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Article(id=1240977217187008876, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410299, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729440000000, receivedDateStr=2024-10-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773801624818, onlineDateStr=2026-03-18, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773801624818, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773801624818, creator=13701087609, updateTime=1773801624818, updator=13701087609, issue=Issue{id=1240977214964036360, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773801624289, creator=13701087609, updateTime=1773825591019, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241077738770068227, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241077738770068228, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1897, endPage=1901, ext={EN=ArticleExt(id=1240977217463832942, articleId=1240977217187008876, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Status of tuberculosis infection prevention and controlin primary health care institute, Chongqing City, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the current status of tuberculosis(TB) infection prevention and control in primary health care institute in Chongqing.

Methods

According to evaluation criterion of the Guideline on tuberculosis infection prevention and control in primary health care institute,the survey was conducted on 146 community health service centers and 506 township health centers in Chongqing. The data of tuberculosis infection prevention and control was collected and analyzed, including organizational management, outpatient settings and workflow, ventilation and disinfection, and personal respiratory protection. SPSS 25.0 soft for descriptive statistical analysis.

Results

In organizational management measures, the proportion of infection control work included in the situation, training and assessment, plan formulation, and system establishment were all above 90%. There were statistically significant difference in the proportion of implementing regular evaluation mechanisms, establishing regular physical examination systems, and equipping tuberculosis infection control related facilities and items in different regions(P<0.05). In the setting and workflow of outpatient clinics, the proportion of online direct reporting (95.71%) and pre-examination triage system (90.18%) was relatively high, the proportion of institutions with separate tuberculosis waiting areas, consultation rooms, and supervision drug rooms/health management rooms (40.34%), as well as prominent signs, notices, directional signs (46.47%), was relatively low. There were statistically significant differences in the proportion of institutions with separate TB waiting areas, consulting rooms and supervision drug rooms/health management rooms in different regions, establishing a pre-screening triage system, and arranging priority for patients with suspected symptoms of TB or suspected TB patients or tuberculosis patients(P<0.05). 82.36% of institutions had good ventilation, and 61.04% of institutions mainly used mobile UV disinfection vehicles for UV disinfection. There was no statistically significant difference in ventilation, disinfection, and personal respiratory protection measures(P>0.05).

Conclusion

The prevention and control of tuberculosis infection in primary health care institute in Chongqing is generally good, but there are still weak links. It is necessary to further strengthen the outpatient setting of primary health care institute, the allocation of health resources in Wuling Mountain Area in southeast Chongqing, establish a regular physical examination system for tuberculosis, improve environmental facilities, enhance the personal protection awareness of medical personnel, and reduce the risk of tuberculosis infection.

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目的

了解重庆市基层医疗卫生机构结核感染预防与控制措施实施现状。

方法

根据《基层医疗卫生机构结核感染预防与控制指南》对重庆市146个社区卫生服务中心和506个乡镇卫生院进行调查，收集和分析组织管理、门诊设置和工作流程、通风与消毒及个人呼吸防护等结核感染预防与控制相关数据，采用SPSS 25.0软件进行描述性统计分析。

结果

组织管理措施中，感染控制工作纳入、培训与考核、制定计划和建立制度等方面比例均在90%以上，不同地区开展定期评价、建立定期体检制度的机构比例差异有统计学意义（P<0.05）。门诊设置和工作流程中，网络直报（95.71%）、预检分诊制度（90.18%）比例较高，机构设单独结核候诊区、诊室和督导用药室/健康管理室（40.34%）、有醒目标识、告示、指引牌等（46.47%）比例较低；不同地区设单独结核候诊区、诊室和督导用药室/健康管理室、建立预检分诊制度、安排肺结核可疑症状者或疑似肺结核患者或结核病患者优先就诊的机构比例差异有统计学意义（P<0.05）。82.36%的机构通风良好，61.04%的机构紫外线消毒以移动式紫外线消毒车为主，不同地区通风与消毒及个人呼吸防护措施差异无统计学意义（P>0.05）。

结论

重庆市基层医疗卫生机构结核感染预防与控制情况总体较好，但仍存在薄弱环节，需要进一步加强基层医疗卫生机构门诊设置、渝东南武陵山区卫生资源配置，建立定期体检结核病制度，改善环境设施，提升医务人员个人防护意识，降低结核感染风险。

