Article(id=1324077869651079911, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202507478, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753891200000, receivedDateStr=2025-07-31, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614364301, onlineDateStr=2026-11-02, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614364301, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614364301, creator=13701087609, updateTime=1793614364301, updator=13701087609, issue=Issue{id=1324077868950631142, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614364134, creator='13701087609', updateTime=1793614446224, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078213328142371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078213332336676, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=676, endPage=681, ext={EN=ArticleExt(id=1324077869948875497, articleId=1324077869651079911, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on disease prevention risk assessment in medical institutions under the pilot program of disease control supervisor system: A comprehensive application based on the Delphi method, FMEA, and Borda ranking method, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To provide a basis for formulating response strategies under the pilot program of the disease control supervisor system, research on disease prevention risk assessment in medical institutions is conducted.

Methods

In the pilot work of the disease control supervisor system in medical institutions, the Delphi method, FMEA, and Borda rank method were used to conduct risk evaluation, and ranking of the likelihood, severity, and detectability of disease prevention risks.

Results

10 primary and 53 secondary medical institution disease prevention risk indicators have been constructed, and the risk levels have been classified and ranked:the 10 primary risks were ranked from high to low as infectious disease treatment and prevention and disinfection and isolation, infectious disease monitoring and epidemic reporting, medical waste disposal, pathogenic microorganism laboratory biosafety management, organizational management, facility equipment, personnel allocation and capacity building, infectious disease investigation and epidemic control, information construction and application, preventive vaccination, and others; Among the 53 secondary risks, the top 10 risks were in the following order: One person, one use, one disinfection or sterilization of medical devices>Epidemic control of infectious diseases within the institution=Infection control (protection and isolation)=Compliance with laboratory operating procedures>Professional quality and sense of responsibility of personnel=Implementation of pre examination and triage work system=Hand hygiene>Treatment of infectious disease patients>Prevention and control of key infectious diseases>Compliance with infectious disease epidemic reports in accordance with the law.

Conclusion

In the pilot work of the disease control supervisor system, this study comprehensively applied the Delphi method, FMEA, and Borda ordinal value method to evaluate disease prevention risks, enabling more potential disease prevention risks that are easily overlooked to be identified, warned, tracked, and intervened in a timely manner, forming a closed loop and promoting the integration of medical and prevention. This is a new thinking and method that can provide a reference for various regions.

, authors=Ze-lin XIANG1, Xiao-liao WANG2, Jia-liang XU3, Jin-qi LU4, Hui-fang LIN5, Hao-yue ZHOU4, Xiao-fei FU1, Lei JIA4, Fen-juan SHI4, Guo-ying ZHU1, authorsList=Ze-lin XIANG, Xiao-liao WANG, Jia-liang XU, Jin-qi LU, Hui-fang LIN, Hao-yue ZHOU, Xiao-fei FU, Lei JIA, Fen-juan SHI, Guo-ying ZHU, authorCompany=null, correspAuthors=Guo-ying ZHU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077870347334378, articleId=1324077869651079911, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=疾控监督员制度试点下医疗机构疾病预防风险评估研究:基于Delphi法、FMEA与Borda序值法的综合应用, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

疾控监督员制度试点下,开展医疗机构疾病预防风险评估研究,为制定应对策略提供依据。

方法

在“医疗机构疾控监督员制度试点”中,采用Delphi法、FMEA、Borda序值法对疾病预防风险发生可能性、后果严重性及可探测性进行风险评价并排序。

结果

构建了10项一级、53项二级医疗机构疾病预防风险指标,划分了风险水平并排序:10项一级风险由高到低依次为传染病救治防控和消毒隔离、传染病监测与疫情报告、医疗废物处置、病原微生物实验室生物安全管理、组织管理设施设备人员配备与能力建设、传染病流调与疫情控制、信息化建设与应用、预防接种、其他;53项二级风险中,前10位依次为医疗器械一人一用一消毒或灭菌>机构内传染病疫情控制=院感控制(防护及隔离)=实验室操作规程执行情况符合规定>人员专业素质、责任心=落实预检、分诊工作制度=手卫生>传染病患者救治>重点传染病防控>依法履行传染病疫情报告。

结论

在“疾控监督员制度试点工作”中,综合应用Delphi法、FMEA与Borda序值法评估疾病预防风险,使更多潜在的易被忽视的疾病预防风险被及时识别、预警、追踪、干预,形成闭环,助推医防融合,是一种新思维、新方法,可为各地借鉴。

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向泽林(1984—),男,硕士,副主任医师,研究方向:疾病控制工作

