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Article(id=1325521022144872487, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325520723858568134, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025165, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742140800000, receivedDateStr=2025-03-17, revisedDate=1745856000000, revisedDateStr=2025-04-29, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958438668, onlineDateStr=2026-11-06, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958438668, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958438668, creator=13701087609, updateTime=1793958438668, updator=13701087609, issue=Issue{id=1325520723858568134, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='6', pageStart='761', pageEnd='912', issueExtLink='null', onlineDate='null', pubDate='1750780800000', pubDateStr='2025-06-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958367551, creator='13701087609', updateTime=1793958367551, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=868, endPage=872, ext={EN=ArticleExt(id=1325521022522359848, articleId=1325521022144872487, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Risk assessment analysis of infectious disease prevention and control in schools of Shangcheng District, Hangzhou, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To establish a risk assessment system for infectious disease prevention and control in schools in Shangcheng District, Hangzhou and determine risk levels for each school, and propose corresponding risk management measures, so as to provide a scientific reference for infectious disease prevention and control in primary and secondary schools.

Methods

Based on the Failure Mode and Effects Analysis (FMEA) method, potential failure analysis and current situation investigation of infectious disease prevention and control risks were conducted in 110 primary and secondary schools from 2022 to 2024 in Shangcheng District, Hangzhou. Risk levels were classified using K-Means cluster analysis.

Results

Through expert panel discussions using FMEA, 6 first-level indicators and 28 second-level indicators were identified. The top three risk priority numbers were implementation of required prevention and control measures for clustered infectious disease outbreaks in schools in the past three years (189.00), student morning/afternoon health checks (168.00), and reporting status of clustered infectious disease outbreaks in schools in the past three years (144.00). The comprehensive prevention scores of schools ranged from 61.00 to 98.00 (mean: 87.40). There were no statistically significant differences in the average scores(primary school: 88.17±7.39, nine-year consistent education: 86.26±7.68, junior high school: 85.55±8.20, and high school: 88.72±4.91) and risk level distribution of schools with different educational stages(F/H=0.95, 1.47, P>0.05).K-Means cluster analysis divided the schools into 5 risk levels with cluster centers at 93.25, 85.78, 79.69, 70.29, 61.00 (F=309.21, P < 0.05), with 80% of schools classified as low-risk or below.

Conclusion

The infectious disease prevention and control risk assessment system for primary and secondary schools can be established, and hierarchical management can be conducted according to school risk levels, thereby improving the efficiency and effectiveness of school infectious disease prevention and control, and enhancing the precision and sustainability of prevention efforts.

, authors=Ying YAO, Kuangming YU*, Jiayi SUN, Siqing JIANG, Hui WANG, authorsList=Ying YAO, Kuangming YU, Jiayi SUN, Siqing JIANG, Hui WANG, authorCompany=null, correspAuthors=Kuangming YU, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., 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=1325521022975344681, articleId=1325521022144872487, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=杭州市上城区学校传染病疫情防控风险评估分析, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

建立杭州市上城区学校传染病防控风险评估体系并确定各学校风险等级，并提出相应风险管理措施，为中小学校传染病防控工作提供科学的参考依据。

方法

基于失效模式和效应分析方法(FMEA)，对2022—2024年杭州市上城区110所中小学校进行传染病防控风险潜在失效分析及现状调查，并通过K-Means聚类分析法划分风险等级。

结果

通过FMEA专家小组讨论，确定6个一级指标和28个二级指标，风险数前3位的分别为近3年学校发生传染病聚集性疫情按要求落实防控措施情况(189.00)、学生晨午/晚检情况(168.00)和近3年学校发生传染病聚集性疫情上报情况(144.00)。学校防控综合得分范围为61.00~98.00分(均值87.40)，不同学段的学校平均得分和风险等级分布差异均无统计学意义(F/H值分别为0.95，1.47，P值均>0.05)。经K-Means聚类分析，以聚类中心93.25，85.78，79.69，70.29和61.00分划分为5个风险等级(F=309.21，P < 0.05)，80%的学校属较低风险及以下。

结论

建立中小学校传染病防控风险评估体系，并根据学校风险等级分级进行管理，可以提高学校传染病防控的效率和效果，以进一步提升防控精准度与可持续性。

, authors=姚英, 郁旷明*, 孙家逸, 蒋思清, 汪慧, authorsList=姚英, 郁旷明, 孙家逸, 蒋思清, 汪慧, authorCompany=null, correspAuthors=郁旷明, authorNote=

