【作者】 刘永泉；

【导师】 孙振球；

【作者基本信息】 中南大学 ， 社会医学与卫生事业管理， 2012， 博士

【摘要】 目的：本研究通过对北京2008奥运会公共卫生监督风险管理实践(包括奥运前风险识别和奥运后经验总结)和公共卫生监督遗产进行系统分析,提出适合我国国情的、适用于大型活动的公共卫生监督管理模式,为我国今后举办大型活动的公共卫生监督管理工作提供科学参考。方法：1.文献复习：系统查阅并收集国内外与奥运会公共卫生保障有关的资料和近年来海淀区范围内发生的突发公共卫生事件资料,北京市或全国范围内的突发公共卫生事件相关资料；收集北京2008奥运会保障中形成的各种有关材料。2.专题小组讨论：通过专题小组讨论建立“卫生监督公示制度实施认可度调查表”和“大型活动保障专业保障人员调查表”的问卷条目库。3.个人深入访谈：采用自编的“访谈提纲”于2007年7-12月对各专业卫生监督专家进行个人深入访谈,了解大型活动期间公共卫生保障工作内容、方式、操作规程,以及在大型活动公共卫生保障过程中所面临的困难、存在的问题、解决的方式、经验和建议。4.问卷调查：采用多阶段抽样方法,随机抽取海淀区20个乡镇(街道),选择500名餐饮单位管理相对人进行“卫生监督公示制度实施认可度”和“卫生法律法规知识知晓情况”调查。使用自编的“调查表”分别于奥运前期、奥运期间和奥运后,对管理相对人进行调查。5.比较研究：(1)纵向比较研究,分析2006-2010年海淀区各卫生监督专业的经常性卫生监督情况、突发事件和投诉举报情况的变化趋势；(2)横向比较研究,将海淀区2006-2010年各卫生监督专业的情况与杭州市、深圳市同期情况进行横向比较,分析北京2008奥运会公共卫生保障工作对海淀区卫生监督工作的影响。结果：(一)公共卫生监督风险识别1.食品卫生2000-2006年,北京市共发生食物中毒事件317起,中毒6034人,7-9月份为食物中毒的高发期(129起,中毒2145人)。发生场所主要是集体食堂(147起,中毒3650人)和饮食服务单位(106起,中毒1707人)；致病因素主要是微生物性(125起,中毒2724人)、动植物性(107起,中毒2025人)、农药及化学性(42起,中毒425人)；植物类食品所致的食物中毒起数和涉及人数最多(85起,中毒1893人)。2.传染病2000-2006年,北京市发生的常见传染病主要有：肠道传染病,如霍乱、细菌性痢疾、甲型病毒性肝炎,6-9月是其发病高峰期；呼吸道传染病全年均有发病,如流行性感冒(高发月份为10月-次年3月)、流行性脑脊髓膜炎(高发月份为3-5月)、麻疹(高发月份为1-6月)、军团菌病等；接触性传染病4-9月发病最多；虫媒和自然疫源性疾病1-5月发病最多。3.公共场所1998-2006年,全国共报道33起事件公共场所突发公共卫生事件,发生高峰在6-8月份(23起,占69.70%)。事件涉及14个省,发生场所主要涉及游泳场所(15起)、沐浴场所(6起)、住宿场所(3起)等。原因分别为生物性污染(18起)、化学性(14起)和物理性(1起)。每起事件的平均影响人数为87人,最大一起涉及468人。4.生活饮用水2001-2006年,北京市共发生93起生活饮用水污染突发事件,6-9月份是生活水污染突发事件发生的高峰期(50起,53.76%),涉及自备水源井(60起,64.51%),市政供水(17起,18.27%),二次供水(16起,17.20%)；污染原因涉及化学性污染(47起,41.59%),生物性污染(35起,30.97%)和物理性污染(31起,27.43%)。平均每起事件影响人数为1722人,最大一起达到2万人。19起事件导致发病,涉及发病人数2287人,平均每起120人。5.职业卫生1994-2003年,北京市共发生急性职业病危害事件78起,病例292例,死亡42例(病死率为14.38%),总体数量呈逐年上升趋势。急性职业中毒事件集中于7-9月,占总事件数的64.29%。主要原因为无通风排毒设备(21起,26.92%),其次是无个人防护设备(17起,21.79%),夏天露天作业因气温较高,易造成高温中暑事件发生。6.投诉举报2003-2007年,海淀区共发生公共卫生投诉举报11447起,7-9月的投诉举报数量排在前3位,分别为1302起(11.37%)、1462起(12.77%)和1240起(10.83%)。7.个人深入访谈选择10家卫生监督机构的45位各专业卫生监督的专家进行的个人深入访谈,分析总结出大型活动期间各公共卫生监督专业突发事件的防控重点和要点共17条和大型活动期间突发公共卫生事件的防控措施10条。(二)公共卫生监督遗产分析1.有形遗产(1)教材和书籍奥运保障培训教材包括《2008北京奥运(残奥)会海淀区赛事场馆内卫生保障工作手册》、《2008北京奥运(残奥)会海淀区赛事场馆外围卫生保障工作手册》、《奥运公共卫生保障涉外交流手册》。(2)文件汇编编写了《奥运场馆内公共卫生保障工作文件及方案汇编》和《奥运城市运行公共卫生保障工作文件及方案汇编》。(3)量化分级管理制度食品卫生A级和B级单位数量从2007年开始呈明显上升趋势,其中2008年A级单位有390家,B级单位有2448家；生活饮用水供水和公共场所经营A级和B级单位也呈逐年递增趋势。(4)财政资金投入从2008年起,海淀区每年拨款均超过了2000万元(2008年为2108.33万元,2009年为2190,86万元,2010年为2334.13万元),2008年奥运会期间及奥运会后较奥运会之前有了大幅提高。(5)卫生监督装备配置海淀区奥运场馆内公共卫生保障用现场快速检测设备配备得到加强,并根据公共卫生保障需求,购置食品卫生、公共场所卫生以及生活饮用水等专业的现场快速检测设备277件,配备数量超出标准的11.59倍。(6)在线监测系统启用了公共场所空气卫生质量GPRS在线即时监测系统和游泳场所水质在线监测系统,目前海淀区共设置公共场所空气卫生质量监测点26处,游泳场所水质监测点10处。(7)论文及成果报告在国家级期刊共发表奥运遗产课题相关文章14篇,形成了奥运会对卫生监督工作影响评估总报告和6份专业报告以及2部工作纪实系列作品集。2.无形遗产(1)圆满完成了奥运会保障任务奥运场馆保障方面,公共卫生保障人员对奥运场馆共巡查3251户次,保障食品355988份,食品留样3616份,书写现场检查笔录1123份；城市运行保障方面,开展监督检查1348户次,书写现场检查笔录1348份,保障食品原料供货企业供货441批次,共出动3563人次,监督10238户次,保障奥运送餐企业累计供餐458406份。卫生监测工作按计划完成,现场快速检测和实验室检测合格率较高,奥运期间海淀区奥运场馆内和城市运行中均未发生突发公共卫生事件,并按要求及时上报了公共卫生保障工作信息,投诉举报处理实现4个100%。(2)建立了完整的奥运公共卫生保障组织管理体系根据实际工作需求并借鉴矩阵式管理模式,海淀区分别在场馆公共卫生保障和城市运行公共卫生保障方面创新性地建立了由专业技术人员和骨干卫生监督员组成的矩阵式奥运公共卫生保障团队组织管理体系,即以所领导为组长,主管科长为副组长,奥运协调办公室为枢纽,基层工作组为辅助机构,分别以场馆或城市运行保障对象为中心成立公共卫生保障团队,并相应地制定工作规则,明确工作职责,全面开展奥运公共卫生保障工作。(3)探索出一套完整的大型活动公共卫生保障程序海淀区通过全面分析和总结奥运公共卫生保障工作,形成了一套完整的大型活动公共卫生监督保障程序,即：成立领导小组,强化组织领导,开展风险识别,制订保障方案,开展团队培训,制定应急方案及时沟通协调,建立了完善的沟通协调机制。这一套工作程序可以直接应用于除奥运会以外的其它大型活动,可供其它公共卫生监督机构参考使用。(4)提高了管理相对人公共卫生责任认识和法律法规知识在奥运前、奥运期间和奥运后期分别对餐饮单位经营管理者进行的“卫生监督公示制度实施认可度调查”和“卫生法律法规知识调查”显示,经营管理者对卫生监督公示制度认可度,卫生法律法规知识知晓率普遍提高。经营管理者同意对监督结果按照卫生状况档次向消费者公示的比例不断提高(奥运前、中、后分别为68.72%、82.67%、84.99%)；从业人员对个人卫生要求的知晓率不断提高(奥运前、中、后分别为81.30%、85.70%和88.30%)。