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朱国英,E-mail:
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(In Chinese), articleTitle=Integrated application of Delphi consultation, FMEA, and Borda count methods in vaccination risk assessment in immunization clinics, refAbstract=null), Reference(id=1324077882464678740, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=45, issue=19, pageStart=2254, pageEnd=2259, url=null, language=null, rfNumber=[10], rfOrder=18, authorNames=黄捷, 张先洲, journalName=中国医院药学杂志, refType=null, unstructuredReference=黄捷,张先洲.基于FMEA模式及SHEL分析法在静脉用药调配中心药品调配差错风险管理中的应用[J].中国医院药学杂志,2025,45(19):2254-2259., articleTitle=基于FMEA模式及SHEL分析法在静脉用药调配中心药品调配差错风险管理中的应用, refAbstract=null), Reference(id=1324077882561147733, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=45, issue=19, pageStart=2254, pageEnd=2259, url=null, language=null, rfNumber=[10], rfOrder=19, authorNames=Huang J, Zhang XZ, journalName=Chinese Journal of Hospital Pharmacy, refType=null, unstructuredReference=Huang J, Zhang XZ. Application of FMEA model and SHEL analysis in the risk management of drug dispensing errors in the PIVAS[J]. Chinese Journal of Hospital Pharmacy, 2025, 45(19): 2254-2259. (In Chinese), articleTitle=Application of FMEA model and SHEL analysis in the risk management of drug dispensing errors in the PIVAS, refAbstract=null), Reference(id=1324077882649228118, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=35, issue=23, pageStart=3613, pageEnd=3617, url=null, language=null, rfNumber=[11], rfOrder=20, authorNames=周贵, 王慧玲, 王吉丽, journalName=中华医院感染学杂志, refType=null, unstructuredReference=周贵,王慧玲,王吉丽,等.血透不同环节FEMA管理模式风险评估及其应用效果[J].中华医院感染学杂志,2025,35(23):3613-3617., articleTitle=血透不同环节FEMA管理模式风险评估及其应用效果, refAbstract=null), Reference(id=1324077882724725591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=35, issue=23, pageStart=3613, pageEnd=3617, url=null, language=null, rfNumber=[11], rfOrder=21, authorNames=Zhou G, Wang HL, Wang JL, journalName=Chin J Nosocomiol, refType=null, unstructuredReference=Zhou G, Wang HL, Wang JL, et al. Risk assessment of FEMA management modes in different stages of hemodialysis and its application effects[J]. Chin J Nosocomiol, 2025, 35(23): 3613-3617. (In Chinese), articleTitle=Risk assessment of FEMA management modes in different stages of hemodialysis and its application effects, refAbstract=null), Reference(id=1324077882812805976, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=40, issue=20, pageStart=114, pageEnd=119, url=null, language=null, rfNumber=[12], rfOrder=22, authorNames=胡悦, 许佳佳, 李珊, journalName=护理学杂志, refType=null, unstructuredReference=胡悦,许佳佳,李珊,等.基于风险矩阵和Borda序值法的老年人“互联网+居家护理”服务项目风险评估研究[J].护理学杂志,2025,40(20):114-119., articleTitle=基于风险矩阵和Borda序值法的老年人“互联网+居家护理”服务项目风险评估研究, refAbstract=null), Reference(id=1324077882879914841, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2025, volume=40, issue=20, pageStart=114, pageEnd=119, url=null, language=null, rfNumber=[12], rfOrder=23, authorNames=Hu Y, Xu JJ, Li S, journalName=Journal of Nursing Science, refType=null, unstructuredReference=Hu Y, Xu JJ, Li S, et al. Research on risk assessment of the “Internet +home care” services projects for the elderly based on risk matrix and Borda rankingmethods[J]. Journal of Nursing Science, 2025, 40(20): 114-119. (In Chinese), articleTitle=Research on risk assessment of the “Internet +home care” services projects for the elderly based on risk matrix and Borda rankingmethods, refAbstract=null), Reference(id=1324077882959606618, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2024, volume=45, issue=1, pageStart=161, pageEnd=170, url=null, language=null, rfNumber=[13], rfOrder=24, authorNames=胡海兵, 赵昆昆, 陈永毅, journalName=中山大学学报(医学科学版), refType=null, unstructuredReference=胡海兵,赵昆昆,陈永毅,等.睡眠相关痛性勃起发病相关风险的评估[J].中山大学学报(医学科学版),2024,45(1):161-170., articleTitle=睡眠相关痛性勃起发病相关风险的评估, refAbstract=null), Reference(id=1324077883093824347, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, doi=null, pmid=null, pmcid=null, year=2024, volume=45, issue=1, pageStart=161, pageEnd=170, url=null, language=null, rfNumber=[13], rfOrder=25, authorNames=Hu HB, Zhao KK, Chen YY, journalName=Journal of Sun Yat-Sen University(Medical Sciences), refType=null, unstructuredReference=Hu HB, Zhao KK, Chen YY, et al. Risk assessment of the onset of sleep-related painful erection[J]. Journal of Sun Yat-Sen University(Medical Sciences), 2024, 45(1): 161-170. (In Chinese), articleTitle=Risk assessment of the onset of sleep-related painful erection, refAbstract=null)], funds=[Fund(id=1324077879105041215, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, awardId=2025JK103, language=CN, fundingSource=2025年度浙江省疾病预防控制科技计划项目(2025JK103), fundOrder=null, country=null), Fund(id=1324077879205704512, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, awardId=2024ZHA-KEB341, language=CN, fundingSource=2024年浙江省康恩贝医院管理软科学研究项目(2024ZHA-KEB341), fundOrder=null, country=null), Fund(id=1324077879297979201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, awardId=2026JKP-07, language=CN, fundingSource=浙江省疾病预防控制创新培育团队(2026JKP-07), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077870787736299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, xref=1., ext=[AuthorCompanyExt(id=1324077870796124908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077870787736299, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Center for Disease Control and Prevention of Jiaxing City, Jiaxing, Zhejiang 314050, China), AuthorCompanyExt(id=1324077870804513517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077870787736299, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.嘉兴市疾病预防控制中心,浙江 嘉兴 314050)]), AuthorCompany(id=1324077870888399598, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, xref=2., ext=[AuthorCompanyExt(id=1324077870900982511, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077870888399598, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.嘉兴市卫生健康委员会)]), AuthorCompany(id=1324077870984868592, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, xref=3., ext=[AuthorCompanyExt(id=1324077870993257201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077870984868592, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.上虞区疾病预防控制中心)]), AuthorCompany(id=1324077871072948978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, xref=4., ext=[AuthorCompanyExt(id=1324077871085531891, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077871072948978, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.嘉兴市第一医院)]), AuthorCompany(id=1324077871152640756, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, xref=5., ext=[AuthorCompanyExt(id=1324077871161029365, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, companyId=1324077871152640756, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.嘉兴中医院)])], figs=[ArticleFig(id=1324077878131962677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=EN, label=Table 1, caption=