姚英和孙家逸为共同第一作者。

姚英(1983-)，女，浙江杭州人，大学本科，主管医师，主要从事传染病控制方面的工作

孙家逸(1995-)，男，浙江绍兴人，大学本科，医师，主要从事传染病预防控制方面的工作

, correspAuthorsNote=
郁旷明，E-mail:
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姚英(1983-)，女，浙江杭州人，大学本科，主管医师，主要从事传染病控制方面的工作

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孙家逸(1995-)，男，浙江绍兴人，大学本科，医师，主要从事传染病预防控制方面的工作

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(in Chinese), articleTitle=null, refAbstract=null)], funds=[Fund(id=1325521033024897110, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, awardId=null, language=CN, fundingSource=杭州市医药卫生科技项目(B20230920), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325521023352832042, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, xref=null, ext=[AuthorCompanyExt(id=1325521023361220651, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, companyId=1325521023352832042, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shangcheng District Center for Disease Control and Prevention (Shangcheng District Health Supervision Institute), Hangzhou (310009), Zhejiang Province, China), AuthorCompanyExt(id=1325521023369609260, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, companyId=1325521023352832042, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=杭州市上城区疾病预防控制中心(上城区卫生监督所)，浙江 310009)])], figs=[ArticleFig(id=1325521028771872846, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=EN, label=Tab.1, caption=

Risk indicators and scores for infectious disease prevention and control among primary and secondary schools in Shangcheng District, Hangzhou City

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标得分(x±s)得分率/%
1.传染病防控制度及保障(13分)10.62±2.0681.69
传染病预防控制工作小组(2分)1.50±0.3397.50
传染病防控年度工作计划或方案(3分)1.59±0.1994.50
传染病防控相关制度(3分)2.90±0.4196.67
传染病防控专项经费(3分)1.09±1.4536.33
传染病防控工作纳入年度工作考核(3分)2.70±0.9090.00
2.传染病常规监测(34分)31.50±3.5692.65
开展学生晨午/晚检情况(8分)7.93±0.7699.13
开展学生因病缺课登记情况(6分)5.26±1.1687.67
班级因病缺课相关情况及时上报(6分)5.84±0.9897.33
使用传染病症状监测预警系统开展工作(3分)2.40±1.2180.00
明确传染病疫情报告人和班级传染病症状监测报告人(4分)4.00±0.00100.00
开展教职员工症状监测(4分)3.45±1.3886.25
开展教职员工因病缺勤监测(3分)2.62±1.0087.33
3.传染病培训及演练(7分)6.00±1.8285.71
组织/参加过对校医务室及传染病报告人的传染病防控知识培训(3分)2.54±1.0984.67
2023年参与卫生健康部门对学校开展传染病防控培训情况(1分)0.92±0.2892.00
2023年组织开展传染病疫情及相关突发公共卫生事件应急演练情况(3分)2.54±1.0984.67
4.传染病健康教育(9分)8.37±1.3193.00
传染病健康教育纳入工作计划(1分)0.92±0.2892.00
定期开展传染病健康教育课程(3分)2.75±0.8391.67
教职员工开展传染病防控健康教育(3分)2.97±0.2999.00
家长开展传染病防控健康教育(2分)1.73±0.6986.50
5.传染病疫情控制(24分)20.41±2.8985.04
近3年学校发生传染病聚集性疫情情况(3分)0.35±0.9711.67
近3年学校发生传染病聚集性疫情上报情况(7分)7.00±0.00100.00
近3年学校发生传染病聚集性疫情按要求落实防控措施情况(8分)7.05±2.5988.13
辖区社区卫生服务中心或疾控中心沟通联系良好(6分)6.00±0.00100.00
6.基础卫生建设(13分)10.50±1.1680.77
卫生间卫生(3分)2.24±0.5474.67
食堂卫生(3分)2.95±0.2198.33
教室卫生(3分)2.43±0.8281.00
卫生室设置情况(2分)1.89±0.3184.50
卫生老师配置数情况(600∶1)(2分)0.99±0.0149.50
), ArticleFig(id=1325521030457983055, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=CN, label=表1, caption=