(5)奥运后海淀区卫生监督工作成效明显提升2008-2010年,海淀区食品卫生、公共场所卫生、职业卫生等各专业的监督合格率均呈上升趋势,深圳市食品卫生监督合格率在2009年有所下降,杭州市食品卫生和生活饮用水卫生经常性检查卫生合格率均上升；海淀区除生活饮用水专业之外,其它各卫生监督专业的行政处罚数量均呈下降趋势,投诉举报数量也呈下降趋势,深圳市食品卫生、公共场所卫生的投诉举报数量均上升,杭州市食品卫生、公共场所卫生、职业卫生等专业的投诉举报数量也均呈上升趋势。结论：1.北京2008奥运举办期间可能发生多种公共卫生风险,7-9月是食品卫生、传染病防控、公共场所卫生、生活饮用水卫生以及职业卫生突发事件风险的高发时段。通过风险识别,海淀区采取了有效的奥运会公共卫生保障工作措施,圆满完成北京2008奥运会海淀区公共卫生监督任务,建议今后的大型活动公共卫生保障工作将风险识别和评估常态化。2.本研究首次系统分析了公共卫生监督遗产。通过对北京2008奥运会公共卫生监督的风险管理实践,海淀区从有形遗产和无形遗产两个方面对奥运会公共卫生监督遗产进行了总结,形成了可用于今后大型活动公共卫生保障的教材、书籍、文件汇编以及监督管理模式等。3.本研究提出了适合于我国国情的大型活动公共卫生监督的科学管理模式,包括：(1)大型活动公共卫生监督保障程序,形成了.一套完整的大型活动公共卫生监督保障程序；(2)公共卫生监督管理矩阵式组织管理模式。该模式对今后的大型活动公共卫生监督风险管理有一定的参考价值。更多还原

【Abstract】 Objective:To propose a management model and provide scientific reference for the public health supervision during the later mass gatherings, by systematically analysing the risk management practices and public health legacies of the Beijing2008Olympic Games.Methods:1. Literature Review:We systematically collected and analysed the literatures involving public health supervision in the Olympic Games and the data about the public health emergencies at the Haidian District, Beijing or national level; we also collected and analysed relevant documents formed during the public health supervision in the Beijing2008Olympic Games.2. Focus Group Discussion:We found a focus group and had some discussions, through which we developed the "Questionnaire on Recognition of Public health supervision Notification" and the "Questionnaire on Public Health Personnels in Mass Gatherings".3. Personal Interview:For the purpose of understanding the contents, methods and operating procedures, the potential difficulties and corresponding solutions, and experience in mass gathering public health supervision, from July to December2012, we interviewed experts from different public health areas using the interview outlines drafted by ourselves.4. Questionnaire Survey:Through multi-stage sampling method,500managers in catering units from20different towns were sampled, and then the investigations on recognition of public health supervision notification were carried out among these managers before, during and after the Beijing2008Olympic Games.5. Comparative Study:We implemented the longitudinal comparative study for analysing the trends of normal public health supervisions, emergencies and complaints and reports in different public health areas in Haidian District from2006to2010, and cross-sectional comparative study for comparing the situations of public health supervisions in Haidian, Hanzhou and Shenzhen from2006to2010and analysing the impact of Beijing2008Olympic Games on public health supervision in Haidian District.Results:1. Risk Identification of Public Health Supervision1) Food Hygine317food poison events were reported in Beijing from2000to2006. The main places where the events occurred included canteen (147events,46.37%) and catering units (106events,33.44%); the most common pathogenic factors were microbial factors (125events,39.43%), vegeto-animal factors (107events,33.75%), pesticides and chemical factors (42events,13.24%); the number of poison events caused by plant foods and the number of persons involved were bigger than that for other factors.2) Infectious DiseaseThe most common infectious diseases in Beijing were as follows: Intestinal infectious diseases, such as cholera, bacillary dysentery, viral hepatitis A, hand-foot-and-mouth-disease etc.; respiratory infectious diseases, including influenza, epidemic cerebrospinal meningitis, measles, Legionnaires’disease