医疗失效模式与效应分析在骨折及开颅手术Ⅰ类切口手术部位感染防控中的应用

Application of health failure mode and effect analysis to prevent surgical site infection in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision

目的探讨医疗失效模式与效应分析(health failure mode and effect analysis,HFMEA)在骨折及开颅手术Ⅰ类切口手术部位感染(surgical site infection,SSI)防控中的应用方法及价值。方法选择成都市郫都区人民医院2020年1月—2021年12月Ⅰ类切口手术的骨折及开颅手术患者。根据是否采用基于HFMEA的风险管理,分为常规组及干预组。比较在HFMEA实施期间不同阶段(干预后第1个月和干预后第10个月)的防控措施的依从率变化及风险项目的风险优先系数变化,并比较常规组及干预组SSI发生率的变化。结果共纳入患者884例次。其中,常规组399例次,干预组485例次;发生SSI 16例次;制定7项SSI防控措施。除手术规范着装依从率外(P>0.05),其余6项SSI防控措施依从率变化差异均有统计学意义(P<0.05)。干预后第10个月的术前、术中、术后的风险优先系数均低于干预后第1个月(P<0.05)。除开颅手术SSI发生率(6.1%vs.1.8%,P=0.375)外,常规组和干预组的总SSI发生率(3.3%vs.0.6%)、骨折手术SSI发生率(2.7%vs.0.5%)比较,差异均有统计学意义(P>0.05)。结论运用HFMEA前瞻性识别、评估、分析、应对及追踪骨折和开颅手术Ⅰ类切口SSI风险,可有效提高防控措施依从性,降低SSI发生率。

Objective To explore the application methods and values of using health failure mode and effect analysis(HFMEA)to prevent surgical site infection(SSI)in patients undergoing bone fracture and craniotomy surgery with classⅠincision.Methods Patients undergoing bone fracture and craniotomy surgery with classⅠincision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected.Based on whether receiving HFMEA-based risk management or not,the patients were divided into conventional group and intervention group.The compliance rates with infection control measures,changes in risk priority numbers(RPN)at various stages(1 month and 10 months after intervention)of HFMEA implementation,and the incidence of SSI between the conventional group and the intervention group were compared.Results A total of 884 surgeries were included.Among them,there were 399 cases in the conventional group and 485 cases in the intervention group;16 cases SSI occurred.A total of 7 SSI prevention and control measures had been formulated.Except for proper surgical attire(P>0.05),there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients(P<0.05).In the intervention group,the RPN values of pre-operative,intra-operative,and postoperative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention(P<0.05).Except for the incidence of SSI during craniotomy surgery(6.1%vs.1.8%,P=0.375),there were statistically significant differences in the total SSI incidence(3.3%vs.0.6%)and bone fracture surgery SSI incidence(2.7%vs.0.5%)between the conventional group and the intervention group(P>0.05).Conclusion Applying HFMEA-based risk management techniques to prospectively identify,assess,analyze,manage and track the risk of SSI in bone fracture and craniotomy surgery with classⅠincision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.