杭州市上城区中小学校传染病防控风险指标及得分情况

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标得分(x±s)得分率/%
1.传染病防控制度及保障(13分)10.62±2.0681.69
传染病预防控制工作小组(2分)1.50±0.3397.50
传染病防控年度工作计划或方案(3分)1.59±0.1994.50
传染病防控相关制度(3分)2.90±0.4196.67
传染病防控专项经费(3分)1.09±1.4536.33
传染病防控工作纳入年度工作考核(3分)2.70±0.9090.00
2.传染病常规监测(34分)31.50±3.5692.65
开展学生晨午/晚检情况(8分)7.93±0.7699.13
开展学生因病缺课登记情况(6分)5.26±1.1687.67
班级因病缺课相关情况及时上报(6分)5.84±0.9897.33
使用传染病症状监测预警系统开展工作(3分)2.40±1.2180.00
明确传染病疫情报告人和班级传染病症状监测报告人(4分)4.00±0.00100.00
开展教职员工症状监测(4分)3.45±1.3886.25
开展教职员工因病缺勤监测(3分)2.62±1.0087.33
3.传染病培训及演练(7分)6.00±1.8285.71
组织/参加过对校医务室及传染病报告人的传染病防控知识培训(3分)2.54±1.0984.67
2023年参与卫生健康部门对学校开展传染病防控培训情况(1分)0.92±0.2892.00
2023年组织开展传染病疫情及相关突发公共卫生事件应急演练情况(3分)2.54±1.0984.67
4.传染病健康教育(9分)8.37±1.3193.00
传染病健康教育纳入工作计划(1分)0.92±0.2892.00
定期开展传染病健康教育课程(3分)2.75±0.8391.67
教职员工开展传染病防控健康教育(3分)2.97±0.2999.00
家长开展传染病防控健康教育(2分)1.73±0.6986.50
5.传染病疫情控制(24分)20.41±2.8985.04
近3年学校发生传染病聚集性疫情情况(3分)0.35±0.9711.67
近3年学校发生传染病聚集性疫情上报情况(7分)7.00±0.00100.00
近3年学校发生传染病聚集性疫情按要求落实防控措施情况(8分)7.05±2.5988.13
辖区社区卫生服务中心或疾控中心沟通联系良好(6分)6.00±0.00100.00
6.基础卫生建设(13分)10.50±1.1680.77
卫生间卫生(3分)2.24±0.5474.67
食堂卫生(3分)2.95±0.2198.33
教室卫生(3分)2.43±0.8281.00
卫生室设置情况(2分)1.89±0.3184.50
卫生老师配置数情况(600∶1)(2分)0.99±0.0149.50
), ArticleFig(id=1325521030848053329, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=EN, label=Tab.2, caption=

Failure analysis of infectious disease prevention and control risks in primary and secondary schools in Shangcheng District, Hangzhou City

, figureFileSmall=null, figureFileBig=null, tableContent=
二级指标潜在失效模式SODRPN
近3年学校发生传染病聚集性疫情按要求落实防控措施情况防控措施落实不到位或者不落实7.006.004.50189.00
学生晨午/晚检情况不开展晨午检或流于形式8.006.003.50168.00
近3年学校发生传染病聚集性疫情上报情况未上报疫情或上报不及时6.006.004.00144.00
学生因病缺课登记情况未做因病缺课登记或登记不全7.006.503.00136.50
班级因病缺课相关情况及时上报班级因病缺课情况不上报或上报不及时7.006.503.00136.50
辖区社区卫生服务中心或疾控中心沟通联系良好缺乏沟通联系6.505.503.50125.13
开展教职员工症状监测未开展教职员工症状监测5.505.503.0090.75
明确传染病疫情报告人和班级传染病症状监测报告人疫情报告人不明确6.005.003.0090.00
传染病防控专项经费无专项经费6.004.003.5084.00
卫生间卫生无独立卫生间、未配备手清洗物品及规范消毒6.005.002.5075.00
使用传染病症状监测预警系统开展工作未开展任何形式的传染病症状监测预警系统5.505.002.5068.75
开展教职员工因病缺勤监测未开展教职员工因病缺勤监测5.004.503.0067.50
食堂卫生未配备专门清洗消毒餐盘的消毒设置、手清洗物品及相关预防性消毒工作未开展6.504.002.5065.00
近3年学校发生传染病聚集性疫情情况从未发生疫情3.504.504.0063.00
教室卫生未配备应急消毒用品以及个人防护用品、通风不良及相关预防性消毒工作未开展5.504.502.5061.88
传染病防控工作纳入年度工作考核未将传染病防控工作纳入年度工作考核5.003.503.5061.25
定期开展传染病健康教育课程未定期开展传染病健康教育课程5.003.503.5061.25
传染病防控相关制度无制度或者各项制度不全6.005.002.0060.00
组织/参加过对校医务室及传染病报告人的传染病防控知识培训从未参加传染病防控专业培训5.503.503.0057.75
教职员工开展传染病防控健康教育从未对教职员工开展传染病防控健康教育5.503.003.5057.75
2023年组织开展传染病疫情及相关突发公共卫生事件应急演练情况未开展5.004.502.5056.25
卫生老师配置数情况(600∶1)未配备或配备不足5.504.502.0049.50
传染病防控年度工作计划或方案缺少传染病防控年度工作计划或方案5.504.002.0044.00
家长开展传染病防控健康教育从未对家长开展传染病防控健康教育4.003.003.5042.00
传染病预防控制工作小组缺少传染病预防控制工作小组6.503.002.0039.00
卫生室设置情况卫生室、隔离观察室未设置6.003.002.0036.00
2023年参与卫生健康部门对学校开展传染病防控培训情况未参与5.003.502.0035.00
传染病健康教育纳入工作计划未将传染病健康教育工作纳入工作计划5.003.002.0030.00
), ArticleFig(id=1325521031246512210, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=CN, label=表2, caption=

