失效模式与效应分析在血液透析中心医院感染管理中的应用

Application of failure mode and effect analysis in management of hospital-associated infections in hemodialysis center

  • 摘要:
    目的 探讨失效模式与效应分析(FMEA)在血液透析中心医院感染管理工作中的应用效果。
    方法 2023年11月,采取风险优先指数(RPN)和措施优先度(AP)相结合的方式,应用FMEA法对华中科技大学同济医学院附属同济医院血液透析中心医院感染管理工作存在的危险因素进行风险识别、分析及评价,筛选出需要干预的高风险点、并制定针对性措施进行风险控制;干预期结束后,2024年11月对高风险点改进情况进行第二轮风险评估,评价管理成效。
    结果 从组织架构、自查督导、人员管理、环境布局、清洁消毒、监测、操作流程和物品管理八个方面共48个风险点进行风险评估,发现有9个风险点的RPN值超过125,其中3个风险点的AP值为“H”;采取针对性措施干预后,其中8个风险点的RPN值<125,6个风险点AP值降至L,显示风险管理成效良好。
    结论 采取RPN和AP相结合的FMEA法可以准确识别血液透析中心质量管理的高风险点;针对性采取干预措施可以有效提升血液透析中心的医院感染防控效果,降低血液透析患者发生医院感染的风险。

     

    Abstract:
    OBJECTIVE To explore the effect of failure mode and effect analysis (FMEA) on management of hospital-associated infections (HAIs) in hemodialysis center.
    METHODS In Nov. 2023, the risk priority number (RPN) integrated with action priority (AP) was adopted to identify, analyze and evaluate the risk factors in management of HAIs in hemodialysis center of Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology by FMEA method. The high risk points that needed to be taken interventions were screened out, and the targeted measures were formulated to control the risks. At the end of the intervention period, a second round of risk assessment was carried out for improvement status of the high-risk points in Nov. 2024, and the effect on the management of HAIs was evaluated.
    RESULTS The risk assessment was carried out for 48 risk points covering eight aspects, including organizational structure, self-inspection and supervision, staff management, environmental layout, cleaning and disinfection, surveillance, operation procedures and item management. There were 9 risk points with the RPN values greater than 125, 3 of which were with the AP value of "H". There were 8 risk points with the RPN value less than 125 and 6 risk points with the AP value dropping down to L after the targeted intervention measures were taken, indicating that the risk management has achieved favorable effect.
    CONCLUSIONS The RPN and AP integrated with FMEA can accurately identify the high-risk points in the quality management of the hemodialysis center. It is necessary to take targeted intervention measures so as to boost the effect on prevention and control of HAIs in the hemodialysis center and reduce the risk of HAIs in the hemodialysis patients.

     

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