etc.; contagious disease; insect-borne diseases and natural focal diseases.3) Public Places Hygine33public health emergencies in public places were reported at national level from1998-2006, events occurred in2004and2005were more than that in other years. The emergency events were reported by14provinces, the most common places involved were swimming places (15events), bathing places (6events), accommodation places (3events). The causes of events were biological (18events), chemical (14events) and physical pollutions (1events). The average number of persons involved in the events was87, the biggest was468.4) Drinking Water Hygine93drinking water emergencies were reported in Beijing from2001 to2006, involving water source wells (60events,64.51%), municipal water supply (17events,18.27%) and secondary water supply (16events,17.20%); the distribution of pollution factors were as follows: chemical factors (47events,41.59%), biological factors (35events,30.97%) and physical factors (31events,27.43%). The average number of persons involved in the events was1722, the biggest was almost20,000.19out of these93events resulted in diseases in population,2287patients were reported and the average number of patients reported in the19events was120.5) Occupational Hygine78acute occupational hazard events involving292patients and42deaths were reported in Beijing from1994to2003, a trend of increase was found. Most of the acute occupational poisoning events were reported from July to September, accounting for64.29%of the total number. The main causes of events were absence of ventilation equipments (21events,26.92%), absence of individual protective devices (17events,21.79%) and so on. The high temperature in summer was apt to cause heat apoplexy event.6) Complaints and Reports11,447complaints and reports were received in Haidian from2003to2007, the number of complaints and reports received in July, August and September were on the top,1302(11.37%),1462(12.77%) and 1240(10.83%) events were reported respectively.7) Personal Interview45experts from10nationwide public health supervision institutions were interviewed, through which we concluded17prevention priorities and10prevention measures for the public health emergencies in mass gatherings.8) Previous Experiences in Olympic GamesAtlanta1996Olympic Games took rapid response to epidemic outbreak, prevention of food-borne diseases and water-borne diseases as the main objectives of public health supervision. Sydney2000Olympic Games had evaluated the potential public health problems, established an broad health supervision system and implemented food safety and environmental health projects to fully ensure the accomplishment of public health supervision work. During the Athens2004Olympic Games, an Olympic Planning Group was found, aiming at studying the needs and deficiencies of public health supervision, potential public health risks, so as to define the risk level and implement the public health supervision specifically.2. Analysis of Public Health Supervision Legacies1) Tangible Legaciesa) Training materials:including training materials for public health supervision in Beijing2008Olympic Games,"Workbook for Public health supervision in Olympic Venue During the Beijing2008Olympic Games","Workbook for Public health supervision Outside Olympic Venue During Beijing2008Olympic Games".b) Document assembly:such as Working Documents and Plans for Public health supervision in Olympic Venues and Working Documents and Plans for Public health