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吴成果，E-mail:
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庞艳（1985—），女，硕士研究生，副主任医师，研究方向：结核病防治

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(In Chinese), articleTitle=Analysis of the awareness about knowledge on the updated TB diagnosis standard among the practitioners in TB control institutions, refAbstract=null), Reference(id=1240996925705613494, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=9, pageStart=1647, pageEnd=1650, 1669, url=null, language=null, rfNumber=[23], rfOrder=36, authorNames=雷蓉蓉, 刘英, 张婷, journalName=现代预防医学, refType=null, unstructuredReference=雷蓉蓉，刘英，张婷，等．重庆市结核病防治医务人员结核潜伏感染及预防性治疗的认知态度分析[J].现代预防医学，2020,47(9):1647-1650, 1669., articleTitle=重庆市结核病防治医务人员结核潜伏感染及预防性治疗的认知态度分析, refAbstract=null), Reference(id=1240996925823054011, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=9, pageStart=1647, pageEnd=1650, 1669, url=null, language=null, rfNumber=[23], rfOrder=37, authorNames=Lei RR, Liu Y, Zhang T, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Lei RR, Liu Y, Zhang T, et al. Cognitive attitude of latent infection of tuberculosis bacillus and preventive treatment among tuberculosis control medical staff, Chongqing[J]. Modern Preventive Medicine, 2020, 47(9): 1647-1650, 1669. (In Chinese), articleTitle=Cognitive attitude of latent infection of tuberculosis bacillus and preventive treatment among tuberculosis control medical staff, Chongqing, refAbstract=null)], funds=[Fund(id=1240996919917474762, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, awardId=2024MSXM140, language=CN, fundingSource=重庆市科卫联合医学科研项目(2024MSXM140), fundOrder=null, country=null), Fund(id=1240996920085246928, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, awardId=null, language=CN, fundingSource=重庆市首批公共卫生重点学科, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240996913185616510, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, xref=null, ext=[AuthorCompanyExt(id=1240996913194005119, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, companyId=1240996913185616510, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Institute of Tuberculosis Prevention and Treatment of Chongqing, Chongqing 400050, China), AuthorCompanyExt(id=1240996913202393728, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, companyId=1240996913185616510, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆市结核病防治所，重庆 400050)])], figs=[ArticleFig(id=1240996917354754923, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=EN, label=Table 1, caption=

Basic information of 652 primary healthcare institutions

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区域人口数活动性患者登记率
（1/10万）		社区卫生服务中心
（家）		乡镇卫生院
（家）		接诊的肺结核可疑症状数
（人次）		接诊的疑似肺结核患者
（人次）		督导用药的肺结核患者人数
（人）
渝东北三峡库区804.1457.68 3721016 1402472 641
渝东南武陵山区286.4872.08 2011617 6541361 021
中心城区1 047.7620.68 412876369596
主城新区1 074.9636.30 481529 9712002 083
合计3 213.3439.75 14650644 5286526 341
), ArticleFig(id=1240996917447029621, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=CN, label=表1, caption=

652家基层医疗卫生机构基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
区域人口数活动性患者登记率
（1/10万）		社区卫生服务中心
（家）		乡镇卫生院
（家）		接诊的肺结核可疑症状数
（人次）		接诊的疑似肺结核患者
（人次）		督导用药的肺结核患者人数
（人）
渝东北三峡库区804.1457.68 3721016 1402472 641
渝东南武陵山区286.4872.08 2011617 6541361 021
中心城区1 047.7620.68 412876369596
主城新区1 074.9636.30 481529 9712002 083
合计3 213.3439.75 14650644 5286526 341
), ArticleFig(id=1240996917551887226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=EN, label=Table 2, caption=

