失效模式和效应分析在提高ICU护士洗手依从性中的应用

APPLICATION OF FAILURE MODE AND EFFECT ANALYSIS IN IMPROVING HAND-WASHING COMPLIANCE OF ICU NURSES

目的通过失效模式与效应分析(FMEA)探讨护理人员洗手依从性及认知情况,并分析存在问题。方法采用FMEA法针对ICU护理人员洗手依从性低的问题组成护理团队,制作流程图,进行失效模式与潜在风险原因分析,计算事先的风险指数(RPN)值,针对最高风险指数进行优先处理,制定改善措施及实施。结果实施FMEA后事先风险指数有明显的下降,原RPN值1 515分,后RPN值490分,下降了67.6%,手卫生的相关知识及操作前后的洗手频率与前对比均有提高,差异有统计学意义(p<0.05)。并形成ICU手卫生的指引及具体的操作流程。结论 FMEA方法的应用可有效提高ICU护理人员手卫生的意识及洗手的依从性,有助于降低院内感染的发生及控制。

Objective To explore the hand-washing compliance and aware of nurses by Failure Mode and Effect Analysis（FMEA） and analyze the problems exist in it.Methods Used the FMEA to compose the nurse team for the problem of low hand-washing compliance of the ICU nurses,produced flow chart,analyzed the causes of the failure mode and potential risk,calculated value of the risk index（RPN） in advance,given prior process to the highest risk index,formulated and enforced the enhanced measures.Results Prior risk index decreased significantly after the implementation of FMEA,1 515 points of original RPN value,490 points of post RPN value with a drop of 67.6%,hand-hygiene knowledge and the frequency of hand-washing after operation were improved compared with the former,the difference was statistically significant（p0.05）,and formed the guidelines and specific operating process of ICU hand-hygiene.Conclusion Application of the FMEA method could effectively improve the awareness and hand-washing compliance of hand-hygiene of ICU nursing staff,and help to reduce and control the incidence of nosocomial infections.