杭州市上城区中小学校传染病防控风险失效分析

, figureFileSmall=null, figureFileBig=null, tableContent=
二级指标潜在失效模式SODRPN
近3年学校发生传染病聚集性疫情按要求落实防控措施情况防控措施落实不到位或者不落实7.006.004.50189.00
学生晨午/晚检情况不开展晨午检或流于形式8.006.003.50168.00
近3年学校发生传染病聚集性疫情上报情况未上报疫情或上报不及时6.006.004.00144.00
学生因病缺课登记情况未做因病缺课登记或登记不全7.006.503.00136.50
班级因病缺课相关情况及时上报班级因病缺课情况不上报或上报不及时7.006.503.00136.50
辖区社区卫生服务中心或疾控中心沟通联系良好缺乏沟通联系6.505.503.50125.13
开展教职员工症状监测未开展教职员工症状监测5.505.503.0090.75
明确传染病疫情报告人和班级传染病症状监测报告人疫情报告人不明确6.005.003.0090.00
传染病防控专项经费无专项经费6.004.003.5084.00
卫生间卫生无独立卫生间、未配备手清洗物品及规范消毒6.005.002.5075.00
使用传染病症状监测预警系统开展工作未开展任何形式的传染病症状监测预警系统5.505.002.5068.75
开展教职员工因病缺勤监测未开展教职员工因病缺勤监测5.004.503.0067.50
食堂卫生未配备专门清洗消毒餐盘的消毒设置、手清洗物品及相关预防性消毒工作未开展6.504.002.5065.00
近3年学校发生传染病聚集性疫情情况从未发生疫情3.504.504.0063.00
教室卫生未配备应急消毒用品以及个人防护用品、通风不良及相关预防性消毒工作未开展5.504.502.5061.88
传染病防控工作纳入年度工作考核未将传染病防控工作纳入年度工作考核5.003.503.5061.25
定期开展传染病健康教育课程未定期开展传染病健康教育课程5.003.503.5061.25
传染病防控相关制度无制度或者各项制度不全6.005.002.0060.00
组织/参加过对校医务室及传染病报告人的传染病防控知识培训从未参加传染病防控专业培训5.503.503.0057.75
教职员工开展传染病防控健康教育从未对教职员工开展传染病防控健康教育5.503.003.5057.75
2023年组织开展传染病疫情及相关突发公共卫生事件应急演练情况未开展5.004.502.5056.25
卫生老师配置数情况(600∶1)未配备或配备不足5.504.502.0049.50
传染病防控年度工作计划或方案缺少传染病防控年度工作计划或方案5.504.002.0044.00
家长开展传染病防控健康教育从未对家长开展传染病防控健康教育4.003.003.5042.00
传染病预防控制工作小组缺少传染病预防控制工作小组6.503.002.0039.00
卫生室设置情况卫生室、隔离观察室未设置6.003.002.0036.00
2023年参与卫生健康部门对学校开展传染病防控培训情况未参与5.003.502.0035.00
传染病健康教育纳入工作计划未将传染病健康教育工作纳入工作计划5.003.002.0030.00
), ArticleFig(id=1325521031745634388, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=EN, label=Tab.3, caption=

