目的 运用Kirkpatrick评估模型评价医院感染知识培训项目的 效果,以期逐步提高医院感染知识培训质量.方法 结合问卷调查、现场调查及专家访谈法,运用Kirkpatrick四层次评估模型,对开展的新职工医院感染知识培训效果进行评估.结果 共192名学员参加新职工培训,问卷回收率为100%.其中医生与技术人员(简称医技人员)132名(68.75%),护理人员60名(31.25%);培训学员总体满意度达89.41%.培训人员培训后成绩为(83.43±5.56)分,较培训前的(54.22±5.13)分显著提高(t=54.15,P<0.001);年终考核成绩为(82.38±4.28)分,与培训后成绩(83.43±5.56)分比较,差异有统计学意义(t=2.16,P=0.03),年终考核成绩较培训后考核成绩下降1.05分.两两比较医技人员、护理人员培训前后对医院感染各知识点的掌握情况,除"医院清洁、消毒灭菌与隔离"以及"无菌操作技术"知识点,两者得分差异无统计学意义外,其余各知识点得分差异均有统计学意义(均P＜0.05);分别比较医技人员、护理人员培训后和年终考核各知识点得分情况,大部分知识点得分都有所下降(均P＜0.05),其中医技人员对"手卫生"和"职业安全"的掌握下降幅度较大,护理人员对"细菌耐药机制、抗菌药物合理应用" 的掌握下降幅度较大.结论 Kirkpatrick四层次评估模型能客观反映培训的内部和外部效果,此次培训短期效果显著,长期效果不明显.可通过多种措施完善培训模式,建立系统化、结构化评估体系,提高培训质量.%Objective To evaluate the epidemiological characteristics and related risk factors for surgical site infection (SSI) , so as to propose intervention measures. Methods Medical records of 25 228 surgery patients who were discharged between January 2009 and September 2011 were surveyed retrospectively, distribution of healthcare-associated infection(HAI), influencing factors and distribution of pathogens were analyzed, and possible risk factors were conducted Logistic analysis. Results Among 25 228 surgery patients, 539 developed 554 times of SSI, SSI rate was 2. 14%, case infection rate was 2. 20%. Logistic analysis showed the risk factors for SSI infection were as follows: classification of operation(OR 95% CI, 1. 29 - 18. 43) , incision type (OR 95% CI, 1. 19 - 9. 28) , diabetes (OR 95% CI, 1.25-7.23), duration of operation (OR 95% CI, 1. 14 - 6. 69), age (OR 95% CI, 1. 13-3. 99) , intraoperative bleeding (OR 95% CI, 1. 25 - 2. 78), length of hospital stay (OR 95% CI, 1. 38 - 2. 39), preoperative injection focus (OR 95%CI, 1. 21 - 1. 50). SSI mainly concentrated in departments of hepatobiliary surgery(6. 53%) , cardio thoracic surgery(4. 87%) and urology(3. 91 %) ; a total of 506 psihogenic isolates were detected, the majority were Pseudomonas aeruginosa (22. 33%) ,Acinetobacler baumannii (14. 62%) and Enlerococcus faecalis(11. 07%). Conclusion The occurrence of SSI is related to multiple factors, incision infection surveillance should be intensified.showed Lhal the scores on most knowledge points have declined (P＜0. 05). Doctors and technicians' knowledge on "hand hygiene" and "occupational safety" decreased, and the nurses' knowledge on "bacterial resistance mechanisms" and ''rational use of antimicrobial agents" decreased. Conclusion Kirkpatnck lour-level training evaluation model can objectively reflect the internal and external effectiveness of training, the training has achieved a significant short-term effect, but long-term effect is not obvious. The quality of training can be improved by perfecting training mode and establishing a systematic evaluation system.
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