基于多学科协作的FMEA在口腔综合治疗台水路污染管理的应用及效果评价

Application of FMEA based on multidisciplinary teamwork in contamination management of dental unit waterlines and its effect

  • 摘要: 目的 分析基于多学科协作(MDT)的失效模式与效应分析(FMEA)在口腔综合治疗台水路(DUWLs)污染风险管控的应用及效果评价。方法 选取2023年7月-2024年6月自贡市第四人民医院口腔门诊16台口腔综合治疗台(DCU)为研究对象,MDT-FMEA管理小组运用FMEA法找出DUWLs管理过程存在的潜在失效模式,采用四分位数法确定高风险失效模式,分析原因与可能发生的后果并实施干预及效果评价。结果 实施FMEA管理后,10项高风险失效模式风险优化指数(RPN)值下降率达39.92%~63.93%。开诊前与诊疗之间手机端口、三用枪头、水路、吸唾管道及痰盂冲洗依从率较干预前均提升(P<0.05)。水路消毒、水路余水排空及操作人员手卫生依从率由35.90%、57.39%和64.09%提升至78.05%、95.00%和88.33%(P<0.001)。高速手机出水口菌落总数由62.00(14.25,670.00)CFU/ml下降为30.00(10.00,60.00)CFU/ml(Z=-2.147,P=0.032); 三用枪出水口菌落总数由33.50(20.50,175.50)CFU/ml下降为23.00(9.50,57.00)CFU/ml(Z=-2.252,P=0.024); 高速手机与三用枪水样合格率均提升至90%以上(P<0.05)。干预后高速手机与三用枪均未再检出致病菌。结论 基于多学科协作的FMEA法可运用于DUWLs的风险管理,有效提升水路管理水平,提高口腔诊疗用水合格率。

     

    Abstract: OBJECTIVE To observe the application of Failure Mode and Effects Analysis (FMEA) based on multidisciplinary teamwork (MDT) in contamination risk control of dental unit waterlines (DUWLs) and evaluate the effect. METHODS From Jul. 2023 to Jun. 2024, a total of 16 dental units were chosen from stomatology department of Zigong Fourth People's Hospital. The MDT-FMEA team employ FMEA to find out the potential failure modes during the process of DUWLs management, the high risk failure modes were determined by quartile method; the causes and possible consequences were analyzed, the intervention measures were taken, and the effects were evaluated. RESULTS The declined rates of the risk priority number (RPN) values of the 10 high risk failure modes reached 39.92% to 63.93%. The compliance rates of rinsing mobile ports, three-in-one syringe tips, waterlines, suction pipelines and cuspidors between the pre-treatment and the treatment were higher after the intervention than before the intervention (P< 0.05). The compliance rates of waterline disinfection, remaining water drainage from waterlines and hand hygiene of operators increased from 35.90%, 57.39% and 64.09% to 78.05%, 95.00% and 88.33%, respectively (P< 0.001). The total bacterial colony counts at the outlet of high-speed handpieces decreased from 62.00 (14.25, 670.00) CFU/ml to 30.00 (10.00, 60.00) CFU/ml (Z=-2.147, P= 0.032); the total bacterial colony counts at the outlet of three-in-one syringes decreased from 33.50 (20.50, 175.50) CFU/ml to 23.00 (9.50, 57.00) CFU/ml (Z=-2.252, P= 0.024). The qualified rates of water samples from both high-speed handpieces and three-in-one syringes increased to over 90% (P< 0.05). No pathogenic bacteria were detected in the high-speed handpieces or three-in-one syringes after the intervention. CONCLUSIONS The FMEA based on multidisciplinary collaboration can be applied in risk management of DUWLs, effectively improve the management of waterlines, and raise the qualified rate of water for oral diagnosis and treatment.

     

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