HFMEA工具结合QCC质控管理措施对消毒供应室院感防控的效果研究

Effect of HFMEA tool combined with QCC quality control management measures on the prevention and control of nosocomial infection in the disinfection supply room

目的探讨医疗失效模式与效应分析(HFMEA)工具结合品管圈(QCC)质控管理措施对消毒供应室院感防控的效果。方法回顾性分析2020年6月至2022年6月西安市第三医院消毒供应室的相关资料。其中以2020年6月至2021年6月实施常规管理时期为实施前阶段,2021年7月至2022年6月实施HFMEA工具结合QCC质控管理措施时期为实施后阶段。评估HFMEA合并QCC质控管理措施实施前后失效模式风险指数(RPN);采用自制量表抽查和比较两个阶段消毒供应室的工作质量(回收、消毒、包装、储存合格率)和工作人员管理效果(工作人员积极性、工作技巧、服务态度);分别随机抽查实施前后各300件消毒物品和50例患者,比较差错发生率及感染发生率;并采用布维-狄克试验(B-D试验)、生物监测方法对实施前后脉动真空灭菌柜的消毒质量进行检查,各抽检100次。结果与实施前比较,HFMEA合并QCC实施后自动清洗消毒机、灭菌器未定期维护、工作人员培训不到位、操作流程不规范、工作区域温、湿度、照明不达标各RPN值显著下降,差异均有统计学意义(P<0.05);实施后消毒供应室的回收合格率、消毒合格率、包装合格率、储存合格率分别为98.00%、98.33%、99.33%、98.67%,明显高于实施前的80.00%、84.33%、87.00%、86.33%,差异均有统计学意义(P<0.05);实施后工作人员的工作积极性、工作技巧及服务态度评分分别为(94.35±5.13)分、(95.56±3.43)分、(98.54±3.25)分,明显高于实施前的(84.23±3.25)分、(87.83±5.22)分、(90.32±3.33)分,差异均有统计学意义(P<0.05);实施后消毒物品的差错发生率、院感发生率分别为1.33%(4/300)、2.00%(1/50),明显低于实施前的10.67%(32/300)、20.00%(10/50),B-D试验合格率、生物监测合格率分别为100.00%(100/100)、93.00%(93/100),明显高于实施前的84.00%(84/100)、81.00%(81/100),差异均有统计学意义(P<0.05)。结论HFMEA工具结合QCC质控管理措施有助于提升消毒供应室院感防控效果,提高器械及物品消毒合格率,提高工作人员积极性,降低医院感染发生风险。

Objective To explore the effect of Healthcare failure mode and effect analysis(HFMEA)tool combined with quality control circle(QCC)quality control management measures on the prevention and control of nosocomial infection in disinfection supply room.Methods The relevant data of Disinfection Supply Room,Xi'an Third Hospital from June 2020 to June 2022 were retrospectively analyzed.The implementing period of routine management from June 2020 to June 2021 was the pre-implementation stage,and the period of implementing HFMEA tool combined with QCC quality control management measures from July 2021 to June 2022 was the post-implementation stage.The failure mode risk index(RPN)was evaluated before and after the implementation of HFMEA combined with QCC quality control management measures.The work quality(recovery,disinfection,packaging,storage qualified rate)and staff management effect(staff enthusiasm,work skills,service attitude)in the two stages of the disinfection and supply room were randomly and compared by self-made scale.The incidence of error rate and infection were compared by random sampling of 300 sterilized articles and 50 patients before and after the implementation.The Bouvey-Dick test(B-D test)and biological monitoring methods were used to check the disinfection quality of the pulsating vacuum sterilization cabinet before and after the implementation,100 times for each sampling test.Results Compared with those before the implementation of HFMEA combined with QCC,the RPN values of automatic cleaning and disinfection machine,sterilizer not regularly maintained,the staff training not in place,the operation process not standardized,the temperature,humidity,lighting substandard decreased significantly after the implementation of HFMEA combined with QCC(P<0.05).After the implementation,the recovery qualified rate,disinfection qualified rate,packaging qualified rate,and storage quali fied rate of the disinfection supply room were 98.00%,98.33%,99.33%,and 98.67%,which were significantly higher than 80.00%,84.33%,87.00%,and 86.33% before the implementation(P<0.05).After the implementation,the scores of work enthusiasm,work skills,and service attitude of the staff were(94.35±5.13)points,(95.56±3.43)points,and(98.54±3.25)points,which were significantly higher than(84.23±3.25)points,(87.83±5.22)points,and(90.32±3.33)points before the implementation(P<0.05).After the implementation,the error rate of disinfection items and the incidence of hospital infection were 1.33%(4/300)and 2.00%(1/50),which were significantly lower than 10.67%(32/300)and 20.00%(10/50)before implementation,and the pass rate of B-D test and biological monitoring were 100.00%(100/100)and 93.00%(93/100),which were significantly higher than 84.00%(84/100)and 81.00%(81/100)before implementation,with statistically significant differences(P<0.05).Conclusion HFMEA tool combined with the QCC quality control management measures can help improve the prevention and control effect of hospital infection in the disinfection supply room,improve the disinfection pass rate of disinfection of instruments and articles,improve the enthusiasm of the staff,and reduce the risk of hospital infection.