Implementation status of organizational management measures

, figureFileSmall=null, figureFileBig=null, tableContent=
组织管理合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		χ2P
结核感染控制纳入院内感染控制整体工作628（96.32）238（96.36）131（96.32）67（97.10）192（96.00）0.1780.981
感染管理人员接受上级培训并考核合格631（96.78）239（96.76）132（97.06）67（97.10）193（96.50）0.1070.991
制定机构感染控制计划608（93.25）235（95.14）125（91.91）66（95.65）182（91.00）4.0330.258
建立本机构的结核感染预防与控制培训制度619（94.94）235（95.14）130（95.59）66（95.65）188（94.00）0.5800.901
对机构的结核感染控制工作开展定期评价565（86.66）221（89.47）123（90.44）59（85.51）162（81.00）8.9930.029
建立定期体检制度525（80.52）204（82.59）96（70.59）65（94.20）160（80.00）17.4900.001
), ArticleFig(id=1240996917631579013, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=CN, label=表2, caption=

组织管理措施实施情况

, figureFileSmall=null, figureFileBig=null, tableContent=
组织管理合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		χ2P
结核感染控制纳入院内感染控制整体工作628（96.32）238（96.36）131（96.32）67（97.10）192（96.00）0.1780.981
感染管理人员接受上级培训并考核合格631（96.78）239（96.76）132（97.06）67（97.10）193（96.50）0.1070.991
制定机构感染控制计划608（93.25）235（95.14）125（91.91）66（95.65）182（91.00）4.0330.258
建立本机构的结核感染预防与控制培训制度619（94.94）235（95.14）130（95.59）66（95.65）188（94.00）0.5800.901
对机构的结核感染控制工作开展定期评价565（86.66）221（89.47）123（90.44）59（85.51）162（81.00）8.9930.029
建立定期体检制度525（80.52）204（82.59）96（70.59）65（94.20）160（80.00）17.4900.001
), ArticleFig(id=1240996917711270796, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=EN, label=Table 3, caption=

Outpatient settings and workflow

, figureFileSmall=null, figureFileBig=null, tableContent=
门诊设置和工作流程合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		χ2P
有单独结核候诊区、诊室和结核病患者督导用药室/健康管理室263(40.34)106(42.91)70(51.47)23(33.33)64(32.00)14.8690.002
有醒目标识、告示、指引牌等303(46.47)126(51.01)67(49.26)25(36.23)85(42.5)6.650.084
接诊诊室、督导用药室/健康管理室保证一室一医一患399(61.20)156(63.16)78(57.35)47(68.12)118(59.00)3.0440.385
诊室、督导用药室/健康管理室安装紫外线灯或配备移动式紫外线消毒车545(83.59)205(83.00)116(85.29)61(88.41)163(81.50)2.1540.541
建立本机构的预检分诊制度588(90.18)230(93.12)115(84.56)68(98.55)175(87.50)14.3460.002
咨询处或预检分诊处的工作人员对就诊者进行肺结核可疑症状筛查（咳嗽、咳痰）563(86.35)213(86.23)119(87.50)63(91.30)168(84.00)2.5290.470
预检分诊处工作人员采取标准预防措施505(77.45)202(81.78)108(79.41)52(75.36)143(71.50)7.1800.066
安排肺结核可疑症状者或疑似肺结核患者或结核病患者优先就诊564(86.50)220(89.07)125(91.91)54(78.26)165(82.50)11.5600.009
具备网络直报条件624(95.71)239(96.76)128(94.12)69(100.00)188(94.00)6.0160.111
), ArticleFig(id=1240996917895820184, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=CN, label=表3, caption=

门诊设置和工作流程

, figureFileSmall=null, figureFileBig=null, tableContent=
门诊设置和工作流程合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		χ2P
有单独结核候诊区、诊室和结核病患者督导用药室/健康管理室263(40.34)106(42.91)70(51.47)23(33.33)64(32.00)14.8690.002
有醒目标识、告示、指引牌等303(46.47)126(51.01)67(49.26)25(36.23)85(42.5)6.650.084
接诊诊室、督导用药室/健康管理室保证一室一医一患399(61.20)156(63.16)78(57.35)47(68.12)118(59.00)3.0440.385
诊室、督导用药室/健康管理室安装紫外线灯或配备移动式紫外线消毒车545(83.59)205(83.00)116(85.29)61(88.41)163(81.50)2.1540.541
建立本机构的预检分诊制度588(90.18)230(93.12)115(84.56)68(98.55)175(87.50)14.3460.002
咨询处或预检分诊处的工作人员对就诊者进行肺结核可疑症状筛查（咳嗽、咳痰）563(86.35)213(86.23)119(87.50)63(91.30)168(84.00)2.5290.470
预检分诊处工作人员采取标准预防措施505(77.45)202(81.78)108(79.41)52(75.36)143(71.50)7.1800.066
安排肺结核可疑症状者或疑似肺结核患者或结核病患者优先就诊564(86.50)220(89.07)125(91.91)54(78.26)165(82.50)11.5600.009
具备网络直报条件624(95.71)239(96.76)128(94.12)69(100.00)188(94.00)6.0160.111
), ArticleFig(id=1240996917983900572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=EN, label=Table 4, caption=

