医疗失效模式与效应分析对肿瘤放疗患者医院感染的预防作用

【摘要】 目的 探讨医疗失效模式及效应分析（HFMEA）对肿瘤放疗患者医院感染的预防作用，为降低感染率提供参考依据。方法 根据HFMEA方法，组建项目团队，进行肿瘤放疗患者医院感染危险因素分析，制定并实施一系列干预控制措施。结果 四个失效模式的事先风险数值（RPN）有明显下降，依次为“手卫生的依从性”、“放疗患者的自身因素”、“疑似医院感染病例的识别”、“侵入性操作的规范性”，分别减少了85.12%、80.71%、78.13%、56.25%；管理前医生、护士、放技人员手卫生依从性分别为67.5%、70.3%、60.7%，管理后依次为74.6%、83.6%、77.5%，管理前后比较差异均有统计学意义（P﹤0.01）；患者医院感染率管理前为 2.07％，明显高于管理后的0.97％，两组患者比较差异有统计学意义（P﹤0.01）。结论 医疗失效模式与效应分析在肿瘤放疗患者医院感染管理中的应用可以明显降低患者的感染率，提高医务人员的手卫生依从性。

Effect of health failure mode and effects analysis on prevention of hospital infection of patients treated with radiation therapy

[Abstract] Objective: To explore health failure mode and effects analysis (HFMEA) on prevention of hospital infection of patients treated with radiation therapy. This study would provide reference for reducing hospital infection rate. Methods: The project team was built to analyze risk failures of cancer patients treated with radiation therapy. A series of control interventions were formulated and implemented . Results: Risk priority number(RPN) of four failure mode was reduced significantly. Hand hygiene compliance, personal factor of radiation oncology patients, identification of suspected hospital infection and the normative nature of invasive operation were reduced 85.12%, 80.71%, 78.13% and 56.25, respectively. Hand hygiene compliance of doctors, nurses and radiological technicians were 65.7%, 70.3% and 60.7% before intervention, while those were 74.6%, 83.6% and 77.5%, respectively after intervention. These are statistically significant(p<0.01). Hospital infection rate of patients before and after intervention was 2.07% and 0.97% , respectively (p<0.01). Conclusions: Hospital infection rate of patients treated with radiation therapy through HFMEA was dramatically reduced. Hand hygiene compliance of medical stuff was improved.