本文選題：感 + 防控��； 參考：《華中科技大學(xué)》2009年碩士論文

【摘要】：研究目的: 本研究在總結(jié)分析發(fā)達(dá)國(guó)家突發(fā)公共衛(wèi)生事件應(yīng)急管理體系實(shí)踐經(jīng)驗(yàn)的基礎(chǔ)上,通過(guò)對(duì)縣級(jí)醫(yī)療衛(wèi)生機(jī)構(gòu)的人禽流感/流感大流行應(yīng)急能力進(jìn)行調(diào)查與評(píng)估,發(fā)現(xiàn)縣級(jí)醫(yī)療衛(wèi)生機(jī)構(gòu)應(yīng)對(duì)流感大流行的特點(diǎn)以及存在的突出問(wèn)題,在此基礎(chǔ)上,為進(jìn)一步完善我國(guó)縣級(jí)醫(yī)療衛(wèi)生機(jī)構(gòu)流感大流行應(yīng)急管理體系提供科學(xué)依據(jù)和政策性建議,提高我國(guó)流感大流行的應(yīng)對(duì)能力,從而有效保護(hù)廣大人民的生命財(cái)產(chǎn)安全,維護(hù)社會(huì)的穩(wěn)定和經(jīng)濟(jì)的可持續(xù)發(fā)展。 研究?jī)?nèi)容與方法: 在文獻(xiàn)查閱與情報(bào)分析的基礎(chǔ)上,進(jìn)行現(xiàn)場(chǎng)調(diào)研,并運(yùn)用卡方分析、描述性分析等研究方法,對(duì)縣級(jí)醫(yī)療衛(wèi)生機(jī)構(gòu)的流感大流行防控政策與制度、監(jiān)測(cè)與預(yù)警體系,臨床醫(yī)療服務(wù)提供能力、資金及應(yīng)急物資的籌備能力、應(yīng)急人力資源貯備以及政府和防控相關(guān)部門的協(xié)作力度等進(jìn)行分析。 研究結(jié)果: 1.美國(guó)突發(fā)公共衛(wèi)生事件管理體系對(duì)我國(guó)的啟示(1)強(qiáng)烈的危機(jī)意識(shí);(2)獨(dú)立完善的綜合應(yīng)急組織體系;(3)全社會(huì)型的聯(lián)動(dòng)系統(tǒng);(4)快捷高效的運(yùn)作機(jī)制。 2.安徽省縣級(jí)醫(yī)療衛(wèi)生機(jī)構(gòu)流感大流行應(yīng)急機(jī)制初步建立(1)應(yīng)急機(jī)制:93.86%縣級(jí)衛(wèi)生行政部門、72.13%縣級(jí)疾病預(yù)防控制中心、26.23%的縣政府制定了流感大流行相關(guān)應(yīng)急預(yù)案,醫(yī)療機(jī)構(gòu)應(yīng)急預(yù)案的制定比例較低,衛(wèi)生行政部門的人禽流感疫情應(yīng)急處理預(yù)案制定比例最高,達(dá)98.36%;同一應(yīng)急制度,縣級(jí)與地市級(jí)的制定率成正比,不同經(jīng)濟(jì)發(fā)展地區(qū)衛(wèi)生行政部門制定的人禽流感疫情應(yīng)急處理預(yù)案的差異具有統(tǒng)計(jì)學(xué)意義(χ2 =5.003, P0.05)。(2)應(yīng)急組織:所有被調(diào)查縣均成立了突發(fā)公共事件應(yīng)急領(lǐng)導(dǎo)小組,52.80%的縣級(jí)衛(wèi)生局成立了衛(wèi)生應(yīng)急指揮中心。22.95%的縣政府成立了流感大流行應(yīng)對(duì)領(lǐng)導(dǎo)小組;縣級(jí)衛(wèi)生局中50.82%成立了本部門的流感大流行應(yīng)對(duì)領(lǐng)導(dǎo)小組,95.08%成立了本轄區(qū)的人禽流感疫情防控領(lǐng)導(dǎo)小組;各類領(lǐng)導(dǎo)小組的設(shè)置比例與各類事件發(fā)生的頻率成正比,與應(yīng)急預(yù)案的制定比例成正比。 3.流感大流行防控隊(duì)伍規(guī)模及技術(shù)水平有待進(jìn)一步提高 (1)人員規(guī)模:安徽省縣級(jí)每千人口衛(wèi)生技術(shù)人員1.76人,低于中部地區(qū)(2.15人)及全國(guó)平均水平(2.14人);衛(wèi)生應(yīng)急人員不足,多數(shù)被調(diào)查縣只能同時(shí)派出2個(gè)疫情處理小組;當(dāng)可利用的人力資源不足時(shí),91.67%的縣級(jí)CDC擬將所有休息的工作人員召回上班,90.16%向上級(jí)匯報(bào)請(qǐng)求支援。(2)學(xué)歷:應(yīng)急人員學(xué)歷偏低,應(yīng)急管理人員和應(yīng)急技術(shù)人員均以大專及以下學(xué)歷為主,約占60%-88%,低于2005年全國(guó)平均水平;不同經(jīng)濟(jì)發(fā)展水平地區(qū)衛(wèi)生應(yīng)急人員學(xué)歷水平無(wú)顯著性差異,縣級(jí)與地市級(jí)之間的差異有統(tǒng)計(jì)學(xué)意義。