Ventilation and disinfection situation

, figureFileSmall=null, figureFileBig=null, tableContent=
通风与消毒合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		FisherP
通风2.8420.836
通风良好，每小时换气次数达到12次537(82.36)205(83.00)114(83.82)59(85.51)159(79.50)
通风不好，安装排气扇14(2.15)5(2.02)3(2.21)2(2.90)4(2.00)
通风不好，未安装排气扇101(15.49)37(14.98)19(13.97)8(11.59)37(18.50)
紫外线消毒9.0160.434
上照型33(5.06)19(7.69)4(2.94)3(4.35)7(3.50)
下照型114(17.48)43(17.41)23(16.91)10(14.49)38(19.00)
移动式紫外线消毒车398(61.04)143(57.89)89(65.44)48(69.57)118(59.00)
未使用107(16.41)42(17.00)20(14.71)8(11.59)37(18.50)
), ArticleFig(id=1240996918067786659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=CN, label=表4, caption=

通风与消毒情况

, figureFileSmall=null, figureFileBig=null, tableContent=
通风与消毒合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区
(n=136)		中心城区
(n=69)		主城新区
(n=200)		FisherP
通风2.8420.836
通风良好，每小时换气次数达到12次537(82.36)205(83.00)114(83.82)59(85.51)159(79.50)
通风不好，安装排气扇14(2.15)5(2.02)3(2.21)2(2.90)4(2.00)
通风不好，未安装排气扇101(15.49)37(14.98)19(13.97)8(11.59)37(18.50)
紫外线消毒9.0160.434
上照型33(5.06)19(7.69)4(2.94)3(4.35)7(3.50)
下照型114(17.48)43(17.41)23(16.91)10(14.49)38(19.00)
移动式紫外线消毒车398(61.04)143(57.89)89(65.44)48(69.57)118(59.00)
未使用107(16.41)42(17.00)20(14.71)8(11.59)37(18.50)
), ArticleFig(id=1240996919586124719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=EN, label=Table 5, caption=

Personal protection situation

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个人呼吸防护合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区(n=136)中心城区
(n=69)		主城新区
(n=200)		χ2P
接诊肺结核时，佩戴医用防护口罩556(85.28)215(87.04)118(86.76)60(86.96)163(81.50)3.2820.350
督导用药时，佩戴医用防护口罩561(86.04)219(88.66)114(83.82)59(85.51)169(84.50)2.3840.497
), ArticleFig(id=1240996919724536761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977217187008876, language=CN, label=表5, caption=

个人防护情况

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个人呼吸防护合计
(n=652)		渝东北三峡库区
(n=247)		渝东南武陵山区(n=136)中心城区
(n=69)		主城新区
(n=200)		χ2P
接诊肺结核时，佩戴医用防护口罩556(85.28)215(87.04)118(86.76)60(86.96)163(81.50)3.2820.350
督导用药时，佩戴医用防护口罩561(86.04)219(88.66)114(83.82)59(85.51)169(84.50)2.3840.497
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重庆市基层医疗卫生机构结核感染预防与控制现况调查
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庞艳 , 吴成果 , 汪清雅 , 张婷
现代预防医学 | 疾病预防控制 2025,52(10): 1897-1901
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现代预防医学 | 疾病预防控制 2025, 52(10): 1897-1901
重庆市基层医疗卫生机构结核感染预防与控制现况调查
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庞艳, 吴成果 , 汪清雅, 张婷
作者信息
  • 重庆市结核病防治所，重庆 400050

