基于FMEA管理模式的风险评估在医院感染防控中应用效果的Meta分析

Application efficacy of FMEA management model-based risk assessment in prevention and control of healthcare-associated infection: a Meta-analysis

摘要:

目的 系统评价失效模式与效应分析(FMEA)管理模式在医院感染防控中的应用效果。方法 计算机检索PubMed、Embase、the Cochrane Library、中国期刊全文数据库(CNKI)、维普数据库、万方数据库、中国生物医学文献数据库(CBM)中FMEA管理模式在医院感染防控中应用的相关文献,由2名研究者独立筛选文献、提取资料并进行交叉核对,采用ROB工具对纳入的随机对照研究进行风险及质量评价,采用NOS量表对纳入的队列研究进行评分,应用RevMan 5.4软件进行Meta分析。结果 共纳入22项研究,42 815例患者,其中FMEA管理模式组21 784例,对照组21 031例。Meta分析结果显示,FMEA管理模式组医院感染发病率低于对照组［OR＝0.31,95%CI(0.24,0.40)］; 与常规管理模式相比,FMEA管理模式组表浅手术切口感染发病率［OR＝0.53,95%CI (0.36,0.78)］、呼吸系统感染发病率［OR＝0.44,95%CI(0.35,0.56)］、泌尿系统感染发病率［OR＝0.45,95%CI(0.38,0.53)］及血液系统感染发病率［OR＝0.29,95%CI(0.18,0.45)］更低(均P＜0.01)。结论 FMEA管理模式在医院感染防控中的应用,能够降低医院感染发病率,应在医院管理中积极推广应用。

Abstract:

Objective To systematically evaluate the application efficacy of failure mode and effect analysis (FMEA) management mode in the prevention and control of healthcare-associated infection (HAI). Methods Li-terature on the application of FMEA management mode in HAI prevention and control were retrieved from PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). Two researchers independently screened the literature, extracted data, and conducted cross checking. Risk and quality assessments were performed on the included studies of randomized controlled trials by ROB tool, the included cohort studies were scored by Newcastle-Ottawa (NOS) scale, and Meta-analysis was conducted by RevMan 5.4 software. Results A total of 22 studies involving 42 815 patients were included in the analysis, with 21 784 in the FMEA management mode group and 21 031 in the control group. Meta-analysis results showed that the incidence of HAI in the FMEA management mode group was lower than that in the control group (OR=0.31, 95%CI ［0.24, 0.40］). Compared with the conventional management mode, incidences of superficial surgical site infection (OR=0.53, 95%CI ［0.36, 0.78］), respiratory system infection (OR=0.44, 95%CI ［0.35, 0.56］), urinary system infection (OR=0.45, 95%CI ［0.38, 0.53］), and blood system infection (OR=0.29, 95%CI ［0.18, 0.45］) in the FMEA management mode group were all lower (all P<0.01). Conclusion The application of FMEA management mode in HAI prevention and control can reduce the incidence of HAI, which should be actively promoted in hospital management.