应用失效模式与效应分析防范手术中血源性职业暴露

Applying failure mode and effect analysis to prevent blood-borne occupational exposure during surgery

摘要:

目的 探讨失效模式与效应分析（FMEA）在防范手术流程中血源性职业暴露的效果。方法 根据2016年1-12月手术流程中血源性职业暴露基线调查资料的分析结果，于2017年1-12月采用FMEA管理模式对手术中血源性职业暴露进行干预，筛选风险优先指数（RPN）>125分的失效模式进行针对性整改并持续质量改进。比较FMEA干预前后手术流程中失效模式RPN分值以及血源性职业暴露发生情况。结果 经FMEA干预后，手术流程中经过整改的9项失效模式的总体RPN值下降了67.68%，各项失效模式的RPN值均下降了50%；血源性职业暴露发生率由FMEA干预前的48.48%下降为干预后的13.87%（χ²=65.78，P<0.01），每个血源性职业暴露高发操作环节上的暴露发生率和暴露人均次数均低于干预前（均P<0.05）；手术医生、护士和麻醉师的暴露发生率分别由干预前的45.86%、55.00%和70.00%，降为干预后的14.52%、14.29%和0，差异均有统计学意义（均P<0.01）。结论 应用FMEA可有效降低手术流程中血源性职业暴露风险，规范医务人员操作行为，提高职业防护意识和标准预防的依从性。

Abstract:

Objective To explore the effect of failure mode and effect analysis (FMEA) on preventing blood-borne occupational exposure in surgical process. Methods According to baseline survey data of blood-borne occupational exposure in surgical process from January to December 2016, intervention in occupation exposure during surgery was performed by adopting FMEA management from January to December 2017, failure modes with risk priority number(RPN)>125 were selected for targeted rectification and continuous quality improvement. RPN score of fai-lure mode and the occurrence of blood-borne occupational exposure in surgical process before and after FMEA intervention were compared. Results After FMEA intervention, the overall RPN scores of 9 rectified failure modes in surgical process decreased by 67.68%, and RPN scores of all failure modes decreased by 50%; incidence of blood-borne occupational exposure decreased from 48.48% before FMEA intervention to 13.87% after intervention (χ²=65.78,P<0.01),incidence of exposure and per capita exposure times of each high-risk operation link of blood-borne occupational exposure were lower than those before intervention(all P<0.05). Incidence of blood-borne occupational exposure among surgeons, nurses and anaesthetists decreased from 45.86%, 55.00% and 70.00% before intervention to 14.52%, 14.29% and 0 after intervention respectively, with significant differences(all P<0.01). Conclusion Application of FMEA can effectively reduce the risk of blood-borne occupational exposure in the surgical process, standardize the operation behavior of medical personnel, and improve the awareness of occupational protection and compliance to standard prevention.