    • 庞艳（1985—），女，硕士研究生，副主任医师，研究方向：结核病防治

通讯作者:

吴成果，E-mail:
Status of tuberculosis infection prevention and controlin primary health care institute, Chongqing City
Yan PANG, Cheng-guo WU , Qing-ya WANG, Ting ZHANG
Affiliations
  • Institute of Tuberculosis Prevention and Treatment of Chongqing, Chongqing 400050, China
出版时间: 2025-05-25 doi: 10.20043/j.cnki.MPM.202410299
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摘要
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目的

了解重庆市基层医疗卫生机构结核感染预防与控制措施实施现状。

方法

根据《基层医疗卫生机构结核感染预防与控制指南》对重庆市146个社区卫生服务中心和506个乡镇卫生院进行调查，收集和分析组织管理、门诊设置和工作流程、通风与消毒及个人呼吸防护等结核感染预防与控制相关数据，采用SPSS 25.0软件进行描述性统计分析。

结果

组织管理措施中，感染控制工作纳入、培训与考核、制定计划和建立制度等方面比例均在90%以上，不同地区开展定期评价、建立定期体检制度的机构比例差异有统计学意义（P<0.05）。门诊设置和工作流程中，网络直报（95.71%）、预检分诊制度（90.18%）比例较高，机构设单独结核候诊区、诊室和督导用药室/健康管理室（40.34%）、有醒目标识、告示、指引牌等（46.47%）比例较低；不同地区设单独结核候诊区、诊室和督导用药室/健康管理室、建立预检分诊制度、安排肺结核可疑症状者或疑似肺结核患者或结核病患者优先就诊的机构比例差异有统计学意义（P<0.05）。82.36%的机构通风良好，61.04%的机构紫外线消毒以移动式紫外线消毒车为主，不同地区通风与消毒及个人呼吸防护措施差异无统计学意义（P>0.05）。

结论

重庆市基层医疗卫生机构结核感染预防与控制情况总体较好，但仍存在薄弱环节，需要进一步加强基层医疗卫生机构门诊设置、渝东南武陵山区卫生资源配置，建立定期体检结核病制度，改善环境设施，提升医务人员个人防护意识，降低结核感染风险。

结核病  /  感染控制  /  卫生系统机构
Objective

To investigate the current status of tuberculosis(TB) infection prevention and control in primary health care institute in Chongqing.

Methods

According to evaluation criterion of the Guideline on tuberculosis infection prevention and control in primary health care institute,the survey was conducted on 146 community health service centers and 506 township health centers in Chongqing. The data of tuberculosis infection prevention and control was collected and analyzed, including organizational management, outpatient settings and workflow, ventilation and disinfection, and personal respiratory protection. SPSS 25.0 soft for descriptive statistical analysis.

Results

In organizational management measures, the proportion of infection control work included in the situation, training and assessment, plan formulation, and system establishment were all above 90%. There were statistically significant difference in the proportion of implementing regular evaluation mechanisms, establishing regular physical examination systems, and equipping tuberculosis infection control related facilities and items in different regions(P<0.05). In the setting and workflow of outpatient clinics, the proportion of online direct reporting (95.71%) and pre-examination triage system (90.18%) was relatively high, the proportion of institutions with separate tuberculosis waiting areas, consultation rooms, and supervision drug rooms/health management rooms (40.34%), as well as prominent signs, notices, directional signs (46.47%), was relatively low. There were statistically significant differences in the proportion of institutions with separate TB waiting areas, consulting rooms and supervision drug rooms/health management rooms in different regions, establishing a pre-screening triage system, and arranging priority for patients with suspected symptoms of TB or suspected TB patients or tuberculosis patients(P<0.05). 82.36% of institutions had good ventilation, and 61.04% of institutions mainly used mobile UV disinfection vehicles for UV disinfection. There was no statistically significant difference in ventilation, disinfection, and personal respiratory protection measures(P>0.05).

Conclusion

The prevention and control of tuberculosis infection in primary health care institute in Chongqing is generally good, but there are still weak links. It is necessary to further strengthen the outpatient setting of primary health care institute, the allocation of health resources in Wuling Mountain Area in southeast Chongqing, establish a regular physical examination system for tuberculosis, improve environmental facilities, enhance the personal protection awareness of medical personnel, and reduce the risk of tuberculosis infection.