(3)人員配置:62.30%的縣建立了突發(fā)公共衛(wèi)生事件應(yīng)急處理專家?guī)?組,不同經(jīng)濟(jì)發(fā)展水平地區(qū)的縣與縣之間沒有沒有顯著性差異;但是,縣與縣之間突發(fā)各類公共衛(wèi)生事件調(diào)查處理人員的配置數(shù)量相差較大。 4.流感大流行疫情監(jiān)測(cè)、預(yù)警和現(xiàn)場(chǎng)救治能力弱 (1)現(xiàn)場(chǎng)處置能力:安徽省僅有22.95%的縣級(jí)CDC能夠從事流感快速診斷試劑盒檢測(cè),49.18%的縣級(jí)CDC具有采集鼻咽拭子標(biāo)本的能力,監(jiān)測(cè)、預(yù)警、現(xiàn)場(chǎng)處置能力整體較低;卡方分析發(fā)現(xiàn),應(yīng)急預(yù)案是否建立,領(lǐng)導(dǎo)小組是否設(shè)置,區(qū)域經(jīng)濟(jì)發(fā)展水平皆不是影響現(xiàn)場(chǎng)處置能力的關(guān)鍵因素。(2)疫情報(bào)告:95.1%的縣級(jí)CDC均采用衛(wèi)生部規(guī)定的預(yù)警指標(biāo)進(jìn)行監(jiān)測(cè)報(bào)告,縣級(jí)對(duì)流感樣病例或流感暴發(fā)疫情比較重視。(3)醫(yī)療救治能力:休寧縣人民醫(yī)院出院者平均出院日、實(shí)際開放床位數(shù)、病床使用率和病床周轉(zhuǎn)次數(shù)均高于全國(guó)縣級(jí)醫(yī)院的平均水平,但流感相關(guān)急救設(shè)備及床位仍遠(yuǎn)不能滿足應(yīng)對(duì)流感大流行的需求。職責(zé)分工不同與工作人員的技術(shù)水平是影響疫情監(jiān)測(cè)、預(yù)警和現(xiàn)場(chǎng)救治能力的關(guān)鍵因素。 5.風(fēng)險(xiǎn)溝通能力建設(shè)尚需加強(qiáng) (1)宣傳教育:安徽省各縣對(duì)公眾進(jìn)行流感/人禽流感的預(yù)防與控制的宣傳教育主要是發(fā)放宣傳材料,宣傳方式缺乏多樣性。(2)應(yīng)急聯(lián)絡(luò):91.80%的縣級(jí)CDC設(shè)置了專門的突發(fā)公共衛(wèi)生事件聯(lián)絡(luò)人,57.38%的縣級(jí)CDC掌握了突發(fā)公共衛(wèi)生事件應(yīng)急處理專家組專家的聯(lián)系方式,掌握率較低。(3)信息發(fā)布:只有5個(gè)(8.20%)縣級(jí)CDC有經(jīng)過(guò)授權(quán)的專門的信息發(fā)布組或指定的發(fā)言人對(duì)外發(fā)布信息。 6.應(yīng)急保障體系建設(shè)有待提高 僅24.59%的縣政府承諾提供流感大流行準(zhǔn)備的資金,96.72%的縣配備有現(xiàn)場(chǎng)調(diào)查設(shè)備,但是90%以上的縣級(jí)CDC被調(diào)查人員認(rèn)為目前的消毒器材、藥品的種類及數(shù)量不能滿足本轄區(qū)應(yīng)對(duì)突發(fā)公共衛(wèi)生事件的需要。是否建立政府領(lǐng)導(dǎo)小組,是應(yīng)急保障資金足額到位的關(guān)鍵影響因素。 7.培訓(xùn)與演練工作需進(jìn)一步落實(shí) 42.62%縣級(jí)行政部門或疾病預(yù)防控制中心曾組織人禽流感、流感大流行防控預(yù)案的演練,且只組織1次,多為衛(wèi)生部門內(nèi)部的演練,僅5個(gè)縣開展了禽流感多部門演練。是否建立政府領(lǐng)導(dǎo)小組,是能否順利開展多部門演練的關(guān)鍵因素。 建議: (1)制定針對(duì)性應(yīng)急預(yù)案,開展常規(guī)應(yīng)急演練;(2)建立問(wèn)責(zé)制,確保預(yù)案有效執(zhí)行;(3)科學(xué)設(shè)置衛(wèi)生系統(tǒng)領(lǐng)導(dǎo)小組結(jié)構(gòu),健全應(yīng)急網(wǎng)絡(luò);(4)根據(jù)縣級(jí)特點(diǎn),強(qiáng)化政府角色;(5)構(gòu)建政府應(yīng)急領(lǐng)導(dǎo)小組,促進(jìn)多部門溝通與協(xié)作;(6)合理調(diào)整人員結(jié)構(gòu),優(yōu)化衛(wèi)生人力資源;(7)提高危機(jī)意識(shí),保障經(jīng)費(fèi)與物資儲(chǔ)備;(8)豐富宣傳培訓(xùn)形式,積極做好風(fēng)險(xiǎn)溝通。
[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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R184

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