Judgment basis and familiarity

, figureFileSmall=null, figureFileBig=null, tableContent=
判断依据Caa量化值熟悉程度Cs量化值
大中小
理论分析Ca10.30.20.1很熟悉1.0
实践经验Ca20.50.40.3熟悉0.8
对国内外同行的了解Ca30.10.10.1一般熟悉0.5
直觉Ca40.10.10.1不太熟悉0.2
总计1.00.80.6不熟悉0.0
), ArticleFig(id=1324077878207460150, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=CN, label=表1, caption=

判断依据、熟悉程度

, figureFileSmall=null, figureFileBig=null, tableContent=
判断依据Caa量化值熟悉程度Cs量化值
大中小
理论分析Ca10.30.20.1很熟悉1.0
实践经验Ca20.50.40.3熟悉0.8
对国内外同行的了解Ca30.10.10.1一般熟悉0.5
直觉Ca40.10.10.1不太熟悉0.2
总计1.00.80.6不熟悉0.0
), ArticleFig(id=1324077878291346231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=EN, label=Table 2, caption=

FMEA assessment

, figureFileSmall=null, figureFileBig=null, tableContent=
可能性O评分严重性S评分探测度Da评分
罕见发生1~2无关重要1~2几乎能探测到1~2
不太可能发生3~4较小3~4较容易探测到3~4
可能发生5~6中等5~6探测难易一般5~6
很可能发生7~8较大7~8较难探测7~8
几乎肯定发生9~10灾难性9~10几乎不能探测9~10
), ArticleFig(id=1324077878400398136, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=CN, label=表2, caption=

FMEA评分

, figureFileSmall=null, figureFileBig=null, tableContent=
可能性O评分严重性S评分探测度Da评分
罕见发生1~2无关重要1~2几乎能探测到1~2
不太可能发生3~4较小3~4较容易探测到3~4
可能发生5~6中等5~6探测难易一般5~6
很可能发生7~8较大7~8较难探测7~8
几乎肯定发生9~10灾难性9~10几乎不能探测9~10
), ArticleFig(id=1324077878505255737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=EN, label=Table 3, caption=

Indicator system for disease prevention risk assessment in medical institutions

, figureFileSmall=null, figureFileBig=null, tableContent=
一级风险指标(10项)二级风险指标(53项)
组织管理、设施设备、人员配备与能力建设组织管理、机制
物质、设施设备
人员配备
人员专业素质、责任心
能力建设
信息化建设与应用信息化设备
信息化运行
资料和数据管理
传染病监测与疫情报告疫情报告制度建立、执行情况
疫情报告
报告质量控制、内部自查情况
疫情交流机制、数据交换情况
哨点监测
预警反馈机制
传染病流调与疫情控制流行病学调查和处置
突发原因不明传染病会商
机构内传染病疫情控制
传染病救治防控落实预检、分诊工作制度
感染性疾病科或传染病分诊点设置
发热门诊管理
院感控制(防护及隔离)
传染病患者救治
传染病患者转诊
重点传染病防控
心理健康服务
母婴传播阻断
传染病死因登记管理
消毒隔离功能分区布局、通风情况
消毒管理组织、制度
消毒设施设备、物质储备与使用
消毒设施设备、消毒产品进货检查验收制度建立、执行情况
消毒隔离知识培训
手卫生
医疗器械一人一用一消毒或灭菌
消毒与灭菌效果监测
其他消毒隔离情况
医疗废物处置医疗废物处置和管理人员职业卫生安全防护和培训
医疗废物分类收集
使用专用包装物及容器
医疗废物交接、运送、暂存及登记
建立医疗废物暂时贮存设施并符合要求
医院污水经消毒处理并开展监测
病原微生物实验室生物安全管理实验室是否备案
从事实验活动的人员按要求培训、考核及上岗
实验室操作规程执行情况符合规定
按要求建立和保存实验档案
实验结束将菌(毒)种或样本销毁或者送交保藏机构保藏
预防接种接种单位和人员的资质、备案
预防接种实施
预防接种资料管理
预防接种医学建议
AEFI报告与处置
其他其他传染病防控工作
), ArticleFig(id=1324077878593336122, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=CN, label=表3, caption=

