Application of failure mode and effect analysis combined with PDCA cycle in prevention and control of healthcare-associated multidrug-resistant organism infections in intensive care unit_West China Medical Journal

Authors：

LIN Lu ¹ , ZHANG Ju ² , LI Gang ³ , LI Jun ¹ , ZHANG Yuexin ¹ , LI Hua ¹ , YAN Juan ¹ , PENG Jiabing ¹ ,  ZHANG Ge ¹

1. Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
2. Department of Nosocomial Infection Management, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospitital Sichuan University, Chengdu, Sichuan 610100, P. R. China;
3. Department of Traditional Chinese Medicine, the First People’s Hospital of Longquanyi District of Chengdu, West China Longquan Hospital Sichuan University, Chengdu, Sichuan 610100, P. R. China;

Corresponding author：

ZHANG Ge, Email: 7836586@qq.com

Keywords：

Failure mode and effect analysis; PDCA cycle; multidrug-resistant organism; healthcare-associated infection

DOI：

10.7507/1002-0179.202201062

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Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ²=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ²=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ²=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.

Citation： LIN Lu, ZHANG Ju, LI Gang, LI Jun, ZHANG Yuexin, LI Hua, YAN Juan, PENG Jiabing, ZHANG Ge. Application of failure mode and effect analysis combined with PDCA cycle in prevention and control of healthcare-associated multidrug-resistant organism infections in intensive care unit. West China Medical Journal, 2022, 37(3): 363-368. doi: 10.7507/1002-0179.202201062 Copy

1.	黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 2015, 14(1): 1-9.
2.	贾宁, 刘丁, 罗爱武, 等. 30 家医院重症监护室多药耐药菌感染分布特征. 中华医院感染学杂志, 2017, 27(13): 2885-2888.
3.	欧阳育琪, 向阳. 风险评估在医院感染控制中的应用现状与展望. 实用预防医学, 2017, 24(10): 1277-1280, 封 3.
4.	文进, 谢瑜, 高晓凤, 等. 美国飓风风险管理的循证评价及其对我国医疗风险管理的启示——医疗风险系列研究之三. 中国循证医学杂志, 2006(3): 209-217.
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6.	余元华, 符湘云, 王恵芳, 等. PDCA 循环法在控制 ICU 患者呼吸机相关肺炎中的应用. 临床和实验医学杂志, 2012, 11(4): 275-277.
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10.	韦燕萍, 高铭云, 刘柳芳, 等. 应用 FMEA 模式降低 PICC 非计划性拔管风险的临床研究. 实用医学杂志, 2014, 30(2): 309-311.
11.	Ashley L, Armitage G, Taylor J. Recognising and referring children exposed to domestic abuse: a multi-professional, proactive systems-based evaluation using a modified Failure Mode and Effects Analysis (FMEA). Health Soc Care Community, 2017, 25(2): 690-699.
12.	陶静, 高莲莲, 刘清华, 等. 追踪方法学联合失效模式与效应分析在非内分泌科胰岛素泵质量管理中的应用. 中华护理杂志, 2016, 51(12): 1417-1421.
13.	胡冬, 陈曦, 胥明勇, 等. 失效模式与效应分析在新型冠状病毒核酸检测中的应用. 华西医学, 2021, 36(8): 1011-1015.
14.	黄菊, 杨坚娥, 黄少君. FMEA 风险评估法在 ICU 多重耐药菌医院感染防控中的应用. 中国感染控制杂志, 2019, 18(11): 1079-1083.
15.	胡慧芳, 马永辉, 孔立, 等. 灾害脆弱度分析风险评估法在医院感染管理中的应用. 中华医院管理杂志, 2017, 33(11): 822-825.
16.	中华人民共和国卫生部. 卫生部办公厅关于印发《三级综合医院评审标准实施细则(2011 年版)》的通知. 中华人民共和国卫生部公报, 2011(11): 45.
17.	蔡玲, 张映华, 胡兰文, 等. 基于 FMEA 法在重症监护病房器械相关感染防控中的应用. 中国感染控制杂志, 2021, 20(6): 494-498.
18.	王海艳, 孙光英, 陈熙. FMEA 模式预测风险度及预防 ICU 导管相关性血源感染的临床研究. 湖南师范大学学报(医学版), 2019, 16(5): 54-58.
19.	张研婷, 杜荣, 刘琴, 等. PDCA 在新生儿重症监护病房医院感染防控中的应用. 中国感染控制杂志, 2020, 19(10): 921-925.
20.	Omar I, Shirazy M, Omar M, et al. Controlling nosocomial infection in adult intensive treatment unit: a quality improvement project. Int J Risk Saf Med, 2020, 31(4): 267-273.
21.	Kong X, Zhu X, Zhang Y, et al. The application of plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: it does work. Int J Clin Pract, 2021, 75(8): e14351.
22.	陈琳, 闻婷, 忻弘, 等. PDCA 循环管理应用于神经外科多重耐药菌感染中的临床效果. 国际护理学杂志, 2020, 39(24): 4533-4536.

