失效模式与效应分析在医务人员血源性职业暴露监测分析及防护的应用

Application of failure mode and effect analysis in monitoring and protection of blood-borne occupational exposure in medical personnel

目的观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果采用FMEA后,RPN、权重系数(W_(i))均降低,且RPN实施前为2633分,实施后为853分,降幅为67.60%,W_(i)实施前为0.7299,实施后为0.2680,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。

Objective To observe the application of failure mode and effect analysis(FMEA)in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel.Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019,to calculate the risk priority number(RPN),to give priority to the highest risk factor,to formulate improvement measures.The improved scheme was adopted from July 2019 to December 2020.The RPN value of failure mode,blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale(C-HSCS)before and after the implementating of the scheme were compared and analyzed.Results After implementating FMEA,RPN and weight coefficient(W_(i))decreased,and the RPN scores were 2633 and 853 before and after implementation,with a decrease of 67.60%,W_(i) was 0.7299 before implementation and 0.2680 after implementation,with a decrease of 63.28%.Before FMEA,the blood-borne occupational exposure rate was 28.74%,and after FMEA,the rate was 4.65%.After the implementation,the scores of safety work obstruction was(11.99±2.16),cleanliness and tidiness was(11.48±1.89),management and support was(28.58±3.24),conflict and communication was(22.54±2.83),feedback and training was(13.82±2.55),which were higher than those before the implementation:(10.67±2.68),(10.06±2.36),(26.80±3.86),(20.85±2.62),(12.52±1.19),P<0.05.Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps,improve the pertinence of improvement measures and reduce occupational exposure.