失效模式与效应分析法在神经内科ICU医院感染控制中的应用

Application of Failure Mode and Effects Analysis in Nosocomial Infection Control in Neurology Intensive Care Unit

目的探讨失效模式与效应分析法(failure mode and effects analysis,FMEA)在神经内科ICU医院感染控制中的应用,发现高风险因素,为院感防控提供参考依据。方法根据神经内科ICU临床实际情况,通过FMEA风险评估法对34项医院感染风险事件进行风险评估,按照"二八法则"筛选出风险优先级事件。结果根据每一项风险因素的平均RPN值进行风险排序,按照"二八法则"筛选出风险优先级前6位的事件分别是:本科室医护人员手卫生依从性不到位(平均RPN值=5.6)、导尿管日常维护不到位(平均RPN值=4.17)、多耐患者未有效执行接触隔离措施(平均RPN值=3.80)、物表清洁消毒未有效执行(平均RPN值=3.73)、未严格掌握留置导尿指征(平均RPN值=3.70)、未保持尿液引流系统的密闭性(平均RPN值=3.53)。结论FMEA风险评估法可以发现神经内科ICU医院感染防控中的薄弱环节,为精准化感控措施的制订提供依据。

Objective To investigate the application of failure mode and effect analysis(FMEA)in the control of nosocomial infection in neurology intensive care unit(ICU)so as to identify the highrisk factors and provide reference for prevention and control of nosocomial infection.Methods According to the clinical situation of Neurology ICU,34 risk events of nosocomial infection were assessed by using FMEA.Risk priority events were selected based on the 80/20 rule.Results The risk ranking is based on the average RPN value of each risk factors and top 6 events of risk priority were selected by using the 80/20 rule.These events included poor compliance of medical staff’s hand hygiene(mean RPN=5.6),inadequate routine maintenance of catheter(mean RPN=4.17),poor implementation of contact isolation measures for patients with multidrug resistant bacteria(mean RPN=3.80),poor implementation of surface cleaning and disinfection(mean RPN=3.73),inadequate grasp of indications of indwelling catheterization(mean RPN=3.70),and poor tightness of urine drainage system(mean RPN=3.53).Conclusion FMEA can find out the weak links in the prevention and control of nosocomial infection in neurology ICU,and provide the basis for the formulation of precise control measures.