级医疗卫生机构的人禽流感/流感大流行应急能力进行调查与评估,发现县级医疗卫生机构应对流感大流行的特点以及存在的突出问题,在此基础上,为进一步完善我国县级医疗卫生机构流感大流行应急管理体系提供科学依据和政策性建议,提高我国流感大流行的应对能力,从而有效保护广大人民的生命财产安全,维护社会的稳定和经济的可持续发展。研究内容与方法: 在文献查阅与情报分析的基础上,进行现场调研,并运用卡方分析、描述性分析等研究方法,对县级医疗卫生机构的流感大流行防控政策与制度、监测与预警体系,临床医疗服务提供能力、资金及应急物资的筹备能力、应急人力资源贮备以及政府和防控相关部门的协作力度等进行分析。研究结果: 1.美国突发公共卫生事件管理体系对我国的启示(1)强烈的危机意识;(2)独立完善的综合应急组织体系;(3)全社会型的联动系统;(4)快捷高效的运作机制。 2.安徽省县级医疗卫生机构流感大流行应急机制初步建立(1)应急机制:93.86%县级卫生行政部门、72.13%县级疾病预防控制中心、26.23%的县政府制定了流感大流行相关应急预案,医疗机构应急预案的制定比例较低,卫生行政部门的人禽流感疫情应急处理预案制定比例最高,达98.36%;同一应急制度,县级与地市级的制定率成正比,不同经济发展地区卫生行政部门制定的人禽流感疫情应急处理预案的差异具有统计学意义(χ2 =5.003, P0.05)。(2)应急组织:所有被调查县均成立了突发公共事件应急领导小组,52.80%的县级卫生局成立了卫生应急指挥中心。22.95%的县政府成立了流感大流行应对领导小组;县级卫生局中50.82%成立了本部门的流感大流行应对领导小组,95.08%成立了本辖区的人禽流感疫情防控领导小组;各类领导小组的设置比例与各类事件发生的频率成正比,与应急预案的制定比例成正比。 3.流感大流行防控队伍规模及技术水平有待进一步提高 (1)人员规模:安徽省县级每千人口卫生技术人员1.76人,低于中部地区(2.15人)及全国平均水平(2.14人);卫生应急人员不足,多数被调查县只能同时派出2个疫情处理小组;当可利用的人力资源不足时,91.67%的县级CDC拟将所有休息的工作人员召回上班,90.16%向上级汇报请求支援。(2)学历:应急人员学历偏低,应急管理人员和应急技术人员均以大专及以下学历为主,约占60%-88%,低于2005年全国平均水平;不同经济发展水平地区卫生应急人员学历水平无显著性差异,县级与地市级之间的差异有统计学意义。(3)人员配置:62.30%的县建立了突发公共卫生事件应急处理专家库/组,不同经济发展水平地区的县与县之间没有没有显著性差异;但是,县与县之间突发各类公共卫生事件调查处理人员的配置数量相差较大。 4.流感大流行疫情监测、预警和现场救治能力弱 (1)现场处置能力:安徽省仅有22.95%的县级CDC能够从事流感快速诊断试剂盒检测,49.18%的县级CDC具有采集鼻咽拭子标本的能力,监测、预警、现场处置能力整体较低;卡方分析发现,应急预案是否建立,领导小组是否设置,区域经济发展水平皆不是影响现场处置能力的关键因素。(2)疫情报告:95.1%的县级CDC均采用卫生部规定的预警指标进行监测报告,县级对流感样病例或流感暴发疫情比较重视。(3)医疗救治能力:休宁县人民医院出院者平均出院日、实际开放床位数、病床使用率和病床周转次数均高于全国县级医院的平均水平,但流感相关急救设备及床位仍远不能满足应对流感大流行的需求。职责分工不同与工作人员的技术水平是影响疫情监测、预警和现场救治能力的关键因素。 5.风险沟通能力建设尚需加强 (1)宣传教育:安徽省各县对公众进行流感/人禽流感的预防与控制的宣传教育主要是发放宣传材料,宣传方式缺乏多样性。(2)应急联络:91.80%的县级CDC设置了专门的突发公共卫生事件联络人,57.38%的县级CDC掌握了突发公共卫生事件应急处理专家组专家的联系方式,掌握率较低。(3)信息发布:只有5个(8.20%)县级CDC有经过授权的专门的信息发布组或指定的发言人对外发布信息。 6.应急保障体系建设有待提高仅24.59%的县政府承诺提供流感大流行准备的资金,96.72%的县配备有现场调查设备,但是90%以上的县级CDC被调查人员认为目前的消毒器材、药品的种类及数量不能满足本辖区应对突发公共卫生事件的需要。是否建立政府领导小组,是应急保障资金足额到位的关键影响因素。 7.培训与演练工作需进一步落实 42.62%县级行政部门或疾病预防控制中心曾组织人禽流感、流感大流行防控预案的演练,且只组织1次,多为卫生部门内部的演练,仅5个县开展了禽流感多部门演练。是否建立政府领导小组,是能否顺利开展多部门演练的关键因素。建议: (1)制定针对性应急预案,开展常规应急演练;(2)建立问责制,确保预案有效执行;(3)科学设置卫生系统领导小组结构,健全应急网络;(4)根据县级特点,强化政府角色;(5)构建政府应急领导小组,促进多部门沟通与协作;(6)合理调整人员结构,优化卫生人力资源;(7)提高危机意识,保障经费与物资储备;(8)丰富宣传培训形式,积极做好风险沟通。
[Abstract]:The purpose of the study is:
On the basis of summarizing and analyzing the practical experience of emergency management system of public health emergencies in developed countries, this study has investigated and evaluated the emergency ability of human influenza / influenza pandemic in county-level medical and health institutions, and found the characteristics and outstanding problems of the county-level medical and health institutions to deal with the influenza pandemic. In order to further improve the emergency management system of the influenza pandemic in our county medical and health institutions, the scientific basis and policy recommendations are provided to improve the coping ability of the influenza pandemic in China, so as to effectively protect the safety of the people's life and property, maintain the stability of the society and the sustainable development of the economy.
