FMEA模式在带状疱疹神经痛病人HIV筛查期医院感染防控中的应用

Application of FMEA risk assessment method in prevention and control of hospital infection during HIV screening in patients with postherpetic neuralgia

目的:分析失效模式与效应分析法(failure mode and effect analysis,FMEA)在带状疱疹后神经痛病人艾滋病筛查期医院感染防控中的应用及其效果。方法:选取2019年1月至2019年12月在本院疼痛科收治的120例带状疱疹后神经痛(postherpetic neuralgia,PHN)病人为对照组;2020年1月至2020年12月收治的120例PHN病人为试验组,分析采用FMEA评估PHN病人艾滋病筛查期的风险因素,找出主要失效模式并计算危急值,对危急值较高的项目制订改进措施并落实,比较干预前后的效果。结果:实施FMEA风险评估法后,失效模式的危机值(RPN)显著下降,由246分降至64分,差异有统计学意义(P<0.05);检验排查时间由(9.9±2.4)h下降至(0.5±0.1)h,职业暴露及院内感染总发生率由26.7%下降至2.5%,差异均有统计学意义(P<0.05)。结论:FMEA风险评估法可指导医护人员发现PHN病人人类免疫缺陷病毒(HIV)筛查期间院内感染的薄弱环节,有的放矢地进行预防和控制。

Objective:To analyze the application and effect of failure mode and effect analysis(FMEA)in the prevention and control of hospital infection in patients with postherpetic neuralgia during acquired immunodeficiency syndrome(AIDS)screening.Methods:One hundred and twenty patients with postherpetic neuralgia(PHN)treated in the pain department of our hospital from January 2019 to December 2019 were selected as the control group;from January 2020 to December 2020,120 patients with PHN were selected as the experimental group.The risk factors of AIDS screening period after herpes zoster neuralgia were analyzed by the FMEA method.The main failure modes were found out,the critical values were calculated,and the improvement measures were implemented for the projects with high critical values,and the effects were compared before and after intervention.Results:After the implementation of the FMEA risk assessment method,the RPN value of failure mode was decreased significantly,from 246 points to 64 points,the difference was statistically significant(P<0.05);the examination time was decreased from(9.9±2.4)h to(0.5±0.1)h,and the total incidence of occupational exposure and hospital infection decreased from 26.7%to 2.5%(P<0.05),which was statistically significant(P<0.05).Conclusion:FMEA risk assessment can guide medical staff to find the weak spots of nosocomial infection in PHN patients during HIV screening,and carry out targeted prevention and control.