失效模式与效应分析在外科患者术后肺部多药耐药菌感染防控中的应用效果

Effect of FMEA on prevention and control of postoperative pulmonary multidrug-resistant organisms infections

目的 探讨失效模式与效应分析(FMEA)在外科患者术后肺部多药耐药菌感染防控中的应用效果。方法 通过FMEA风险评估筛选出10个高风险及中高风险因素,制定相对应的感染防控措施并监督落实,将2022年1月-6月进行外科手术的5 591例患者作为干预前资料,2022年7月-11月进行外科手术的8 642例患者作为干预后资料,比较干预前后外科患者术后肺部多药耐药菌感染情况。结果 风险评估控制措施实施后FMEA得分较实施前各风险因素得分均有所下降,外科患者术后肺部多药耐药菌的感染率由干预前的0.82%下降至0.31%,差异具有统计学意义(P<0.001),其中耐碳青霉烯类鲍氏不动杆菌(P<0.001)、耐碳青霉烯类肺炎克雷伯菌(P=0.005)、耐甲氧西林的凝固酶阴性葡萄球菌(P=0.043)的感染率均下降。结论 基于FMEA风险评估术后肺部多药耐药菌感染的失效模式,分析其可能产生的风险并进行量化,根据风险程度制定并采取相应的控制措施,可有效降低外科患者术后肺部多药耐药菌感染。

OBJECTIVE To explore the application of failure modes and effects analysis(FMEA)in the prevention and control of pulmonary multidrug-resistant organism(MDRO)infection in surgical patients after operation.METHODS Ten high or medium-high risk factors were screened by FMEA risk assessment.Corresponding infection prevention and control measures were formulated and implemented under supervision.Data of 5591 patients who underwent surgery from Jan to Jun 2022 were collected as the pre-intervention information,and those of 8642 patients who underwent surgery from Jul to Nov 2022 were taken as the post-intervention information,which can be used to compare the pulmonary multidrug-resistant organism infection of surgical patients before and after the intervention.RESULTS After the implementation of risk assessment and control measures,the scores of FMEA decreased when comparing before the implementation.The pulmonary infection rate of multidrug-resistant organism in the surgical patients decreased from 0.82%before the intervention to 0.31%,with a statistically significant difference(P<0.001).The infection rate of carbapenem-resistant Acinetobacter baumannii(P<0.001),carbapenem-resistant Klebsiella pneumoniae and(P=0.005),methicillin-resistant coagulase negative staphylococci(P=0.043)decreased.CONCLUSION FMEA-based risk assessment of the failure mode of postoperative pulmonary multidrug-resistant organism infection is evaluated and the possible risks are analyzed and quantified.According to them,corresponding control measures should be taken to effectively reduce postoperative pulmonary multidrug-resistant organism infection in surgical patients.