基于FMEA评估器械相关感染风险的方法及其效果

Assessment of risk of device-related infections based on FMEA and its effectiveness

  • 摘要:
    目的 探讨风险评估在器械相关感染风险防控中的应用效果, 发现高风险环节, 从而制定针对性措施以降低风险。
    方法 2023年1月应用失效模式与效应分析(FMEA)法对华中科技大学同济医学院附属同济医院重症监护病房的器械相关感染风险因素进行风险评估, 从风险发生可能性、后果严重程度和当前管理体系完整性这三个维度对各风险指标进行风险识别、分析及评价。
    结果 风险评估结果发现医务人员呼吸机相关性肺炎防控知识欠缺、未对呼吸机及气管插管的指征进行每日评估、呼吸机患者床头抬高角度不足30°~45°、呼吸机患者未及时清除声门下分泌物、医务人员导管相关血流感染防控知识欠缺、未做到每日评估中心静脉导管拔管指征、中心静脉置管时未做到最大无菌屏障、导尿管相关尿路感染防控知识欠缺、未做到每日评估导尿管拔管指征这几个方面为高风险因素。通过一年的持续干预, 各项高风险因素均得到不同程度的改进, 医院感染发病率(9.18%下降至6.19%)和器械相关感染发病率均显著下降。
    结论 FMEA法作为一种前瞻性的风险评估方法, 能够针对性筛选出器械相关感染的风险因素, 为精准防控提供理论依据。

     

    Abstract:
    OBJECTIVE To explore the application effectiveness of risk assessment in the prevention and control of device-related infection risks and identify high-risk links thereby formulate targeted measures to reduce risks.
    METHODS In Jan. 2023, the failure mode and effect analysis (FMEA) method was applied to conduct a risk assessment of device-related infection risk factors in the Intensive Care Unit of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Risk identification, analysis and evaluation were performed on each risk indicator from three dimensions: the likelihood of risk occurrence, the severity of consequences and the integrity of the current management system.
    RESULTS The risk assessment results revealed that the following aspects were high-risk factors: healthcare workers′ lack of knowledge in preventing ventilator-associated pneumonia, failure to conduct daily assessments of ventilator and tracheal intubation indications, insufficient elevation of the bedhead for ventilator patients (less than 30°-45°), delayed clearance of subglottic secretions for ventilator patients, healthcare workers′ lack of knowledge in preventing catheter-related bloodstream infections, failure to conduct daily assessments of central venous catheter removal indications, lack of maximum sterile barrier during central venous catheterization, healthcare workers′ lack of knowledge in preventing catheter-associated urinary tract infections and failure to conduct daily assessments of catheter removal indications. After one year of continuous intervention, all high-risk factors were improved to varying degrees, and the incidence rates of both hospital-associated infections (from 9.18% to 6.19%) and device-related infections significantly decreased.
    CONCLUSIONS As a prospective risk assessment method, the FMEA method can specifically screen out risk factors for device-related infections, providing a theoretical basis for precise prevention and control.

     

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