基于医疗失效模式与效应分析法的发热门诊医院感染风险管理

Risk management of nosocomial infection in fever clinics based on medical failure mode and effect analysis

目的 评估发热门诊医院感染风险点,通过持续质量改进措施优化医院感染管理策略,有效控制发热门诊的风险。方法 基于医疗失效模式与效应分析法(HFMEA),评估发热门诊可能存在的风险点,采取持续质量改进措施,逐步改进。结果 需要采取措施改进的风险点有6个,包括发热门诊留观间数量不足、工作人员未严格执行手卫生、保洁员轮换频繁及相关知识掌握不足、消毒顺序不正确、清洁消毒工具混用、发热患者未做到闭环管理。通过实施持续质量改进措施,发热门诊留观间数量由5间增加至12间;工作人员的手卫生依从率由56.25%提高至86.36%;发热门诊保洁员的轮换频次由原来的2周1次改为3个月1次;保洁员相关知识掌握率由54.17%提高至91.30%;保洁员消毒顺序正确率由62.5%提高至95.65%;清洁工具使用正确率由65.22%提高至91.30%;发热患者闭环管理率由87.50%提高至100.00%。结论 基于HFMEA的风险分析方法,可以及时发现潜在的医院感染风险,再利用持续质量改进,采取有针对性的预防和改进措施加以防范,达到有效管控风险的效果。

OBJECTIVE To evaluate the risk points of nosocomial infection in fever clinics, optimize the management strategy of nosocomial infection through continuous quality improvement measures, and effectively control the risk of fever clinics. METHODS Based on the medical failure mode and effect analysis methods(HFMEA), the possible risk points of fever clinics were evaluated, and continuous quality improvement measures were taken to gradually improve. RESULTS There were 6 risk points that need to be improved, including insufficient number of observation rooms in fever clinics, staff’s failure to strictly implement hand hygiene, frequent rotation of cleaners, insufficient relevant knowledge, incorrect disinfection sequence, mixed use of cleaning and disinfection tools, and lack of closed-loop management of fever patients. Through the implementation of continuous quality improvement measures, the number of observation rooms in fever clinic increased from 5 to 12. The hand hygiene compliance rate of staff increased from 56.25% to 86.36%. The rotation frequency of cleaning staff in the fever clinic had been changed from once every two weeks to once every three months. The mastery rate of relevant knowledge of cleaners had increased from 54.17% to 91.30%. The correct rate of disinfection sequence of cleaners increased from 62.5% to 95.65%. The correct rate of cleaning tools usage increased from 65.22% to 91.30%. The closed-loop management rate of fever patients increased from 87.50% to 100.00%. CONCLUSION The risk analysis method based on HFMEA can detect the potential risk of nosocomial infection in time. By making use of continuous quality improvements, risk can be prevented using targeted preventive and improvement measures to achieve the effective risk management.