Division distribution of responsibilities among management entities for infectious disease prevention and control in primary and secondary schools at different risk levels in Shangcheng District, Hangzhou City

, figureFileSmall=null, figureFileBig=null, tableContent=
风险等级综合得分管理主体合计
(n=110)		小学
(n=58)		九年一贯
(n=17)		初中
(n=23)		高中
(n=12)
高风险< 67每月属地疾控中心、社区卫生服务中心和区教育局共同督导1(0.91)1(1.72)000
较高风险68~77每月属地社区卫生服务中心按要求督导，属地疾控中心和区教育局定期抽查指导7(6.36)2(3.45)2(11.76)3(13.04)0
中风险78~82每月属地社区卫生服务中心按要求督导，属地疾控中心定期抽查指导14(12.73)9(15.52)2(11.76)2(8.70)1(8.33)
较低风险83~89每月属地社区卫生服务中心按要求督导35(31.82)14(24.14)5(29.41)9(39.13)7(58.33)
低风险>89属地社区卫生服务中心定期抽查53(48.18)32(55.17)8(47.06)9(39.13)4(33.33)
), ArticleFig(id=1325521032177647701, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521022144872487, language=CN, label=表3, caption=

杭州市上城区中小学校传染病防控不同风险等级管理主体分工分布

, figureFileSmall=null, figureFileBig=null, tableContent=
风险等级综合得分管理主体合计
(n=110)		小学
(n=58)		九年一贯
(n=17)		初中
(n=23)		高中
(n=12)
高风险< 67每月属地疾控中心、社区卫生服务中心和区教育局共同督导1(0.91)1(1.72)000
较高风险68~77每月属地社区卫生服务中心按要求督导，属地疾控中心和区教育局定期抽查指导7(6.36)2(3.45)2(11.76)3(13.04)0
中风险78~82每月属地社区卫生服务中心按要求督导，属地疾控中心定期抽查指导14(12.73)9(15.52)2(11.76)2(8.70)1(8.33)
较低风险83~89每月属地社区卫生服务中心按要求督导35(31.82)14(24.14)5(29.41)9(39.13)7(58.33)
低风险>89属地社区卫生服务中心定期抽查53(48.18)32(55.17)8(47.06)9(39.13)4(33.33)
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杭州市上城区学校传染病疫情防控风险评估分析
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姚英 , 郁旷明 * , 孙家逸 , 蒋思清 , 汪慧
中国学校卫生 | 疾病控制 2025,46(6): 868-872
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中国学校卫生 |疾病控制 2025 , 46 (6) : 868 -872
杭州市上城区学校传染病疫情防控风险评估分析
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姚英, 郁旷明* , 孙家逸, 蒋思清, 汪慧
作者信息
  • 杭州市上城区疾病预防控制中心(上城区卫生监督所)，浙江 310009
通讯作者:
郁旷明，E-mail:
作者简介:

姚英和孙家逸为共同第一作者。

姚英(1983-)，女，浙江杭州人，大学本科，主管医师，主要从事传染病控制方面的工作

孙家逸(1995-)，男，浙江绍兴人，大学本科，医师，主要从事传染病预防控制方面的工作

Risk assessment analysis of infectious disease prevention and control in schools of Shangcheng District, Hangzhou
Ying YAO, Kuangming YU* , Jiayi SUN, Siqing JIANG, Hui WANG
Affiliations
  • Shangcheng District Center for Disease Control and Prevention (Shangcheng District Health Supervision Institute), Hangzhou (310009), Zhejiang Province, China
出版时间: 2025-06-25 doi: 10.16835/j.cnki.1000-9817.2025165
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摘要
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目的

建立杭州市上城区学校传染病防控风险评估体系并确定各学校风险等级，并提出相应风险管理措施，为中小学校传染病防控工作提供科学的参考依据。

方法

基于失效模式和效应分析方法(FMEA)，对2022—2024年杭州市上城区110所中小学校进行传染病防控风险潜在失效分析及现状调查，并通过K-Means聚类分析法划分风险等级。

结果

通过FMEA专家小组讨论，确定6个一级指标和28个二级指标，风险数前3位的分别为近3年学校发生传染病聚集性疫情按要求落实防控措施情况(189.00)、学生晨午/晚检情况(168.00)和近3年学校发生传染病聚集性疫情上报情况(144.00)。学校防控综合得分范围为61.00~98.00分(均值87.40)，不同学段的学校平均得分和风险等级分布差异均无统计学意义(F/H值分别为0.95，1.47，P值均>0.05)。经K-Means聚类分析，以聚类中心93.25，85.78，79.69，70.29和61.00分划分为5个风险等级(F=309.21，P < 0.05)，80%的学校属较低风险及以下。