医疗机构疾病预防风险评估指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
一级风险指标(10项)二级风险指标(53项)
组织管理、设施设备、人员配备与能力建设组织管理、机制
物质、设施设备
人员配备
人员专业素质、责任心
能力建设
信息化建设与应用信息化设备
信息化运行
资料和数据管理
传染病监测与疫情报告疫情报告制度建立、执行情况
疫情报告
报告质量控制、内部自查情况
疫情交流机制、数据交换情况
哨点监测
预警反馈机制
传染病流调与疫情控制流行病学调查和处置
突发原因不明传染病会商
机构内传染病疫情控制
传染病救治防控落实预检、分诊工作制度
感染性疾病科或传染病分诊点设置
发热门诊管理
院感控制(防护及隔离)
传染病患者救治
传染病患者转诊
重点传染病防控
心理健康服务
母婴传播阻断
传染病死因登记管理
消毒隔离功能分区布局、通风情况
消毒管理组织、制度
消毒设施设备、物质储备与使用
消毒设施设备、消毒产品进货检查验收制度建立、执行情况
消毒隔离知识培训
手卫生
医疗器械一人一用一消毒或灭菌
消毒与灭菌效果监测
其他消毒隔离情况
医疗废物处置医疗废物处置和管理人员职业卫生安全防护和培训
医疗废物分类收集
使用专用包装物及容器
医疗废物交接、运送、暂存及登记
建立医疗废物暂时贮存设施并符合要求
医院污水经消毒处理并开展监测
病原微生物实验室生物安全管理实验室是否备案
从事实验活动的人员按要求培训、考核及上岗
实验室操作规程执行情况符合规定
按要求建立和保存实验档案
实验结束将菌(毒)种或样本销毁或者送交保藏机构保藏
预防接种接种单位和人员的资质、备案
预防接种实施
预防接种资料管理
预防接种医学建议
AEFI报告与处置
其他其他传染病防控工作
), ArticleFig(id=1324077878693999419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=EN, label=Table 4, caption=

Assessment of primary risk indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
风险分类SODRPNS
序值
O
序值
D
序值
Borda数Borda
序值
分级排序对比
RPNBorda
传染病救治防控7741962.025.520.5011
消毒隔离7741962.025.520.5011
传染病监测与疫情报告6741684.025.518.5233
医疗废物处置7641682.055.517.5334
病原微生物实验室生物安全管理4651206.551.517.0455
组织管理、设施设备、人员配备与能力建设4551006.571.515.0576
传染病流调与疫情控制5641205.055.514.5657
信息化建设与应用344488.085.58.5788
预防接种233189.599.52.0899
其他223129.5109.51.091010
), ArticleFig(id=1324077878782079804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=CN, label=表4, caption=

一级风险指标评估

, figureFileSmall=null, figureFileBig=null, tableContent=
风险分类SODRPNS
序值
O
序值
D
序值
Borda数Borda
序值
分级排序对比
RPNBorda
传染病救治防控7741962.025.520.5011
消毒隔离7741962.025.520.5011
传染病监测与疫情报告6741684.025.518.5233
医疗废物处置7641682.055.517.5334
病原微生物实验室生物安全管理4651206.551.517.0455
组织管理、设施设备、人员配备与能力建设4551006.571.515.0576
传染病流调与疫情控制5641205.055.514.5657
信息化建设与应用344488.085.58.5788
预防接种233189.599.52.0899
其他223129.5109.51.091010
), ArticleFig(id=1324077878861771581, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=EN, label=Table 5, caption=

