Risk assessment of FEMA management modes for different links of hemodialysis and their application effects

OBJECTIVE To explore the application effect of a management model based on three-stratification combined failure mode and effect analysis (FMEA) on reducing infection events in hemodialysis patients.

METHODS A stratified infection prevention and control management method was adopted for pre-dialysis, intra-dialysis and post-dialysis phases. Hemodialysis patients admitted to Chengdu Fifth People′s Hospital from Oct. 2023 to Jan. 2024 were selected as the study subjects. Among them, 301 patients receiving conventional management from Oct. to Nov. 2023 were assigned to the control group, while 321 patients receiving three-stratification combined FMEA management from Dec. 2023 to Jan. 2024 were assigned to the experimental group. Medium- and high-risk failure modes were identified, and interventions were implemented based on risk priority number (RPN).

RESULTS After intervention, all RPN scores were below 6. The hand hygiene implementation rate in the experimental group was higher than that in the control group before vascular access connection (54.52% vs. 31.56%), before vascular access removal (53.27% vs. 32.56%) and after glove change (94.08% vs. 85.38%) (P < 0.001). The correct implementation rate of vascular access maintenance by nurses (90.65% vs. 68.78%) and patients′ awareness rate of vascular access maintenance (76.32% vs. 48.84%) were higher in the experimental group than in the control group (P < 0.001). The incidence rate of respiratory diseases (4.05% vs. 8.64%) and hemodialysis-related infection events (0.93% vs. 3.32%) were lower in the experimental group than in the control group (P < 0.05).

CONCLUSION The application of the three-stratification combined FMEA management model in hemodialysis patients can effectively identify hemodialysis-related infection risk points, improve the precision of hand hygiene implementation rate and the correct implementation rate of vascular access maintenance among nursing staff, enhance patients′ awareness rate of vascular access maintenance, and reduce the incidence rate of hemodialysis-related infection events and respiratory diseases.