FMEA对老年ICU患者医院感染控制管理的效果  

Effect of FMEA on the management of hospital infection control in elderly ICU patients

作　　者：康益炯 康益敏 KANG Yi-jiong;KANG Yi-min(Taiyuan Fourth People′s Hospital(Pulmonary Hospital Affiliated to Shanxi Medical University),Taiyuan,Shanxi 030053,China)

机构地区：[1]太原市第四人民医院(山西医科大学附属肺科医院)急诊科,山西太原030053 [2]山西中医药大学健康服务与管理学院,山西晋中030619

出　　处：《中华医院感染学杂志》2023年第20期3190-3194,共5页Chinese Journal of Nosocomiology

基　　金：太原市“六个一批”科研基金资助项目(Y2023005)。

摘　　要：目的分析失效模式与效应分析法(FMEA)对老年ICU患者医院感染控制管理的效果。方法选取2018年1月-2019年12月太原市第四人民医院ICU老年(65岁及以上)患者1036例作为对照组,其中患者医院感染例数为135例;选取2020年1月-2022年6月ICU老年患者1002例设为研究组,其中患者医院感染例数为53例;研究组采用FMEA管理方法,对照组开展常规监测,比较两组感染风险及预后情况。结果本研究基于病房内通风不畅、护工/患交叉感染、患者自身因素以及医护人员培训不到位和突发事件应对无效5个主要失效模式的风险有限系数(RPN)得分,区分得出高风险因素为护工/患交叉感染和病房内通风不畅两大因素,RPN得分分别为36分和27分;研究组按照FMEA模式进行持续改进,除患者自身因素外,改进后4种失效模式的RPN值均得到不同程度的降低;对两组患者的感染部位进一步分析,两组感染均主要集中在呼吸道、泌尿道、消化道,皮肤黏膜感染也占有较高比例,此外还包括手术切口感染等;但研究组经基于FMEA的院感控制干预后,医院感染率低于对照组,且呼吸系统感染和泌尿系统感染率低于对照组(P<0.05);研究组住院时间短于对照组,感染患者预后病死率(0%,0/53)低于对照组(10.37%,14/135)(P<0.05)。结论基于FMEA理论进行预防性医院感染管理,对于改善老年ICU患者人群医院感染风险具有积极意义,且可有效改善患者预后。OBJECTIVE To analyze the effectiveness of Failure Mode and Effect Analysis(FMEA)on nosocomial infection control and management in elderly ICU patients.METHODS Totally 1036 elderly patients(65 years old and above)in the ICU of Taiyuan Fourth People′s Hospital from Jan.2018 to Dec.2019 were selected as the control group,with 135 cases of hospital acquired infections,1002 elderly patients in the ICU from Jan.2020 to Jun.2022 were selected as the study group,in which the number of patients with hospital acquired infections was 53 cases.The study group adopted FMEA management method,while the control group conducted routine monitoring,and the risk of infection and prognosis between the two groups were compared.RESULTS In this study,based on the risk limited profitability scores(RPN)of five main failure modes,namely,poor ventilation in the ward,cross infection of nurses/patients,patient′s own factors,inadequate training of medical staff and ineffective response to emergencies,we distinguished the two high-risk factors as cross infection of nurses/patients and poor ventilation in the ward,with RPN scores of 36 and 27 respectively.The study group made continuous improvement according to the FMEA mode,except for the patient′s own factors,the RPN values of the four failure modes were reduced to varying degrees after the improvement.The sites of infection of two groups of patients were further analyzed,and the infections in both groups were mainly concentrated in respiratory tract,urinary tract and digestive tract,with a high proportion of skin and mucous membrane infections,in addition to surgical incision infections.However,the nosocomial infection rate of the study group was lower than that of the control group after the FMEA-based nosocomial control intervention,and the rates of respiratory and urinary infection were lower than that of the control group(P<0.05).The length of hospitalization in the study group was shorter than that of the control group,and the mortality rate of patients with infections(0%,0/53)was

关 键 词：老年 重症监护病房 医院感染 失效模式与效应分析法 管理 

分 类 号：R187[医药卫生—流行病学]