基于措施优先级的失效模式和效应分析在结直肠术手术部位感染防控中的应用

Application of failure mode and effects analysis based on action priority in the prevention and control of surgical site infection after colorectal surgery

摘要:

目的 评估结直肠手术后手术部位感染(SSI)防控措施执行的过程风险, 探讨基于措施优先级的失效模式和效应分析(FMEA)的应用效果。 方法应用基于措施优先级的FMEA评估结直肠手术后SSI防控措施执行的整个流程, 对是否采取优化措施进行优先级排序, 比较FMEA实施前后结直肠手术SSI防控措施依从项达标率、SSI发病率。 结果 评估后SSI高优先级防控措施7项, 中优先级22项, 对中优先级措施加强控制, 重点对高优先级措施制定进一步的预防和可探测措施。改进后再评价结果显示, 7项高优先级措施降至中优先级; 16项中优先级措施降至低优先级。SSI防控措施执行达标率由77.15% (2 566/3 326)提高至92.47%(3 096/3 348), SSI发病率由6.04%(58/960)降至2.54%(60/2 364)。结论 运用基于措施优先级的FMEA可对结直肠手术SSI防控过程进行有效风险评估, 并结合现状针对性采用预防性风险控制措施, 可降低结直肠手术SSI发病率。

Abstract:

Objective To evaluate the process risk of the implementation of prevention and control measures for surgical site infection (SSI) after colorectal surgery, and explore the application effect of failure mode and effects analysis (FMEA) based on action priority. Methods FMEA based on action priority was adopted to evaluate the whole process of the implementation of prevention and control measures for SSI after colorectal surgery. Prioritization ranking was conducted according to whether optimized measures were taken. Standard-reaching rate of comp-liance to SSI prevention and control measures as well as SSI incidence before and after the implementation of FMEA were compared. Results After evaluation, there were 7 high-priority and 22 medium-priority prevention and control measures for SSI. The control of medium-priority measures was strengthened, with a focus on developing further preventive and detectable measures for high-priority measures. The re-evaluation results after improvement showed that 7 high-priority measures have been downgraded to medium priority, and 16 medium-priority measures have been downgraded to low priority. Standard-reaching rate of compliance to SSI prevention and control measures increased from 77.15% (2 566/3 326) to 92.47% (3 096/3 348), and SSI incidence decreased from 6.04% (58/960) to 2.54% (60/2 364). Conclusion Application of FMEA based on action priority can effectively evaluate the risk of prevention and control process of SSI after colorectal surgery, and adopting preventive risk control measures according to the current situation can reduce the incidence of SSI after colorectal surgery.