Research contents and methods:
On the basis of literature review and information analysis, field research is carried out, and the methods of chi square analysis and descriptive analysis are applied to the policy and system of influenza pandemic prevention and control in county-level medical and health institutions, monitoring and early warning system, the ability to provide clinical medical services, the preparatory capacity of funds and emergency supplies, and emergency human resources reserve. And the collaboration between the government and relevant departments.
The results of the study:
1. American public health emergency management system to our country's Enlightenment (1) strong sense of crisis; (2) an independent and comprehensive comprehensive emergency organization system; (3) the whole social linkage system; (4) efficient and efficient operation mechanism.
2. the emergency mechanism of influenza pandemic in Anhui County medical institutions was initially established (1) emergency mechanism: 93.86% county health administrative departments, 72.13% county centers for Disease Control and prevention, 26.23% of the county government formulated an emergency plan for influenza pandemic, the proportion of emergency plans for medical institutions was low, and human avian influenza in the health administration department The proportion of emergency treatment plan for emergency treatment was the highest, up to 98.36%. The same emergency system was proportional to the formulation rate of county and city level. The difference of emergency treatment plan for avian influenza epidemic situation in different economic development areas was statistically significant (x 2 =5.003, P0.05). (2) emergency organization: all the counties under investigation were set up The county government of 52.80% of the County Health Bureau set up.22.95% of the health emergency command center set up the leadership group for influenza pandemic, 50.82% of the County Health Bureau set up the Department's influenza pandemic response leadership group, and 95.08% set up the leadership group of the human avian influenza epidemic prevention and control in this area. The proportion of the leading group is directly proportional to the frequency of various events, and is directly proportional to the proportion of contingency plans.
