基于失效模式与效应分析法的三管风险评估与管理在ICU医院感染控制中的效果评价研究

Study on the effect of three tubes risk assessment and management based on failure mode and effect analysis in nosocomial infection control in ICU

目的 评价失效模式与效应分析法(FMEA)应用于三管(中心静脉导管、气管内插管、留置导尿管)风险评估与管理,对常见ICU医院感染的控制效果。方法 选择徐州市第六人民医院ICU 2019年5月至2020年8月收治的120例患者入对照组,管道护理与感染控制采用该院ICU常规护理措施与质量标准;2020年9月至2021年12月收治的120例患者入观察组,将FMEA法应用于ICU三管风险评估与管理。对两组护理过程失效模式的RPN值,两组患者的呼吸机相关性肺炎(VAP)、中心静脉导管相关血流感染(CRBSI)、导尿管相关性泌尿系感染(CAUTI)发生率进行比较。结果 与三管相关的医院感染病例中出现的失效模式有:评估不准确、侵入性操作、护士准备以及病房环境,在4种失效模式中,观察组的RPN值均明显低于对照组(P<0.05)。观察组患者VAP、CRBSI发生率低于对照组(P<0.05),分别是(5.0%vs.17.5%)、(4.2%vs.14.2%)。结论 应用FMEA护理模式能够预防ICU患者与三管相关的医院感染,护理人员在护理过程中能依据该模式准确注意护理要点,降低ICU患者与三管相关的医院感染的发生率,值得临床推广应用。

Objective To explore and evaluate the effect of three tubes(central venous catheter, endotracheal intubation, indwelling catheter) risk assessment and management based on failure mode and effect analysis in nosocomial infection control in ICU. Methods 120 patients admitted to the Xuzhou Sixth People’s Hospital from May 2019 to August 2020 were selected as the control group, routine nursing measures and quality standards of ICU in our hospital were applied. 120 patients admitted to the Xuzhou Sixth People’s Hospital from September 2020 to December 2021 were selected as the observation group, the FMEA method was applied to the risk assessment and management of three tubes. RPN value of nursing course failure mode, incidence of ventilator-associated pneumonia(VAP), central venous catheter-associated bloodstream infection(CRBSI) and catheter-associated urinary tract infection(CAUTI) were compared. Results The failure modes associated with nosocomial infection were: inaccurate assessment, invasive procedures, nurse preparation and ward environment. In the four failure modes, the RPN value of the observation group was lower than that of the control group(P<0.05). The incidence of ventilator-associated pneumonia and catheter-related bloodstream infection in ICU patients in observation group was lower than that in control group(5.0% vs. 17.5%,4.2% vs. 14.2%). Conclusions The application of FMEA nursing mode can prevent nosocomial infection related to the three tubes in ICU patients. According to this mode, nurses can accurately pay attention to the key points in the nursing process according to this mode, and reduce the incidence of nosocomial infection related to the three tubes in ICU patients, which is worthy of clinical application.