Tuberculosis  /  Infection control  /  Health systems agencies
庞艳, 吴成果, 汪清雅, 张婷. 重庆市基层医疗卫生机构结核感染预防与控制现况调查. 现代预防医学, 2025 , 52 (10) : 1897 -1901 . DOI: 10.20043/j.cnki.MPM.202410299
Yan PANG, Cheng-guo WU, Qing-ya WANG, Ting ZHANG. Status of tuberculosis infection prevention and controlin primary health care institute, Chongqing City[J]. Modern Preventive Medicine, 2025 , 52 (10) : 1897 -1901 . DOI: 10.20043/j.cnki.MPM.202410299
正文
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结核感染预防与控制是世界卫生组织“终止结核病策略”的重要组成部分[1]，行政控制、环境控制、呼吸防护是结核感染预防与控制的3个层级。随着结核病患者健康管理服务项目的实施，基层医疗卫生机构的职责被不断的明确和增强，基层医疗卫生机构需要对辖区内肺结核患者进行管理、追踪患者/疑似患者和可疑症状者、开展重点人群主动筛查和健康教育[2]，由于在工作环境中接触肺结核可疑症状者、疑似肺结核患者和患者的机会多，处于结核分枝杆菌感染的高危环境之中。若基层医疗卫生机构结核感染控制措施实施状况差会使机构的结核病传播风险升高[3] ，使处于其中的医务人员、患者和陪护人员更容易感染和发生结核病。国内外对医疗卫生机构的结核感染控制措施实施状况调查发现[4]，机构的结核感染控制措施实施状况不佳，普遍存在组织管理不足、布局不合理、通风不良、呼吸防护不规范等问题，基层医疗卫生机构问题更为显著[5]。历年来重庆市肺结核疫情均位于全国前五[6]，且医务人员肺结核患病率均高于全人群[7]。因此，本研究对重庆市基层医疗卫生机构结核感染预防与控制现状进行调查，为制定相关政策和措施提供参考。
1　对象与方法
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1.1　调查对象
根据2023年《重庆市统计年鉴》和《重庆市卫生健康统计年鉴》，重庆市38个县区划分为中心城区、主城新区、渝东北三峡库区城镇群和渝东南武陵山区城镇群，分别有161、314、378、195家社区卫生服务中心/乡镇卫生院，合计1 048家。依据随机抽样样本量公式，置信水平95%，误差5%，总体小于10 000，通过校正公式最终需要调查281家机构。本研究于2024年4月19日-7月29日在各片区采取随机抽样的方法分别抽取69、200、247和136家基层医疗卫生机构，包括146家社区卫生服务中心和506家乡镇卫生院，合计652家基层医疗卫生机构，其中，每个区县至少包括3家机构。
1.2　调查方法
根据《基层医疗卫生机构结核感染预防与控制指南》要求，通过查阅文献和咨询专家，设计调查问卷，由基层医疗卫生机构的院感防控负责人通过查阅资料、现场观察和测量，填写调查问卷，收集结核感染预防与控制相关数据。调查结束后，市级结防机构人员对调查表进行复核，将调查人员为非基层医疗卫生机构的院感防控负责人、填写内容不完整或缺失、对评价项目理解有误、逻辑矛盾或数据错误和记录不规范等不合格的调查表重新调查填写。并由课题组成员以片区为单位各选取1个区县进行现场复核，以确保调查质量。
1.3　调查内容
本文所采用的调查指标设置依据《基层医疗卫生机构结核感染预防与控制指南》，调查内容主要包括基层医疗卫生机构组织管理工作开展情况、门诊设置和工作流程、通风与消毒情况、个人呼吸防护情况。
1.4　统计学分析
利用Excel 2007建立数据库，使用SPSS 25.0软件进行描述性统计学分析，计数资料采用频数、构成比描述，组间率的比较采用χ2或Fisher精确检验，检验水准α=0.05。
2　结果
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2.1　基本情况
