FMEA联合RCA在剖宫产手术患者切口感染预防中的应用  

Application of FMEA combined with RCA in preventing incisional infection in patients undergoing cesarean section

作　　者：陈春燕 江帆[1] 孟芳芳 姚芬芬 陈群好 CHEN Chunyan;JIANG Fan;MENG Fangfang;YAO Fenfen;CHEN Qunhao(Minhang Hospital of Fudan University,Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院传染科,上海市201199

出　　处：《护理实践与研究》2024年第2期204-208,共5页Nursing Practice and Research

基　　金：闵行区自然科学研究课题(编号:2022MHZ083)。

摘　　要：目的探究失效模式与效应分析(FMEA)联合根因分析(RCA)在妇产科剖宫产手术患者切口感染预防中的应用。方法选取2022年3—12月医院行剖宫产手术的患者72例为研究对象,将2022年3—7月行剖宫产手术的36例患者为对照组,2022年8—12月行剖宫产手术的36例患者为观察组。对照组实施常规感染预防管理,观察组实施FMEA联合RCA模式的感染预防管理,计算实施前关键风险值(RPN)结果,分析实施前后RPN值,之后观察并记录FMEA与RCA前后RPN值和患者腹部手术切口感染发生的情况,再进行比较分析。结果实施前风险因素中RPN从大到小排序依次为不合理应用抗菌药物、未彻底清洗与消毒灭菌失效、未按无菌技术操作规范执行与手卫生不规范、未严格执行规定与手术室环境未达标、医护人员宣教不足与消毒效果不达标。抽样研究结果显示,实施FMEA与RCA后(观察组)RPN值较实施FMEA与RCA前(对照组)RPN值下降。且干预后观察组患者切口感染发生率低于对照组,差异有统计学意义(P<0.05)。结论FMEA联合RCA模式可有效降低关键RPN值,减少妇产科腹部手术患者切口感染率,从而达到预防感染的目的。Objective To explore the application of failure mode and effect analysis(FMEA)combined with root cause analysis(RCA)in preventing incisional infection in patients undergoing cesarean section.Methods To select 72 patients who underwent cesarean section in the hospital from March to December 2022 as the research subjects,among them,36 patients who underwent cesarean section from March to July 2022 were selected as a control group,and another 36 patients who underwent cesarean section from August to December 2022 were selected as an observation group.The control group implemented routine infection prevention management,and the observation group implemented FMEA combined with RCA model infection prevention management,calculated the key risk value(RPN)results before implementation,analyzed the RPN values before and after implementation,and then observed and recorded the RPN values before and after FMEA and RCA and the patient's abdomen The occurrence of surgical incision infection was then compared and analyzed.Results The risk factors of RPN before implementation were ranked from large to small as unreasonable application of antibacterial drugs;failure of thorough cleaning and disinfection and sterilization;failure to perform aseptic technical operation specifications and non-standard hand hygiene;failure to strictly implement regulations and operations.The room environment was not up to standard,medical staffhad insufficient education and the disinfection effect was not up to standard.The results of the sampling study showed that the RPN value after the implementation of FMEA and RCA(observation group)was lower than the RPN value before the implementation of FMEA and RCA(control group).After nursing,the incidence of incision infection in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion FMEA combined with RCA mode can effectively reduce the key RPN value and reduce the incision infection rate in obstetric and gynecological abdominal surgery

关 键 词：失效模式与效应分析 根因分析 妇产科 剖宫产手术 切口感染 风险值 

分 类 号：R473.71[医药卫生—护理学]