结论

建立中小学校传染病防控风险评估体系，并根据学校风险等级分级进行管理，可以提高学校传染病防控的效率和效果，以进一步提升防控精准度与可持续性。

传染病控制  /  危险性评估  /  聚类分析  /  学生保健服务
Objective

To establish a risk assessment system for infectious disease prevention and control in schools in Shangcheng District, Hangzhou and determine risk levels for each school, and propose corresponding risk management measures, so as to provide a scientific reference for infectious disease prevention and control in primary and secondary schools.

Methods

Based on the Failure Mode and Effects Analysis (FMEA) method, potential failure analysis and current situation investigation of infectious disease prevention and control risks were conducted in 110 primary and secondary schools from 2022 to 2024 in Shangcheng District, Hangzhou. Risk levels were classified using K-Means cluster analysis.

Results

Through expert panel discussions using FMEA, 6 first-level indicators and 28 second-level indicators were identified. The top three risk priority numbers were implementation of required prevention and control measures for clustered infectious disease outbreaks in schools in the past three years (189.00), student morning/afternoon health checks (168.00), and reporting status of clustered infectious disease outbreaks in schools in the past three years (144.00). The comprehensive prevention scores of schools ranged from 61.00 to 98.00 (mean: 87.40). There were no statistically significant differences in the average scores(primary school: 88.17±7.39, nine-year consistent education: 86.26±7.68, junior high school: 85.55±8.20, and high school: 88.72±4.91) and risk level distribution of schools with different educational stages(F/H=0.95, 1.47, P>0.05).K-Means cluster analysis divided the schools into 5 risk levels with cluster centers at 93.25, 85.78, 79.69, 70.29, 61.00 (F=309.21, P < 0.05), with 80% of schools classified as low-risk or below.

Conclusion

The infectious disease prevention and control risk assessment system for primary and secondary schools can be established, and hierarchical management can be conducted according to school risk levels, thereby improving the efficiency and effectiveness of school infectious disease prevention and control, and enhancing the precision and sustainability of prevention efforts.

