基于HFMEA预防ICU多重耐药菌医院感染暴发的效果评价  

Effect evaluation on the prevention of multidrug-resistant organism healthcare-associated infection outbreak in intensive care unit based on HFMEA

作　　者：邬燕[1] 陈婉[1] 谢永兰 邓莹 梁素娟[1] WU Yan;CHEN Wan;XIE Yong-lan;DENG Ying;LIANG Su-juan(Neurosurgery Center,Department of Neurotrauma and Neurocritical Care Medicine,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院神经外科中心-神经创伤重症科,广东广州510282

出　　处：《中国感染控制杂志》2023年第1期102-109,共8页Chinese Journal of Infection Control

摘　　要：目的分析基于医疗失效模式与效应分析(HFMEA)的医院感染防控管理应用于预防多重耐药菌(MDRO)医院感染暴发的效果。方法成立多学科项目实施小组,对某院重症监护病房(ICU)2020年6—12月收治的患者进行回顾性分析,运用HFMEA模式对MDRO医院感染暴发防控进行风险评估,对高风险失效模式进行原因分析,制定针对性防范措施并于2021年1月开始实施。比较实施前后工作人员手卫生、穿脱隔离衣情况及患者MDRO医院感染发生情况。结果HFMEA实施后,ICU MDRO医院感染暴发潜在失效模式风险系数明显下降;工作人员手卫生依从率较实施前提升了10.98%~14.12%;接触MDRO患者及床单位时工作人员使用隔离衣的依从率较实施前提升了8.61%~15.21%;穿脱隔离衣正确率较实施前提升了10.73%~18.43%;ICU医院感染率、MDRO日医院感染率、呼吸机相关肺炎(VAP)发病率、中央导管相关血流感染(CRBSI)发病率、导尿管相关尿路感染(CAUTI)发病率与实施前比较均有下降。结论应用HFMEA前瞻性评估并对MDRO医院感染防控措施进行干预,可以有效降低MDRO医院感染率,从而预防MDRO医院感染的暴发。Objective To analyze the effect of healthcare failure mode and effect analysis(HFMEA)based control management for preventing multidrug-resistant organism(MDRO)healthcare-associated infection(HAI)outbreak.Methods A multi-disciplinary team(MDT)for management implementation was set up to retrospectively analyze patients admitted to the intensive care unit(ICU)of a hospital from June to December 2020.HFMEA model was used to assess the risk of MDRO HAI outbreak prevention and control,causes of high-risk failure mode was analyzed,targeted preventive measures were formulated and implemented from January 2021.Staff’s hand hygiene,wearing and taking off isolation clothing,as well as MDRO HAI occurred in patients before and after implementation were compared.Results After the implementation of HFMEA,the risk coefficient of potential failure mode of MDRO HAI in ICU decreased significantly.Compared with before implementation,Staff’s compliance rate of hand hygiene increased by 10.98%-14.12%;staff’s compliance rate in wearing isolation clothing when contacting MDRO-infected patients and patients’bed units increased by 8.61%-15.21%;correct rate of wearing and taking off isolation clothing increased by 10.73%-18.43%;HAI rate in ICU,daily MDRO HAI rate,incidence of ventilator-associated pneumonia(VAP),incidence of central venous catheter-related bloodstream infections(CRBSI),and catheter-associated urinary tract infection(CAUTI)decreased.Conclusion Prospective assessment of HFMEA as well as intervention of MDRO HAI prevention and control measures can effectively reduce the incidence of MDRO HAI,thus preventing the outbreak of MDRO HAI.

关 键 词：医疗失效模式与效应分析 医院感染 暴发 多重耐药菌 预防与控制 

分 类 号：R197.323.4[医药卫生—卫生事业管理]