Assessment of secondary risk indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
风险分类SODRPNS
序值
O
序值
D
序值
Borda数Borda
序值
分级排序对比
RPNBorda
医疗器械一人一用一消毒或灭菌67521051.049.549.0149.5011
机构内传染病疫情控制57517541.549.549.0140.0122
院感控制(防护及隔离)67416851.049.539.5140.0142
实验室操作规程执行情况符合规定57517541.549.549.0140.0122
人员专业素质、责任心56515041.542.049.0132.5455
落实预检、分诊工作制度56515041.542.049.0132.5455
手卫生66414451.042.039.5132.5475
传染病患者救治56412041.542.039.5123.0798
重点传染病防控55512541.527.549.0118.0889
疫情报告57310541.549.526.5117.591110
实验结束将菌(毒)种或样本销毁或者送交保藏机构保藏47411224.549.539.5113.5101011
发热门诊管理5639041.542.026.5110.0111512
人员配备55410041.527.539.5108.5121213
医疗废物处置和管理人员职业卫生安全防护和培训4649624.542.039.5106.0131414
组织管理、机制45510024.527.549.0101.0141215
能力建设5448041.514.539.595.5151616
疫情报告制度建立、执行情况5537541.527.526.595.5152016
功能分区布局、通风情况5537541.527.526.595.5152016
其他消毒隔离情况5448041.514.539.595.5151616
消毒与灭菌效果监测5626041.542.010.594.0192320
医疗废物交接、运送、暂存及登记5626041.542.010.594.0192320
物质、设施设备4548024.527.539.591.5211622
流行病学调查和处置4548024.527.539.591.5211622
医疗废物分类收集5525041.527.510.579.5233024
传染病患者转诊4536024.527.526.578.5242325
消毒管理组织、制度4536024.527.526.578.5242325
消毒设施设备、物质储备与使用4536024.527.526.578.5242325
消毒设施设备、消毒产品进货检查验收制度建立、执行情况4536024.527.526.578.5242325
从事实验活动的人员按要求培训、考核及上岗4536024.527.526.578.5242325
按要求建立和保存实验档案4446424.514.539.578.5242225
医院污水经消毒处理并开展监测4624824.542.010.577.0303131
报告质量控制、内部自查情况4344824.57.039.571.0313132
哨点监测3534511.027.526.565.0323333
突发原因不明传染病会商3534511.027.526.565.0323333
感染性疾病科或传染病分诊点设置4524024.527.510.562.5343535
使用专用包装物及容器4524024.527.510.562.5343535
建立医疗废物暂时贮存设施并符合要求4524024.527.510.562.5343535
母婴传播阻断253303.027.526.557.0374038
信息化设备3433611.014.526.552.0383839
消毒隔离知识培训4423224.514.510.549.5393940
预防接种实施3523011.027.510.549.0404041
预警反馈机制3332711.07.026.544.5414242
实验室是否备案4311224.57.00.532.0424743
信息化运行3321811.07.010.528.5434344
资料和数据管理3321811.07.010.528.5434344
疫情交流机制、数据交换情况3321811.07.010.528.5434344
传染病死因登记管理242163.014.510.528.0464647
预防接种资料管理232123.07.010.520.5474748
AEFI报告与处置232123.07.010.520.5474748
接种单位和人员的资质、备案331911.07.00.518.5495050
心理健康服务22283.01.010.514.5505151
预防接种医学建议22283.01.010.514.5505151
), ArticleFig(id=1324077878958240574, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077869651079911, language=CN, label=表5, caption=

二级风险指标评估

, figureFileSmall=null, figureFileBig=null, tableContent=
风险分类SODRPNS
序值
O
序值
D
序值
Borda数Borda
序值
分级排序对比
RPNBorda
医疗器械一人一用一消毒或灭菌67521051.049.549.0149.5011
机构内传染病疫情控制57517541.549.549.0140.0122
院感控制(防护及隔离)67416851.049.539.5140.0142
实验室操作规程执行情况符合规定57517541.549.549.0140.0122
人员专业素质、责任心56515041.542.049.0132.5455
落实预检、分诊工作制度56515041.542.049.0132.5455
手卫生66414451.042.039.5132.5475
传染病患者救治56412041.542.039.5123.0798
重点传染病防控55512541.527.549.0118.0889
疫情报告57310541.549.526.5117.591110
实验结束将菌(毒)种或样本销毁或者送交保藏机构保藏47411224.549.539.5113.5101011
发热门诊管理5639041.542.026.5110.0111512
人员配备55410041.527.539.5108.5121213
医疗废物处置和管理人员职业卫生安全防护和培训4649624.542.039.5106.0131414
组织管理、机制45510024.527.549.0101.0141215
能力建设5448041.514.539.595.5151616
疫情报告制度建立、执行情况5537541.527.526.595.5152016
功能分区布局、通风情况5537541.527.526.595.5152016
其他消毒隔离情况5448041.514.539.595.5151616
消毒与灭菌效果监测5626041.542.010.594.0192320
医疗废物交接、运送、暂存及登记5626041.542.010.594.0192320
物质、设施设备4548024.527.539.591.5211622
流行病学调查和处置4548024.527.539.591.5211622
医疗废物分类收集5525041.527.510.579.5233024
传染病患者转诊4536024.527.526.578.5242325
消毒管理组织、制度4536024.527.526.578.5242325
消毒设施设备、物质储备与使用4536024.527.526.578.5242325
消毒设施设备、消毒产品进货检查验收制度建立、执行情况4536024.527.526.578.5242325
从事实验活动的人员按要求培训、考核及上岗4536024.527.526.578.5242325
按要求建立和保存实验档案4446424.514.539.578.5242225
医院污水经消毒处理并开展监测4624824.542.010.577.0303131
报告质量控制、内部自查情况4344824.57.039.571.0313132
哨点监测3534511.027.526.565.0323333
突发原因不明传染病会商3534511.027.526.565.0323333
感染性疾病科或传染病分诊点设置4524024.527.510.562.5343535
使用专用包装物及容器4524024.527.510.562.5343535
建立医疗废物暂时贮存设施并符合要求4524024.527.510.562.5343535
母婴传播阻断253303.027.526.557.0374038
信息化设备3433611.014.526.552.0383839
消毒隔离知识培训4423224.514.510.549.5393940
预防接种实施3523011.027.510.549.0404041
预警反馈机制3332711.07.026.544.5414242
实验室是否备案4311224.57.00.532.0424743
信息化运行3321811.07.010.528.5434344
资料和数据管理3321811.07.010.528.5434344
疫情交流机制、数据交换情况3321811.07.010.528.5434344
传染病死因登记管理242163.014.510.528.0464647
预防接种资料管理232123.07.010.520.5474748
AEFI报告与处置232123.07.010.520.5474748
接种单位和人员的资质、备案331911.07.00.518.5495050
心理健康服务22283.01.010.514.5505151
预防接种医学建议22283.01.010.514.5505151
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向泽林 1 , 王小辽 2 , 许加亮 3 , 陆锦琪 4 , 林惠芳 5 , 周浩月 4 , 富小飞 1 , 贾磊 4 , 时粉娟 4 , 朱国英 1
现代预防医学 | 卫生政策与管理 2026,53(4): 676-681
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现代预防医学 |卫生政策与管理 2026 , 53 (4) : 676 -681
疾控监督员制度试点下医疗机构疾病预防风险评估研究:基于Delphi法、FMEA与Borda序值法的综合应用
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向泽林1, 王小辽2, 许加亮3, 陆锦琪4, 林惠芳5, 周浩月4, 富小飞1, 贾磊4, 时粉娟4, 朱国英1
作者信息
  • 1.嘉兴市疾病预防控制中心,浙江 嘉兴 314050
  • 2.嘉兴市卫生健康委员会
  • 3.上虞区疾病预防控制中心
  • 4.嘉兴市第一医院
  • 5.嘉兴中医院
通讯作者:
朱国英,E-mail:
作者简介:

