失效模式与效应分析在降低ICU多重耐药菌感染中的应用效果

Application efficacy of failure mode and effect analysis in reducing multidrug-resistant organism infection in intensive care unit

摘要:

目的 探讨失效模式与效应分析（FMEA）在降低重症监护病房（ICU）多重耐药菌（MDRO）感染中的应用效果。 方法 组建科室、医院感染管理科、总务处多部门参与的专案改进小组，通过现状调查及一系列的改进与干预措施，比较FMEA实施前后MDRO防控措施不达标率及MDRO医院感染发现率。 结果 MDRO防控措施不达标率由专案实施前的31.99%（111/347）降至专案实施后的6.07%（44/725），MDRO医院感染发现率由专案实施前的19.89‰（95/4 776）降至专案实施后的9.73‰（46/4 728），差异均有统计学意义（均P < 0.05）。 结论 结合现状运用FMEA质量改进工具能有效降低ICU MDRO感染率，但因标本送检率的差异，在医院感染率方面无法进一步进行研究，后续研究将聚焦全国大样本的MDRO标本送检率。

Abstract:

Objective To explore the application efficacy of failure mode and effect analysis(FMEA)in reducing multidrug-resistant infection (MDRO) in intensive care unit (ICU). Methods A special improvement team with the participation of ICU, healthcare-associated infection (HAI) department and general affairs department was set up, through investigation on current situation and implementation of a series of improvement and intervention measures, non-compliance rate of MDRO prevention and control measures and the discovery rate of MDRO HAI before and after the implementation of FMEA were compared. Results The non-compliance rate of MDRO prevention and control measures decreased from 31.99% (111/347) before the implementation of project to 6.07% (44/725) after the implementation, the discovery rate of MDRO HAI decreased from 19.89 ‰ (95/4 776) before the implementation of the project to 9.73 ‰ (46/4 728) after the implementation, differences were both statistically significant (both P < 0.05). Conclusion Combined with the current situation, application of FMEA quality improvement tool can effectively reduce MDRO infection rate in ICU. However, due to the difference in specimen detection rate, further research on HAI rate cannot be carried out, the follow-up research will focus on the MDRO specimen detection rate of large specimens in China.