supervision Outside Olympic Venues.c) Quantitative grading management system:the number of Level A and B units of food hygiene had been increasing remarkably since2007, the numbers of level A and B units in2008were respectively390and2448. Meanwhile, the number of level A and B units of drinking water and public place also showed an increase trend.d) Financial investment:the annual government appropriations put into the protection of public health safety since2008were all above20million yuan The government appropriations during and after the Beijing2008Olympic had increased substantially compared with the one before the Olympic.e) Equipments and devices for public health supervision:to strengthen the public health supervision during the Olympic Games, the Haidian District purchased the field rapid testing devices for food, public places and life drinking water supervision and equipped vehicles and computers by corresponding standards.f) Online monitoring system:the public places air sanitary quality GPRS online realtime monitering system and the swimming place water quality online monitoring system had been established. At present, there were26monitoring points for public places air sanitary quality and10for swimming place water quality in Haidian District.g) Papers and reports:14papers had been published in national journals from2008to2009. The final report on impact of Beijing2008Olympic Games on public health supervision,6separate reports in different public health areas and2work documentary series anthology had been produced.2) Intangible Legaciesa) Public health supervision in the Beijing2008Olympic Games had been successfully and fully implemented. On the side of public health supervision in Olympic venues,3,251inspections had been done,355,988food samples had been supervised and1,123examination records had been written; on the other side of public health supervision outside the olympic venues,10,238inspections had been implemented,458,406food samples had been inspected,1,348examination records had been written and441batches of raw materials for food supply companies had been supervised. The scheme of public health supervision in and outside the olympic venues had been fully implemented, the eligible rates of field rapid tests and laboratory tests were high, and no public health emergency had occurred during the Beijing2008Olympic Games in Haidian District. Information related to public health supervision were submitted timely and the complaints and reports received were handled properly.b) A full management system for public health supervision during the Beijing2008Olympic Games had been found. Based on the actual needs in our work, and taking the matrix organization into consideration, the Olympic public health supervision matrix organizations including professional technicists and core personnels in our public health organization were respectively found for the public health supervisions in and outside the olympic venues. That was, took the corresponding leaders of our organization as group leaders, the specific section chiefs as vice leaders, the Olympic coordination office as the base, grass-root working group as supporting organs, we found specific teams for public health supervision in and outside Olympic venues. Together with the definite working rules and responsibilities, an successful public health supervision in the Beijing2008Olympic Games had been made.c) By analysing the work in public health supervision for the Beijing2008Olympic Games, we proposed