向泽林(1984—),男,硕士,副主任医师,研究方向:疾病控制工作

Research on disease prevention risk assessment in medical institutions under the pilot program of disease control supervisor system: A comprehensive application based on the Delphi method, FMEA, and Borda ranking method
Ze-lin XIANG1, Xiao-liao WANG2, Jia-liang XU3, Jin-qi LU4, Hui-fang LIN5, Hao-yue ZHOU4, Xiao-fei FU1, Lei JIA4, Fen-juan SHI4, Guo-ying ZHU1
Affiliations
  • The Center for Disease Control and Prevention of Jiaxing City, Jiaxing, Zhejiang 314050, China
出版时间: 2026-02-25 doi: 10.20043/j.cnki.MPM.202507478
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目的

疾控监督员制度试点下,开展医疗机构疾病预防风险评估研究,为制定应对策略提供依据。

方法

在“医疗机构疾控监督员制度试点”中,采用Delphi法、FMEA、Borda序值法对疾病预防风险发生可能性、后果严重性及可探测性进行风险评价并排序。

结果

构建了10项一级、53项二级医疗机构疾病预防风险指标,划分了风险水平并排序:10项一级风险由高到低依次为传染病救治防控和消毒隔离、传染病监测与疫情报告、医疗废物处置、病原微生物实验室生物安全管理、组织管理设施设备人员配备与能力建设、传染病流调与疫情控制、信息化建设与应用、预防接种、其他;53项二级风险中,前10位依次为医疗器械一人一用一消毒或灭菌>机构内传染病疫情控制=院感控制(防护及隔离)=实验室操作规程执行情况符合规定>人员专业素质、责任心=落实预检、分诊工作制度=手卫生>传染病患者救治>重点传染病防控>依法履行传染病疫情报告。

结论

在“疾控监督员制度试点工作”中,综合应用Delphi法、FMEA与Borda序值法评估疾病预防风险,使更多潜在的易被忽视的疾病预防风险被及时识别、预警、追踪、干预,形成闭环,助推医防融合,是一种新思维、新方法,可为各地借鉴。

疾控监督员制度试点工作  /  疾病预防  /  风险  /  Delphi法  /  FMEA  /  Borda序值法
Objective

To provide a basis for formulating response strategies under the pilot program of the disease control supervisor system, research on disease prevention risk assessment in medical institutions is conducted.

Methods

In the pilot work of the disease control supervisor system in medical institutions, the Delphi method, FMEA, and Borda rank method were used to conduct risk evaluation, and ranking of the likelihood, severity, and detectability of disease prevention risks.

Results

10 primary and 53 secondary medical institution disease prevention risk indicators have been constructed, and the risk levels have been classified and ranked:the 10 primary risks were ranked from high to low as infectious disease treatment and prevention and disinfection and isolation, infectious disease monitoring and epidemic reporting, medical waste disposal, pathogenic microorganism laboratory biosafety management, organizational management, facility equipment, personnel allocation and capacity building, infectious disease investigation and epidemic control, information construction and application, preventive vaccination, and others; Among the 53 secondary risks, the top 10 risks were in the following order: One person, one use, one disinfection or sterilization of medical devices>Epidemic control of infectious diseases within the institution=Infection control (protection and isolation)=Compliance with laboratory operating procedures>Professional quality and sense of responsibility of personnel=Implementation of pre examination and triage work system=Hand hygiene>Treatment of infectious disease patients>Prevention and control of key infectious diseases>Compliance with infectious disease epidemic reports in accordance with the law.