1. 黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 2015, 14(1): 1-9.
2. 贾宁, 刘丁, 罗爱武, 等. 30 家医院重症监护室多药耐药菌感染分布特征. 中华医院感染学杂志, 2017, 27(13): 2885-2888.
3. 欧阳育琪, 向阳. 风险评估在医院感染控制中的应用现状与展望. 实用预防医学, 2017, 24(10): 1277-1280, 封 3.
4. 文进, 谢瑜, 高晓凤, 等. 美国飓风风险管理的循证评价及其对我国医疗风险管理的启示——医疗风险系列研究之三. 中国循证医学杂志, 2006(3): 209-217.
5. 中华人民共和国国家质量监督检验检疫总局, 中国国家标准化管理委员会. 风险评估技术: GB/T 27921－2011. 北京: 中国标准出版社, 2011.
6. 余元华, 符湘云, 王恵芳, 等. PDCA 循环法在控制 ICU 患者呼吸机相关肺炎中的应用. 临床和实验医学杂志, 2012, 11(4): 275-277.
7. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
8. AIAG, VDA. 失效模式及影响分析 FMEA 手册. 5 版. 北京: 中国标准出版社, 2019.
9. 成瑶, 刘丁, 黄庆宁, 等. 医疗失效模式与效应分析在呼吸机相关性肺炎控制中的研究分析. 中华医院感染学杂志, 2014, 24(11): 2693-2695.
10. 韦燕萍, 高铭云, 刘柳芳, 等. 应用 FMEA 模式降低 PICC 非计划性拔管风险的临床研究. 实用医学杂志, 2014, 30(2): 309-311.
11. Ashley L, Armitage G, Taylor J. Recognising and referring children exposed to domestic abuse: a multi-professional, proactive systems-based evaluation using a modified Failure Mode and Effects Analysis (FMEA). Health Soc Care Community, 2017, 25(2): 690-699.
12. 陶静, 高莲莲, 刘清华, 等. 追踪方法学联合失效模式与效应分析在非内分泌科胰岛素泵质量管理中的应用. 中华护理杂志, 2016, 51(12): 1417-1421.
13. 胡冬, 陈曦, 胥明勇, 等. 失效模式与效应分析在新型冠状病毒核酸检测中的应用. 华西医学, 2021, 36(8): 1011-1015.
14. 黄菊, 杨坚娥, 黄少君. FMEA 风险评估法在 ICU 多重耐药菌医院感染防控中的应用. 中国感染控制杂志, 2019, 18(11): 1079-1083.
15. 胡慧芳, 马永辉, 孔立, 等. 灾害脆弱度分析风险评估法在医院感染管理中的应用. 中华医院管理杂志, 2017, 33(11): 822-825.
16. 中华人民共和国卫生部. 卫生部办公厅关于印发《三级综合医院评审标准实施细则(2011 年版)》的通知. 中华人民共和国卫生部公报, 2011(11): 45.
17. 蔡玲, 张映华, 胡兰文, 等. 基于 FMEA 法在重症监护病房器械相关感染防控中的应用. 中国感染控制杂志, 2021, 20(6): 494-498.
18. 王海艳, 孙光英, 陈熙. FMEA 模式预测风险度及预防 ICU 导管相关性血源感染的临床研究. 湖南师范大学学报(医学版), 2019, 16(5): 54-58.
19. 张研婷, 杜荣, 刘琴, 等. PDCA 在新生儿重症监护病房医院感染防控中的应用. 中国感染控制杂志, 2020, 19(10): 921-925.
20. Omar I, Shirazy M, Omar M, et al. Controlling nosocomial infection in adult intensive treatment unit: a quality improvement project. Int J Risk Saf Med, 2020, 31(4): 267-273.
21. Kong X, Zhu X, Zhang Y, et al. The application of plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: it does work. Int J Clin Pract, 2021, 75(8): e14351.
22. 陈琳, 闻婷, 忻弘, 等. PDCA 循环管理应用于神经外科多重耐药菌感染中的临床效果. 国际护理学杂志, 2020, 39(24): 4533-4536.

West China Medical Journal

Application of failure mode and effect analysis combined with PDCA cycle in prevention and control of healthcare-associated multidrug-resistant organism infections in intensive care unit

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