按照2023年重庆市活动性肺结核患者登记率39.75/10万为基准进行对比，渝东北三峡库区和渝东南武陵山区活动性肺结核患者登记率高于全市水平。调查机构以乡镇卫生院为主，占77.60%。各区域基层医疗卫生机构基本情况见表1。
2.2　组织管理情况
在调查的652家基层医疗卫生机构中，将结核感染控制纳入院内感染控制整体工作、感染管理人员接受上级培训并考核合格、制定机构感染控制计划、建立培训制度的机构比例分别为96.32%、96.78%、93.25%、94.94%。不同地区对机构结核感染控制工作开展定期评价、建立定期体检制度的比例分别为86.66%和80.52%，差异有统计学意义（P<0.05）。见表2。
2.3　门诊设置和工作流程情况
46.47%的机构有醒目标识、告示、指引牌等；61.20%的机构接诊诊室、督导用药室/健康管理室保证一室一医一患；83.59%的机构安装紫外线灯或配备移动式紫外线消毒车；86.35%的机构咨询处或预检分诊处的工作人员对就诊者进行肺结核可疑症状筛查；77.45%的机构预检分诊处工作人员采取标准预防措施。40.34%的机构设有单独结核候诊区、诊室和结核病患者督导用药室/健康管理室的机构，不同地区差异有统计学意义（χ2=14.869，P<0.01）。90.18%的机构建立了预检分诊制度，不同地区差异有统计学意义（χ2=14.346，P<0.01）。86.50%的机构有结核病患者优先就诊流程，不同地区差异有统计学意义（χ2=11.56，P<0.01）。见表3。
2.4　通风与消毒情况
82.36%的机构通风良好，每小时换气次数达到12次；2.15%的机构通风不好，但安装排气扇；15.49%的机构通风不好，且未安装排气扇；不同地区通风情况差异无统计学意义（P>0.05）。紫外线消毒以移动式紫外线消毒车为主，比例为61.04%，不同地区紫外线消毒情况差异无统计学意义（P>0.05）。见表4。在使用紫外线消毒的545家机构中，38.96%的机构紫外线灯照射强度≥90 μW/cm2，63.65%的机构紫外线灯照射强度≥70 μW/cm2。
2.5　个人呼吸防护情况
85.28%的机构医务人员接诊肺结核时，佩戴医用防护口罩；86.04%的机构医务人员督导用药时，佩戴医用防护口罩,不同地区差异无统计学意义（P>0.05）。见表5。
3　讨论
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基层医疗卫生机构是发生结核感染和结核病传播的高风险场所。从国内外部分地区所开展的调查结果来看[8-10]，医务人员的结核分枝杆菌感染率、结核病发病率和患病率明显高于一般人群，医疗卫生机构结核感染控制相关的组织管理、环境与工程控制、个人呼吸防护等实施情况不容乐观，其中基层医疗卫生机构的感染管理现状堪忧[11]。
本研究发现重庆市基层医疗卫生机构结核感染预防与控制组织管理措施整体较好，这可能与在新冠疫情防控常态化背景下，感染控制工作在各级各类医疗机构受到空前的关注，加大了感染控制培训力度，提高了医疗卫生机构感染控制现况[12]有关。但在开展定期评价、机构人员定期体检等两方面相对不足。定期评价机制是确保结核感染预防与控制工作有效实施的重要手段，定期评价机制的缺失会导致结核感染控制相关制度形同虚设,对机构存在的风险认识不清,不能及时采取改进措施[13]，建议每年进行两次内部评价，并由疾病预防控制机构进行一次外部评价。建立定期体检制度是预防和控制结核病传播的重要措施，建议每年至少对医务人员进行一次包含胸部影像学的结核病检查，有条件的地区还可进一步探索医务人员结核感染筛查和预防性治疗策略[14-15]。不同区域比较发现，中心城区和主城新区对机构结核感染控制工作开展定期评价比例相对较低，渝东北三峡库区和渝东南武陵山区比例虽相对较高，但往往局限于机构内部评价，建议在开展基层医疗卫生机构内部评价的基础上，由当地疾病预防控制机构每年进行一次外部评价，以确保评价质量和整改效果。其次，渝东南武陵山区基层医疗卫生机构建立定期体检制度比例较低，该区域活动性肺结核患者登记率最高，医务人员接触肺结核可疑症状者/疑似肺结核患者/结核病患者机会多，应重视建立定期体检制度，至少每年对所有基层医务人员进行一次包含胸部影像学的结核病检查，并根据需要增加体检项目和/或次数。