Communicable disease control  /  Risk assessment  /  Cluster analysis  /  Student health services
姚英, 郁旷明, 孙家逸, 蒋思清, 汪慧. 杭州市上城区学校传染病疫情防控风险评估分析. 中国学校卫生, 2025 , 46 (6) : 868 -872 . DOI: 10.16835/j.cnki.1000-9817.2025165
Ying YAO, Kuangming YU, Jiayi SUN, Siqing JIANG, Hui WANG. Risk assessment analysis of infectious disease prevention and control in schools of Shangcheng District, Hangzhou[J]. Chinese Journal of School Health, 2025 , 46 (6) : 868 -872 . DOI: 10.16835/j.cnki.1000-9817.2025165
正文
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学校是发生传染病突发公共卫生事件的高危场所，一旦有传染源进入学校，极易造成学校内传染病的传播和流行，影响师生健康并可能扩散至家庭和社会[1]。近年来，传染病的防控需求不断增加、新发传染病的发生频率逐渐上升，风险评估被广泛应用于不同种类的传染病防控，并取得显著效果[2]。失效模式与效应分析(failure mode and effects analysis，FMEA)是一种前瞻性的、有效的风险管理分析方法，在传染病疫情管理及医疗领域应用效果良好[3-5]。本研究针对学校传染病疫情特点及学校传染病防控存在的不足和薄弱环节，结合2022—2024年杭州市上城区学校传染病疫情报告情况，采用FMEA方法，建立杭州市上城区学校传染病防控风险评估体系，通过现场调查和评估，确定各学校风险等级，根据不同风险等级提出风险管理措施，为中小学校传染病防控工作提供参考依据。
1　对象与方法
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1.1　对象
杭州市上城区辖区共有110所中小学校，按照属地管理划分，区属100所，市属10所；小学58所，九年一贯17所，初中23所，高中12所(普通高中5所和职业高中7所)。
1.2　方法
1.2.1　成立FMEA专家小组
小组成员由学校保健老师，市、区两级疾病预防控制中心(以下简称“疾控中心”)工作人员，区属社区卫生服务中心工作人员共12位专家组成。参考《中小学校传染病预防控制工作管理规范》(GB 28932—2012)、《学校卫生综合评价》(GB/T 18205—2012)》[6-7]及相关工作要求，通过“头脑风暴法”和“专家访谈法”结合2022—2024年学校传染病疫情报告情况、传染病防控制度及措施落实、人员配备等防控情况，确定辖区学校传染病防控工作关键环节中的一级指标和二级指标。
1.2.2　制定FMEA分析表
FMEA模式的核心是计算失效模式的风险数(risk priority number, RPN)，为严重度(severity, S)、失效模式出现频率(fequency of occurrence, O)、探测失效模式水平(likelihood of detection, D)3类指标的乘积(RPN=S×O×D[8])。其中S、O、D分别用1~10分[9]表示，1分表示程度最低，10分表示程度最高，RPN的取值在1~1 000之间，数值越大则风险越高。等级分值的赋值由专家小组成员根据相关工作要求、参考文献及经验充分讨论而定。各位专家各自对一级指标和二级指标及潜在失效模式进行S、O、D各项评分，通过整理统计分别得出3类指标的中位数，并将中位数相乘计算各指标的RPN，把计算所得RPN值从高到低排序制定FMEA分析表。
1.3　编制学校传染病防控现状调查表
根据FMEA分析表内容，编制生成杭州市上城区学校传染病防控现状调查表(问卷)，对辖区110所中小学校传染病防控开展现状调查。问卷主要包括学校基本情况、传染病防控制度及保障、学生晨午(晚)检及因病缺勤登记等常规监测、培训及演练、健康教育、疫情控制和基础卫生建设等内容，总分为100分，各项指标根据RPN权重赋分，平均得分率=各指标平均得分数/各指标总分数。课题组成员经过培训统一标准，对学校卫生工作负责人或校医进行调查，按要求填写电子问卷，项目负责人全程在线指导。调查结束后，项目负责人进行数据清理核查，对不合格问卷重新调查，保证数据的真实可靠性。
1.4　统计学分析
采用Excel 2013软件进行数据录入并建立数据库，应用SPSS 23.0统计软件分析。计数资料用频数或百分率描述，计量资料用(x±s)描述。不同学段学校平均得分及不同聚类中心得分比较采用方差分析；不同学段学校风险等级分布比较采用Kruskal-Wallis H非参数检验，风险等级划分采用K-Means聚类分析。检验水准α=0.05。
2　结果
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2.1　杭州市上城区中小学校传染病防控风险指标失效分析
2.1.1　学校传染病防控风险指标分析和确定
根据FMEA专家小组讨论，确定传染病防控制度及保障、传染病常规监测、传染病培训及演练、传染病健康教育、传染病疫情控制和基础卫生建设6个一级指标和28个二级指标，见表1。
2.1.2　学校传染病防控风险指标失效分析
计算各个指标环节的RPN，从高到低排序制定FMEA分析表。前3位分别为近3年学校发生传染病聚集性疫情按要求落实防控措施情况(189.00)、学生晨午/晚检情况(168.00)和近3年学校发生传染病聚集性疫情上报情况(144.00)。见表2。
2.2　杭州市上城区中小学校传染病防控现状
2.2.1　中小学校传染病防控风险指标得分评估
