失效模式与效应分析预防ICU获得性感染的Meta分析

Meta-analysis on failure mode and effect analysis for the prevention of ICU-acquired infection

摘要:

目的 系统评价失效模式与效应分析（FMEA）在预防重症监护病房（ICU）获得性感染中的有效性。 方法 2名研究人员独立检索外文数据库和中文数据库相关文献，检索截止时间为2022年7月15日，根据纳入和排除标准独立筛选文献、提取数据和评估总体质量，并应用RevMan 5.4软件对纳入文献的预防效果进行Meta分析。 结果 共纳入了19篇文献。Meta分析结果显示，运用FMEA方法降低了ICU患者呼吸机相关肺炎发病率[OR=0.40，95%CI（0.31~0.51），P < 0.01]、导尿管相关尿路感染发病率[OR=0.29，95%CI（0.17~0.51），P < 0.01]、中央血管导管相关血流感染发病率[OR=0.28，95%CI（0.18~0.46），P < 0.01]、多重耐药菌感染发生率[OR=0.46，95%CI（0.37~0.58），P < 0.01]、ICU医院感染发病率[OR=0.46，95%CI（0.37~0.59），P < 0.01]，提高了ICU患者及家属满意度[OR=2.34，95%CI（1.72~3.17），P < 0.01]。 结论 FMEA能有效预防ICU获得性感染，提高医院感染管理质量。

Abstract:

Objective To systematically evaluate the effectiveness of failure mode and effect analysis (FMEA) in the prevention of intensive care unit (ICU)-acquired infection. Methods Two researchers independently searched relevant literatures from foreign and Chinese databases, with a search deadline of July 15, 2022. Independent screening of literatures, extraction of data and evaluation on overall quality were performed according to inclusion and exclusion criteria. RevMan 5.4 software was used to conduct Meta-analysis on the preventive effect of the included literatures. Results A total of 19 literatures were included in analysis. Meta-analysis results showed that application of FMEA method reduced the incidences of ventilator-associated pneumonia (OR=0.40, 95%CI [0.31-0.51], P < 0.01), catheter-associated urinary tract infection (OR=0.29, 95%CI [0.17-0.51], P < 0.01), central line-associated bloodstream infection (OR=0.28, 95%CI [0.18-0.46], P < 0.01), and multidrug-resistant organism infection (OR=0.46, 95%CI [0.37-0.58], P < 0.01) in ICU patients, as well as incidence of healthcare-associated infection(HAI) in ICU (OR=0.46, 95%CI [0.37-0.59], P < 0.01), and significantly improved the satisfaction of ICU patients and their families (OR=2.34, 95%CI [1.72-3.17], P < 0.01). Conclusion FMEA can effectively prevent ICU-acquired infection and improve the quality of HAI management.