从门诊设置情况来看，重庆市基层医疗卫生机构门诊设置情况相较于《基层医疗卫生机构结核感染预防与控制指南》[11]要求差距较大。特别是应设置具有独立的肺结核候诊区、诊室和督导用药室/健康管理室和醒目标识，保证一室一医一患，满足分区或分时段实施结核病患者就诊服务要求，尽可能减少机构内传播风险。重庆市基层医疗卫生机构建立预检分诊制度比例（90.18%）较高，但预检分诊处工作人员采取标准预防措施比例较低（77.45%），通过实施标准预防，可以显著降低医院内感染的发生率，保护患者、医务人员和其他人员的安全，因此，应严格要求预检分诊处工作人员采取标准预防措施，佩戴的医用防护口罩需在适合性测试的基础上进行选择。基层医疗卫生机构具备网络直报条件的比例较高，这与历年来国家实施基本公共卫生服务项目，加大对城乡基层医疗机构的投入和建设密切相关，使得基层医疗卫生机构也具备了较高传染病报告意识和敏感性。不同区域比较发现，中心城区和主城新区应强化环境布局和功能分区，优化结核病患者就诊流程；渝东南武陵山区和主城新区应进一步加强预检分诊制度的建立。
通风与消毒是结核感染控制最主要的环境控制措施[16]。重庆市基层医疗卫生机构通风措施总体良好,一是近年来重庆市基层医疗卫生机构各类卫生资源的年均增长速度均高于同期全国平均增速[17]，建筑布局与设备配置逐步完善；此外通过加大了感染控制培训力度，也使得医务人员通风措施执行度高。值得注意的是，在通风不好的基层医疗卫生机构中，未安装排气扇的比例（15.49%）较高，存在较高的感染风险。建议在自然通风较差的医疗卫生机构，使用机械通风，定期开展通风监测。另一方面重庆市基层医疗卫生机构以移动式紫外线消毒车为主，上照型紫外线消毒比较仅为5.06%，且紫外线灯照射强度≥70μW/cm？的比例仅为63.65%。按照国内相关规范的要求[18]，建议基层医疗卫生机构在患者停留的场所最好使用上层空间紫外线灯，辐照度值低于70 μW/cm2者应予更换。
个体防护是结核感染预防与控制的最后一道防线。本研究发现重庆市基层医疗卫生机构医用防护口罩佩戴率高于既往研究[19]，但部分机构医务人员在接诊或督导用药时不佩戴口罩，或佩戴医用防护口罩的医务人员中也存在不定期更换、缺少适合性测试等现象。相关研究显示[20-21]，重庆市市级医疗机构医务人员结核感染控制知晓率仅为69.3%，远低于其他省市（81.8%）[22]，基层医务人员结核感染控制认知情况尤为不足[23]。因此建议基层医疗卫生机构为从事接诊肺结核可疑症状者或疑似肺结核患者或结核病患者、对结核病患者进行直接面视下督导用药的医务人员提供适合的医用防护口罩，增加相应的佩戴适合实验培训和相应的适合性实验，加强医务人员结核结核感染预防与控制培训，提高认识，重视个人防护的作用，降低机构内感染风险。
综上所述，重庆市基层医疗卫生机构结核感染预防与控制现状整体较好，但不同地区基层医疗卫生机构院感防控工作仍存在薄弱环节，需要因地制宜，一地一策，不断完善制度和机制建设，从而提高重庆市基层医疗卫生机构结核感染预防与控制质量和效果。
基金
收起
  • 重庆市科卫联合医学科研项目(2024MSXM140)
  • 重庆市首批公共卫生重点学科
文献
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2025年第52卷第10期
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doi: 10.20043/j.cnki.MPM.202410299
  • 接收时间：2024-10-21
  • 首发时间：2026-03-18
  • 出版时间：2025-05-25
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  • 收稿日期：2024-10-21
基金
重庆市科卫联合医学科研项目(2024MSXM140)
重庆市首批公共卫生重点学科
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    重庆市结核病防治所，重庆 400050

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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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