失效模式与效应分析对血液科PICC置管患者导管相关性血流感染的预防评价  

Prevention of failure mode and effect analysis on catheter-related bloodstream infections in patients with PICC

作　　者：陈瑛[1] 朱霞明[1] 毛燕琴[1] CHEN Ying;ZHU Xia-ming;MAO Yan-qin(The First Hospital Affiliated to Suzhou University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院血液科,江苏苏州215006

出　　处：《中华医院感染学杂志》2018年第15期2314-2317,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨失效模式与效应分析(FMEA)对血液科经外周穿刺中心静脉导管置管(PICC)患者血流感染的预防价值。方法选择2016年1月-2016年12月于医院血液科住院并置入PICC导管的1 896例患者,为FMEA实施阶段组;2015年1月-2015年12月于医院血液科住院并置入PICC导管的1 566例患者,为FMEA未实施阶段组。运用FMEA分析血液科PICC置管患者血流感染发生的原因,并制定相应的改进措施,同时对改进结果进行评估;查询FMEA实施前后血液科发生血流感染的例数,计算感染率;对疑有PICC导管相关性血流感染患者,采集血样进行血培养检查;FMEA实施前后,对科室护理人员PICC导管置管和维护的知识与操作进行考核。结果 FMEA未实施阶段组患者共发生血流感染49例,感染率为3.13%,FMEA实施阶段组患者共发生血流感染18例,感染率为0.95%;FMEA后PICC导管患者血流感染发生率降低(χ2=6.355,P<0.001);FMEA实施前后护理人员对PICC导管置管和维护的知识与操作考核得分分别为(72.56±13.25)和(91.58±8.51),实施后得分高于实施前(t=2.375,P=0.011);67例发生血流感染患者共检出病原菌71株,其中革兰阴性菌56株占78.87%、革兰阳性菌14株占19.72%、真菌1株占1.41%。结论失效模式与效应分析对血液科PICC置管患者血流感染的原因分析准确,相应的改进措施能有效降低血流感染风险,提高护理质量。OBJECTIVE To evaluate the value of failure mode and effect analysis（FMEA）in prevention of catheterrelated bloodstream infections in patients with peripheral puncture central venous catheter（PICC）.METHODS A total of 1896 PICC patients admitted to the department of hematology from Jan.2016 to Dec.2016 were selected and set as FMEA implementation group.A total of 1566 patients with PICC catheter hospitalized in the department of hematology from Jan.2015 to Dec.2015 were selected and set as FMEA non-implementation group.The causes of bloodstream infections in PICC catheter were analyzed by FMEA,the corresponding improvement measures were made and the improved results were evaluated.The numbers of bloodstream infections in the hematology department before and after FMEA were collected and the infection rates were calculated.Blood samples were collected from doubtable for infection for blood culture examination.The knowledge and operation PICC catheter catheterization and maintenance of our nursing staff were assessed before and after the implementation of FMEA.RESULTS Before the implementation of FMEA,there were 49 cases of bloodstream infections,with the infection rate of 3.13%.After the implementation of FMEA,there were 18 cases of bloodstream infections,with infection rate was 0.95%.The incidence of bloodstream infection in PICC catheter was significantly decreased after FMEA（χ^2=6.355,P〈0.001）.Before and after the implementation of FMEA,the scores of PICC catheterization and maintenance were respectively（72.56±13.25）and（91.58±8.51）,and the scores of PICC catheterization and maintenance were significantly higher than those before the implementation（t=2.375,P=0.011）.There were 71 strains of pathogens in 67 cases of bloodstream infections,among which 56 strains（78.87%）were gram-negative bacteria,14 strains（19.72%）were gram-positive bacteria and 1 strain（1.41%）was fungus.CONCLUSION The failure mode and effect analysis is accurate to analyze the cause of bloodstream infection in

关 键 词：失效模式与效应分析 PICC 血流感染 预防 

分 类 号：R472[医药卫生—护理学]