失效模式与效应分析联合PDCA循环在重症监护病房多重耐药菌院内感染防控中的应用  

Application of failure mode and effect analysis combined with PDCA cycle in prevention and control of healthcare-associated multidrug-resistant organism infections in intensive care unit

作　　者：林露 张菊[2] 李刚[3] 李俊 张月薪 李华[1] 晏娟[1] 彭家兵 张戈[1] LIN Lu;ZHANG Ju;LI Gang;LI Jun;ZHANG Yuexin;LI Hua;YAN Juan;PENG Jiabing;ZHANG Ge(Department of Critical Care Medicine,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Nosocomial Infection Management,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospitital Sichuan University,Chengdu,Sichuan 610100,P.R.China;Department of Traditional Chinese Medicine,the First People’s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Chengdu,Sichuan 610100,P.R.China)

机构地区：[1]成都市龙泉驿区第一人民医院/四川大学华西医院龙泉医院重症医学科,成都610100 [2]成都市龙泉驿区第一人民医院/四川大学华西医院龙泉医院医院感染管理科,成都610100 [3]成都市龙泉驿区第一人民医院/四川大学华西医院龙泉医院中医科,成都610100

出　　处：《华西医学》2022年第3期363-368,共6页West China Medical Journal

基　　金：四川省中医药管理局中医药科研专项课题(2020LC0026);四川预防医学会医院感染预防与控制研究基金(SCGK202120)。

摘　　要：目的探讨失效模式与效应分析(failure mode and effect analysis,FMEA)联合PDCA循环在重症监护病房(intensive care unit,ICU)多重耐药菌院内感染防控中的临床效果,为ICU制定预防多重耐药菌院内感染控制措施提供有利依据。方法2020年1月开始,成都市龙泉驿区第一人民医院重症医学科组建风险评估小组分析ICU多重耐药菌感染的可能风险点,通过FMEA进行风险评估,筛选出优先风险数值较高的失效模式用以评价多重耐药菌感染的高风险点;根据筛选出的高风险点进行真因分析,通过PDCA循环管理模式制定改进措施并予以风险控制。收集并比较2018年1月-2019年12月干预措施实施前与2020年1月-2021年6月干预措施后ICU多重耐药菌院内感染发生率、高风险事件失效改善情况、医护满意度。结果筛选出的6项高风险事件分别为多重耐药隔离措施单一、床单元消毒不到位、不合理使用抗菌药物、新入人员感染防控意识薄弱、病原菌送检意识薄弱、消毒不及时。干预前后患者的多重耐药总发生率分别为2.72%(49/1800)和1.71%(31/1808),差异有统计学意义(χ^(2)=4.224,P=0.040);干预前后病原菌送检率分别为56.67%(1020/1800)和61.23%(1107/1808),差异有统计学意义(χ^(2)=7.755,P=0.005);干预前后医护满意度分别为75.0%(30/40)和95.0%(38/40),差异有统计学意义(χ^(2)=6.275,P=0.012)。结论FMEA能有效发现ICU中多重耐药菌感染防治的薄弱点,而PDCA模式能有效针对薄弱点制定改进措施予以风险控制,两者联合应用为ICU多重耐药菌院内感染合理防治提供了科学有效保证。Objective To explore the clinical effect of failure mode and effect analysis(FMEA)combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms(MDROs)in intensive care unit(ICU),and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU.Methods In January 2020,a risk assessment team was established in the Department of Critical Care Medicine,the First People’s Hospital of Longquanyi District of Chengdu,to analyze the possible risk points of MDRO infections in ICU from then on.FMEA was used to assess risks,and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections.The causes of the high-risk points were analyzed,and improvement measures were formulated to control the risks through PDCA cycle management model.The incidence of healthcare-associated MDRO infections in ICU,improvement of high-risk events,and satisfaction of doctors and nurses after the implementation of intervention measures(from January 2020 to June 2021)were retrospectively collected and compared with those before the implementation of intervention measures(from January2018 to December 2019).Results Six high-risk factors were screened out,namely single measures of isolation,unqualified cleaning and disinfection of bed units,irrational use of antimicrobial agents,weak consciousness of isolation among newcomers of ICU,weak awareness of pathogen inspection,and untimely disinfection.The incidence of healthcare-associated MDRO infections was 2.71%(49/1800)before intervention and 1.71%(31/1808)after intervention,and the difference between the two periods was statistically significant(χ^(2)=4.224,P=0.040).The pathogen submission rate was 56.67%(1020/1800)before intervention and 61.23%(1107/1808)after intervention,and the difference between the two periods was statistically significant(χ^(2)=7.755,P=0.005).The satisfaction rate of doctors and nurses was 75.0%(30/40)before intervention and 95.0%(38/40)afte

关 键 词：失效模式与效应分析 PDCA循环 多重耐药菌 医院感染 

分 类 号：R197.323[医药卫生—卫生事业管理]