Conclusion

In the pilot work of the disease control supervisor system, this study comprehensively applied the Delphi method, FMEA, and Borda ordinal value method to evaluate disease prevention risks, enabling more potential disease prevention risks that are easily overlooked to be identified, warned, tracked, and intervened in a timely manner, forming a closed loop and promoting the integration of medical and prevention. This is a new thinking and method that can provide a reference for various regions.

Pilot work on the system of disease control supervisors  /  Disease prevention  /  Risk  /  Delphi consultation  /  FMEA  /  Borda count methods
向泽林, 王小辽, 许加亮, 陆锦琪, 林惠芳, 周浩月, 富小飞, 贾磊, 时粉娟, 朱国英. 疾控监督员制度试点下医疗机构疾病预防风险评估研究:基于Delphi法、FMEA与Borda序值法的综合应用. 现代预防医学, 2026 , 53 (4) : 676 -681 . DOI: 10.20043/j.cnki.MPM.202507478
Ze-lin XIANG, Xiao-liao WANG, Jia-liang XU, Jin-qi LU, Hui-fang LIN, Hao-yue ZHOU, Xiao-fei FU, Lei JIA, Fen-juan SHI, Guo-ying ZHU. Research on disease prevention risk assessment in medical institutions under the pilot program of disease control supervisor system: A comprehensive application based on the Delphi method, FMEA, and Borda ranking method[J]. Modern Preventive Medicine, 2026 , 53 (4) : 676 -681 . DOI: 10.20043/j.cnki.MPM.202507478
长期以来,我国医疗卫生存在“重医轻防”倾向,导致公共卫生与临床服务衔接不畅。3年新冠疫情暴露出医疗机构在传染病防控意识上的薄弱,以及与疾控之间协同不足的深层次问题。随着公众健康需求升级,传统疾病防控模式已难以适应现实需要,系统短板与监管盲区逐步显现,院内感染及聚集性疫情等风险事件[1]时有发生。为压实医疗机构疾病预防控制主体责任,推动医防协同,国家于2023年8月在上海、浙江、四川、安徽、湖北、河南、广东、陕西、甘肃9省(市)启动疾控监督员制度试点[2-5],并于2024年8月将试点拓展至全国。该制度旨在构建前瞻性公共卫生防护网,通过强化监督机制,实现医疗机构疾病预防风险的早期识别、预警、处置与闭环管理,提升“四早”能力,最大限度降低风险事件发生概率。试点初见成效[4-6],在传染病监测、院感控制、生物安全等重点环节实现了风险的有效识别与规避。然而,当前部分医疗机构主体责任落实仍不到位,风险防范依然重要。为此,有必要在推进试点的同时,加快建立系统的疾病预防控制风险评估体系,利用德尔菲法(Delphi)[7] 、失效模式和效应分析(FMEA)[8-11]及Borda序值法[9,12]等工具模型,对潜在风险进行主动识别、评估与干预,推动风险从事后处置向事前预防转变,持续降低院感与传染病聚集性疫情风险发生。
浙江省疾控监督员管理平台;现场督导与调查;中国知网、PubMed等数据库;相关法规方案。
疾控监督员制度试点中,以医疗机构疾病预防风险为研究对象,综合应用Delphi法、FMEA、Borda序值法,通过专家筛选、风险识别、评估、干预开展二级以上医疗机构疾病预防风险评估。
根据从事疾病控制、医院感染年限(≥3年)、学历(≥本科)、职称(≥中级)等因素,从专职、兼职疾控监督员、防保专家、院感专家、行政管理5大相关专业领域按1:1各抽5名专家(累计25名),再利用专家积极系数[9]、专家权威程度CR[9]最后确定入选专家。CR由熟悉程度Cs和判断依据Ca决定,CR=(Ca+Cs)/2。见表1。
应用Delphi法通过2轮建立评价指标,并利用Kendall协调系数(W)[9]评价指标一致性。
FMEA结合Borda序值法
首先利用FMEA[9]确定评估对象为医疗机构疾病预防风险,接着对评估对象每一环节风险失效形式、后果进行分析,在此基础上分析失效的原因及发生的可能性O、严重性S和探测度D,采用10等级评分,并根据O、S、D评分值计算出风险优先指数RPN=O×S×D,最后确定风险大小并排列优先次序。见表2。
根据各评价者给出的N个被评估风险的群体Borda数(bi),从大到小进行排序,得到相应的Borda序值(即各风险的评估结果)。
初选的25名专家中,1名专家未作有效应答,1名专家权威程度不符合要求,剔除后最终23名专家纳入,平均年龄46.39±7.38岁;高级职称占78.26%。
2轮分别为96.00%、100%。
0.89±0.06(>0.70的可接受信度),其变异系数7.12%,说明专家权威程度高,结果可信。