3. influenza pandemic prevention and control team size and technical level to be further improved.
(1) personnel size: 1.76 people per 1000 population of health technology at the county level in Anhui Province, lower than the central region (2.15) and the national average (2.14 people); health emergency personnel are insufficient, most of the counties investigated can only send 2 treatment groups at the same time; when the available human resources are insufficient, 91.67% of the county-level CDC will take all rest staff Recall to work, 90.16% to the superior report request support. (2) education: emergency personnel with low educational background, emergency management personnel and emergency technical personnel are junior college and below, accounting for 60%-88%, lower than the national average level in 2005; the level of health emergency personnel in different economic development level has no significant difference, county and city level There were significant differences in the differences. (3) staffing: 62.30% of the county established an emergency treatment expert bank / group for public health emergencies, and there was no significant difference between counties and counties in different economic development levels. However, there was a large difference in the number of staffs in the county and county.
4. influenza pandemic surveillance, early warning and on-site treatment capacity is weak.
(1) on-site disposal ability: only 22.95% of the county CDC in Anhui can do the detection of rapid influenza diagnostic kits, 49.18% of the county level CDC has the ability to collect nasopharyngeal swabs, monitoring, early warning, and the overall capacity of the on-site disposal is low; the chi square analysis found whether the emergency plan was established, whether the leadership group was set up, the regional economic development level None of the key factors that affect the ability of site disposal. (2) report of the epidemic: 95.1% of the county CDC were monitored by the early warning indicators prescribed by the Ministry of health, the county-level convective cases or influenza outbreaks were paid more attention. (3) the medical treatment ability: the average discharge day of the discharged patients in the Xiuning County People's Hospital, the actual open bed number, the sick bed The rate of use and the turnover of sickbeds were all higher than the average level of the county hospitals in China, but the flu related emergency equipment and beds were still far from meeting the demand for the pandemic. The division of responsibilities and the technical level of the staff were the key factors affecting the monitoring, early warning and on-site treatment.
5. the construction of risk communication capacity needs to be strengthened
(1) publicity and education: the publicity and education of influenza / human avian influenza prevention and control in the counties of Anhui province is mainly dissemination of publicity materials, and the publicity method is lack of diversity. (2) emergency liaison: 91.80% of the county CDC set up special public health emergency liaison people, 57.38% of the county CDC has mastered emergency public health emergency emergency response. Dealing with experts in the expert group, the rate of mastery is low. (3) information release: only 5 (8.20%) County CDC has an authorized special information release group or a designated speaker to release information.
6. the construction of emergency security system needs to be improved
Only 24.59% of the county government promises to provide funds for influenza pandemic preparations, and 96.72% of the counties are equipped with on-site investigation equipment, but more than 90% of the county CDC investigators believe that the current disinfection equipment, the types and quantities of drugs can not meet the needs of the district in response to public health emergencies. The key factors that guarantee the full amount of funds in place.
7. training and rehearsal need to be further implemented
42.62% the county administrative departments or the Centers for Disease Control and prevention have organized the practice of avian influenza, influenza pandemic prevention and control plan, and only organized 1 times, mostly in the health department, and only 5 counties have carried out the multisectoral training of avian influenza. Whether to establish the government leadership group is the key factor for the smooth development of the multi sector exercise.
Suggestion:
(1) formulate specific emergency plans, carry out routine emergency rehearsal; (2) establish accountability system to ensure the effective implementation of the plan; (3) set up the structure of the leadership group of the health system and improve the emergency network; (4) strengthen the role of the government according to the characteristics of the county level; (5) the emergency leadership group of Gou Jianzheng government, promote multi department communication and cooperation; (6) adjust the structure of personnel reasonably, (6) Optimizing health human resources; (7) raising awareness of crisis and ensuring reserves of funds and materials; (8) enriching propaganda and training forms, and actively doing well in risk communication.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R184

【参考文献】