an intact working procedures for mass gathering public health supervision, which could be used directly to guide the public health supervision in other mass gatherings beside Olympic Games and provide experience to other public health organizations. The full procedures were as follows: foundation of leading group, formulation of working plan, training of supervision teams, formulation of the emergency response plan, foundation of national collaborating mechanism and communication system.d) Recognition of managers in catering units on public health had been improved. Before, during and after the Beijing2008Olympic Games, two surveys about recognition of public health supervision notification and knowledge of health laws and regulations had been implemented, which showed that the recognition level of managers in catering units and knowledge of health laws and regulations had been improved. The percentage of managers who agreed to notify customers of the health status of their units grew continuously (the percentage before, during and after the Beijing2008Olympic Games were68.72%,82.67%and84.99%respectively). And the awareness rate of employee about personal hygiene requirement also grew continuously (the percentage before, during and after the Beijing2008Olympic Games were81.30%,85.70%and88.30%respectively).e) Effect of health supervision work had been improved obviously after Olympic game in Haidian District. The qualified rates for food hygine, public places health and occupational health supervision increased year by year. Different with Haidian, the qualified rate for normal food health supervision in Shenzhen declined in2009, the qualified rate for normal food health and life drinking water health supervision in Hangzhou increased; Except for the life drinking water health, the numbers of administrative penalties,complaints and reports received by our organization in other public health supervision areas showed an downtrend, while the numbers of complaints and reports for food health, public place health and occupational health in Shenzhen and Hangzhou all increased.Conclusions:1. Multiple kinds of public health risks could exist during the Beijing2008Olympic Games, and July to September was the period during which food hygine, infectious diseases, public places hygine, life drinking water hygine and occupational hygine emergencies occurred more frequently than in other months. As a result of the effective actions taken by Haidian district, the public health supervision during Beijing2008Olympic Games in Haidian were successfully carried out, and we recommended the risk identification and assessment in later mass gathering public health supervision.2. It was the first time when the Olympic Games public health supervision legacies were raised and analyzed systematically. Through the practices of risk management during Beijing2008Olympic Games, we raised the tangible and intangible public health supervision legacies of Olympic Games, promoted the capability establishment of public health supervision, developed the training materials, document assembly and supervision model which could be used in later mass gathering public health supervision.3. A scientific management model suitable for the Chinese condition had been proposed, including a) the public health supervision procedures for mass gathering and b) the matrix organization for public public health supervision, which would provide a valuable reference to the later mass gathering public health risk management.更多还原