失效模式和效应分析在隔离病房医务人员个人防护暴露风险管理中的应用

Application of failure mode and effect analysis in risk management of personal protective exposure of medical staff in isolation ward

目的探讨失效模式和效应分析(FMEA)在隔离病房医务人员个人防护中的应用效果。方法调查某省三级医院30名医务人员进入隔离病房后个人防护执行情况,采用FMEA法对个人防护进行干预,组建专家团队,分析个人防护中佩戴医用防护口罩、戴护目镜、穿隔离衣防护服、脱卸防护用品等失效模式、失效原因和效应分析,制定切实可行的干预措施,实施FMEA干预,观察FMEA干预前、后7 d风险优先指数(RPN)、防护用品执行率、正确率情况。结果实施FMEA,医务人员脱卸防护用品、佩戴医用防护口罩、穿防护服、穿隔离衣等措施的RPN值由291.25±83.27、191.75±42.38、127.38±42.03、109.88±36.95下降到25.00±4.59、20.25±13.95、15.31±5.07、14.75±7.28(P<0.01);戴护目镜、戴医用防护口罩、脱卸防护用品、穿防护服等措施的正确率分别由33.33%、40.00%、42.86%、57.14%提高到93.55%、96.97%、96.97%、96.97%(P<0.01或P<0.05)。结论在隔离病房医务人员个人防护中应用FMEA,可以提高医务人员个人防护正确率,降低医务人员暴露风险,促进医务人员规范职业防护行为,为医院隔离病房传染性疾病的有效防控提供参考依据。

Objective To explore the effect of failure mode and effect analysis(FMEA)on personal protection of medical personnel in isolation ward.Methods Investigated the implementation of personal protection of 30 medical staff in a provincial tertiary hospital after entering the isolation ward,determined to use the FMEA method to intervene in personal protection,and formed an expert team to analyze the protection of wearing medical protective masks,goggles,and isolation clothing in personal protection.Analyze the failure modes,failure causes and effects of clothing and protective equipment,formulate feasible intervention measures,implement FMEA intervention,and observe the risk priority index(RPN),the implementation rate and correct rate of protective equipment before and after the 7-day FMEA intervention.Results Implement FMEA.The RPN values of medical personnel taking off protective equipment,wearing medical protective masks,wearing protective clothing and wearing isolation clothing decreased from 291.25±83.27,191.75±42.38,127.38±42.03,109.88±36.95 to 25.00±4.59,20.25±13.95,15.31±5.07,14.75±7.28(P<0.01),the difference was statistically significant;The correct rate of wearing goggles,wearing medical protective masks,taking off protective equipment and wearing protective clothing increased from 33.33%,40.00%,42.86%and 57.14%to 93.55%,96.97%,96.97%,96.97%,respectively(P<0.01 or P<0.05),the difference was statistically significant.Conclusion The application of FMEA in the personal protection of medical staff in isolation wards can improve the correct rate of personal protection of medical staff,reduce the exposure risk of medical staff,promote the standardization of occupational protection behavior of medical staff,and provide reference for the effective prevention and control of infectious diseases in isolation wards.