2轮协调系数在0.386~0.572之间,综合专家组意见后,协调程度最高为:协调系数=0.572(χ2=72.163,P<0.01),协调系数>0.5,说明协调性好,结果可取[9-10]。
通过2轮指标筛选、修订,构建了包含10个一级风险、53个二级风险指标的《医疗机构疾病预防风险评估指标体系》。见表3。
(1)根据RPN排序:传染病救治防控=消毒隔离>传染病监测与疫情报告=医疗废物处置>病原微生物实验室生物安全管理=传染病流调与疫情控制>组织管理、设施设备、人员配备与能力建设>信息化建设与应用>预防接种>其他。(2)利用Borda序值改进后排序:传染病救治防控=消毒隔离>传染病监测与疫情报告>医疗废物处置>病原微生物实验室生物安全管理>组织管理、设施设备、人员配备与能力建设>传染病流调与疫情控制>信息化建设与应用>预防接种>其他。
根据原始FMEA得出的风险排序,并列第3位的有2项:“传染病监测与疫情报告”和“医疗废物处置”,而结合Borda序值法得到的Borda序值将以上2项细分为第3位和第4位,可见,Borda序值法完善了FMEA,得到的风险分级排序更细。见表4。
将53项二级指标进行风险评估并排序,Borda序值排在前10位的依次为医疗器械一人一用一消毒或灭菌>机构内传染病疫情控制=院感控制(防护及隔离)=实验室操作规程执行情况符合规定>人员专业素质、责任心=落实预检、分诊工作制度=手卫生>传染病患者救治>重点传染病防控>依法履行传染病疫情报告,风险等级排序后,优先对前十位风险提出了针对性措施,降低、规避风险的发生。见表5。
近年来,风险评估[8-13]、风险管理在卫生领域兴起,许多学者在传染病监测、医院管理等领域进行了探索与应用,提高了“四早”能力,规范了医院管理,减少了风险事故。笔者曾将风险评价技术与管理应用到预防接种领域[9],而将其运用到疾控监督员制度试点领域,未见文献报道,是一种新思维、新探索。
开展风险管理,必须通过风险识别、分析、评价等步骤对风险进行系统地评估,其关键是获得可靠的风险发生可能性、严重性及可探测性。FMEA[8-9]正是基于获得可靠的风险事件发生可能性、严重性及可探测性为原则,评估风险对项目风险发生的概率、潜在影响与风险探测难易,再根据预定标准评价风险等级,开展风险应对工作,弥补了专家会商法、Delphi法仅靠主观经验开展定性评估的片面性,实现定性与定量相结合,目前已在医疗、公共卫生领域多场景应用,但运用FMEA会遇到风险结问题(风险结即由风险等级评分值相同的风险点组成)。笔者在利用FMEA进行预防接种风险评估时显示[9],在起初运用FMEA对风险进行评估时,出现很多风险结,以致无法区分同一等级中多个风险的优先次序。为解决这一问题,后将Borda序值法引入,完善了原始FMEA,减少了风险结,分级排序更细致。
鉴于此,项目组在国家推行的“疾控监督员制度试点”中,创新性开展了疾病预防风险评估研究,综合应用Delphi、FMEA与Borda序值法评估疾病预防风险,避免了专家会商法、Delphi的的片面性,也解决的了FMEA法面临的风险结。这种方法组合既保证了指标体系的权威性和系统性,又通过FMEA与Borda法的联用,克服了传统FMEA在排序上的某些局限,使风险评估结果更为科学、可靠,该方法学本身可为同类研究提供重要的借鉴和参考。
研究构建了多维度疾病预防风险识别管理机制,创建了10项一级、53项二级疾病预防风险,并对所有风险划分等级并排序,目前医疗机构部分风险等级较高,针对潜在高风险,采取了优先措施,将高危风险降至低水平可控范围,规避风险事件的出现,提高疾病预防控制水平。本研究创建的2级风险体系,识别出目前医疗机构存在的主要疾病预防风险,并通过风险评级排序确定潜在高风险后,并优先对潜在的高风险采取了针对性的措施,降低了风险水平。研究具有较强的现实指导意义:一方面,识别出的关键风险点及其等级排序,能够直接为各级医疗机构在资源有限的情况下进行风险管理优先决策,提供清晰的数据支撑,解决其“面对众多风险,应从何处优先入手”的实际困惑。另一方面,整个研究是在国家最新试点政策下开展的,其输出的一套从风险识别到评估分级的管理思路,能够有效推进医疗机构的高质量发展和医防融合的实质深化。
  • 2025年度浙江省疾病预防控制科技计划项目(2025JK103)
  • 2024年浙江省康恩贝医院管理软科学研究项目(2024ZHA-KEB341)
  • 浙江省疾病预防控制创新培育团队(2026JKP-07)
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2026年第53卷第4期
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doi: 10.20043/j.cnki.MPM.202507478
  • 接收时间:2025-07-31
  • 首发时间:2026-11-02
  • 出版时间:2026-02-25
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  • 收稿日期:2025-07-31
基金
2025年度浙江省疾病预防控制科技计划项目(2025JK103)
2024年浙江省康恩贝医院管理软科学研究项目(2024ZHA-KEB341)
浙江省疾病预防控制创新培育团队(2026JKP-07)
作者信息
    1.嘉兴市疾病预防控制中心,浙江 嘉兴 314050
    2.嘉兴市卫生健康委员会
    3.上虞区疾病预防控制中心
    4.嘉兴市第一医院
    5.嘉兴中医院

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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
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