基于FMEA法在重症监护病房器械相关感染防控中的应用

Application of FMEA in prevention and control of device-related infection in intensive care unit

目的采用失效模式与效应分析(FMEA)法筛选出重症监护病房(ICU)医院感染及导管相关感染发生的高风险事件,为ICU制定医院感染预防控制措施提供依据。方法通过风险识别确定20个风险因素,采用FMEA风险评估筛选出高、中高风险因素,制定相对应的感染防控措施并监督落实,比较干预措施实施前后呼吸机相关肺炎(VAP)、中心静脉导管相关血流感染(CLABSI)、导尿管相关尿路感染(CAUTI)情况。结果筛选出4个高风险因素,分别为感染多重耐药菌患者未遵循有效隔离措施、大剂量使用抗菌药物、床单元清洁消毒不合格、诊疗物品交叉使用;筛选出4个中高风险因素,分别为在拔管或气囊放气操作之前忽略气囊上分泌物的清除工作、手卫生依从性差、非本科室人员流通多、探视人员探视制度执行不到位。针对高、中高风险因素,实施对应的防控措施,VAP、CLABSI、CAUTI日发病率分别由2018年的7.62‰、2.99‰、1.90‰降至2019年的3.93‰、1.01‰、0.62‰;医院感染发病率、医院感染例次发病率分别由4.98%、6.89%降至2.37%、3.14%。结论基于FMEA法的风险评估能够发现ICU医院感染预防与控制中的薄弱点,为防控ICU医院感染提供科学有力的证据。

Objective To screen out high-risk events of healthcare-associated infection(HAI)and catheter-related infection in intensive care unit(ICU)by failure mode and effect analysis(FMEA),and provide basis for the formulation of prevention and control measures of HAI in ICU.Methods Twenty risk factors were determined by risk identification,FMEA risk assessment was used to screen out high and medium-high risk factors,corresponding infection prevention and control measures were formulated and supervised,ventilator-associated pneumonia(VAP),central line-associated bloodstream infection(CLABSI)and catheter-associated urinary tract infection(CAUTI)before and after the implementation of intervention measures were compared.Results Four high-risk factors were screened out,including patients infected with multidrug-resistant organisms didn’t follow effective isolation mea-sures,high-dose use of antimicrobial agents,unqualified cleaning and disinfection of bed units,and cross use of diagnosis and treatment articles;four medium-high risk factors were screened out,which were neglect of secretion clearance on the airbag before extubation or air bag deflation,poor hand hygiene compliance,excessive non-staff of department,as well as poor implementation of accompanying and visiting system.In view of the high and medium-high risk factors,corresponding prevention and control measures were implemented,incidences of VAP,CLABSI and CAUTI per 1000 catheter day decreased from 7.62‰,2.99‰and 1.90‰in 2018 to 3.93‰,1.01‰and 0.62‰in 2019 respectively;incidences and case incidences of HAI decreased from 4.98%and 6.89%to 2.37%and 3.14%respectively.Conclusion The risk assessment based on FMEA method can find out the weak links in the prevention and control of HAI in ICU,provide scientific and powerful evidence for the prevention and control of HAI in ICU.