六西格玛管理在优化非哺乳期乳腺炎疮面多重耐药菌感染控制中的应用

Application of Six Sigma management in optimizing the multidrug-resistant organism infection control of non-puerperal mastitis wound

目的探讨六西格玛管理方法在优化非哺乳期乳腺炎(NPM)疮面多重耐药菌感染防控流程中的应用效果。方法2019年1月至6月运用六西格玛管理方法,选取NPM开放性疮面住院患者及家属、后勤保洁人员及病区医务人员作为研究对象。2019年1月至3月为六西格玛管理实施前,NPM开放性疮面住院患者77例,年龄(33.29±6.70)岁;2019年4月至6月为六西格玛管理实施后,NPM开放性疮面住院患者97例,年龄(33.22±5.89)岁。采用包括定义(define)、测量(measure)、分析(analyze)、改进(improve)、控制(control)5个阶段的DMAIC改进模式,对影响NPM疮面多重耐药菌感染防控流程的原因进行鱼骨图、因果矩阵等方法分析,找出5个关键因素,从中医外用药使用、规范换药、手卫生执行、患者及家属的教育、终末消毒控制等方面进行针对性改进。对改进前后多重耐药菌感染发生率及过程指标进行比较。结果实施后,NPM多重耐药菌感染发生率由16.9%(13/77)下降至6.2%(6/97),差异有统计学意义(χ^(2)=5.050,P=0.025);在7项控制指标中,手卫生执行率(医护)实施前后比较差异无统计学意义(P>0.05),其余6项包括中医外用药使用正确率[48.4%(44/91)比24.7%(22/89)]、手卫生执行率(患者及家属)[50.0%(97/194)比1.9%(3/154)]、手卫生执行率(保洁)[84.6%(77/91)比47.2%(42/89)]、患者及家属健康教育知晓率[78.9%(153/194)比14.9%(23/154)]、隔离患者换药规范率[84.6%(77/91)比37.1%(33/89)]、终末消毒规范率[90.7%(88/97)比59.7%(46/77)]指标实施后均得到改善(均P<0.05)。结论基于六西格玛管理方法优化的NPM疮面多重耐药菌感染防控流程可以改善多重耐药菌感染的预防和控制的执行行为,有效降低NPM疮面多重耐药菌感染发生。

Objective To investigate the application effect of Six Sigma management method in optimizing the prevention and control process of multidrug-resistant organism infection in the wound of non-puerperal mastitis(NPM).Methods From January to June 2019,Six Sigma management method was used,and inpatients with NPM and open wound and their family members,logistics and cleaning staff,and medical staff in the ward were selected as the research objects.There were 77 inpatients with NPM and open wound from January to March 2019 before the implementation of Six Sigma management,with the age of(33.29±6.70)years old;there were 97 inpatients with NPM and open wound from April to June 2019 after the implementation of Six Sigma management,with the age of(33.22±5.89)years old.DMAIC(define,measure,analyze,improve,and control)improvement pattern was adopted.The causes affecting the prevention and control process of multidrug-resistant organism infection of NPM wound were analyzed by Fishbone diagram and causal matrix analysis.Five key factors were found out,and targeted improvement were made in the aspects of external TCM use,standard dressing change,hand hygiene implementation,education on patients and their families,terminal disinfection control,and so on.The incidences of multidrug-resistant organism infection and process indexes before and after the improvement were compared.Results After the impleraentation,the incidence of NPM multidrug-resistant organism infection decreased from 16.9%(13/77)to 6.2%(6/97),with a statistically significant difference(χ^(2)=5.050,P=0.025).In the 7 indicators,the hand hygiene implementation rate(medical and nursing staff)had no statistically significant difference before and after the impleraentation(P>0.05),the other 6 items including the accuracy of external TCM use[48.4%(44/91)vs.24.7%(22/89)],the implementation rate of hand hygiene(patients and their families)[50.0%(97/194)vs.1.9%(3/154)],the implementation rate of hand hygiene(cleaning staff)[84.6%(77/91)vs.47.2%(42/89)],the awareness rate of health education of patients and their families[78.9%(153/194)vs.14.9%(23/154)],the standard rate of dressing change of isolated patients[84.6%(77/91)vs.37.1%(33/89)],and the standard rate of terminal disinfection[90.7%(88/97)vs.59.7%(46/77)]all improved after the impleraentation(all P<0.05).Conclusion The optimized prevention and control process of multidrug-resistant organism infection for NPM wound based on Six Sigma management method can improve the prevention and control behaviors of multidrug-resistant organism infection,and effectively reduce the incidence of multidrug-resistant organism infection of NPM wound.