根据杭州市上城区中小学校传染病防控风险失效分析表设计中小学校传染病防控现状调查问卷，对杭州市上城区110所中小学开展调查，涉及14个街道，问卷应答率100%。学校最高得分98.00分，最低得分61.00分，平均得分87.40分，不同学段的学校平均得分分别为小学(88.17±7.39)分、九年一贯制(86.26±7.68)分、初中(85.55±8.20)分和高中(88.72±4.91)分，差异无统计学意义(F=0.95，P>0.05)。一级指标中传染病防控制度及保障、传染病常规监测、传染病培训及演练、传染病健康教育、传染病疫情控制和基础卫生建设平均得分率分别为81.69%，92.65%，85.71%，93.00%，85.04%和80.77%。二级指标中明确传染病疫情报告人和班级传染病症状监测报告人、近3年学校发生传染病聚集性疫情上报情况和辖区社区卫生服务中心或疾控中心沟通联系良好平均得分率最高，均为100.00%。近3年学校发生传染病聚集性疫情情况平均得分率最低，为11.67%。见表1。
2.2.2　中小学校传染病防控风险等级评估
不同学段学校风险等级分布差异无统计学意义(H=1.47，P＞0.05)。使用K-Means聚类分析法将学校传染病防控综合得分以聚类中心93.25，85.78，79.69，70.29和61.00分划分为5个风险等级(F=309.21，P＜0.05)，从高到低分别为高风险、较高风险、中风险、较低风险和低风险，分别对应属地疾控中心、社区卫生服务中心和区教育局不同主体联合或定期督导进行管理。见表3。
3　讨论
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学校在传染病防控工作中存在一定的风险，是目前国内外面临的一个共同问题[10]。本研究结果显示，RPN前5位的风险失效模式，分别为近3年学校发生传染病聚集性疫情按要求落实防控措施情况、学生晨午/晚检情况、近3年学校发生传染病聚集性疫情上报情况、学生因病缺课登记情况和班级因病缺课相关情况及时上报。提示FMEA模式风险评估专家认为这些环节在学校传染病防控工作中存在较大的潜在风险，需优先关注和管理[11-12]。
本研究显示，杭州市上城区中小学校传染病防控综合平均得分为87.40分，总体处于中等偏上水平[13]。虽然专家评估中传染病常规监测失效模式RPN分值较高，但调查结果显示一级指标中传染病常规监测平均得分率(92.65%)较高，二级指标中明确疫情和症状监测报告人、疫情上报及时性及与卫生部门沟通情况均达满分，表明杭州市近年推行的“医校联动”和“卫教会商”机制，并定期在新学期开学前组织学校分管领导进行传染病防控培训等多项措施取得了效果。传染病健康教育平均得分率最高(93.00%)，可能因为杭州市是国内最早参加世界卫生组织健康促进学校试点项目的城市，并全覆盖中学、小学、幼儿园各个学段学校[14]。
本研究显示在二级指标中近3年学校发生传染病聚集性疫情情况的平均得分率为11.67%，明显低于其他各二级指标，可能由于学校人群聚集，流动性强，接触面广，是传染病的易发场所[15]。但学校传染病防控工作落实到位平均得分率为88.13%，提示学校发生聚集性疫情后病例及时发现、隔离、消毒等各项防控措施均落实到位。另基础卫生资源配置不均，绝大多数学校的卫生间、食堂、教室等场所的卫生条件较好，配备了必要的消毒设施和物品，但卫生老师配置平均得分率仅为49.50%，所有学校的卫生老师配置数均未达到600∶1的标准[16]，与唐小哲等[17-18]调查研究一致，表明有关部门应加强卫生老师配备，将卫生老师配备纳入学校考核硬性指标，解决好卫生老师队伍的晋升、待遇等问题，确保学校卫生工作人员的综合素质达标。
本研究结果显示，根据学校传染病防控综合得分以聚类分析划分5个风险等级，不同学段的学校风险等级差异无统计学意义，80%的学校纳入较低风险及以下等级，提示当前以社区卫生服务中心为主体的分级督导模式能够覆盖多数学校的常态化防控需求[19]。7.27%的学校为较高风险以上等级，需属地疾控中心、社区卫生服务中心和区教育局共同参与管理，强化联合督导频次，重点解决防控短板。这种分级管理模式通过多部门协作，属地社区卫生服务中心熟悉辖区学校情况，实行属地化管理和督查，属地疾控中心负责技术指导与统筹协调，提供专业防控方案和相关防控措施补查，区教育局负责行政协调与资源调配，督促学校落实防控措施[20]，保障教学秩序稳定。三者分工互补，不仅能推动学校完善各项防控措施，提高学校传染病防控的效率和效果，提升防控精准度与可持续性。此外，风险等级划分基于本次调查得分，需动态跟踪管理策略的实施效果，并根据当前防控特点和学校措施行为落实情况定期更新优化潜在失效模式和风险等级。
基金
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  • 杭州市医药卫生科技项目(B20230920)
文献
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参考文献 引证文献
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2025年第46卷第6期
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doi: 10.16835/j.cnki.1000-9817.2025165
  • 接收时间：2025-03-17
  • 首发时间：2026-11-06
  • 出版时间：2025-06-25
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  • 收稿日期：2025-03-17
  • 修回日期：2025-04-29
基金
杭州市医药卫生科技项目(B20230920)
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    杭州市上城区疾病预防控制中心(上城区卫生监督所)，浙江 310009

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郁旷明，E-mail:
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2种不同金属材料的力学参数
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Family		 属数
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
species (%)
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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