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

Video：

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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.	黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
2.	賈寧, 劉丁, 羅愛武, 等. 30 家醫院重癥監護室多藥耐藥菌感染分布特征. 中華醫院感染學雜志, 2017, 27(13): 2885-2888.
3.	歐陽育琪, 向陽. 風險評估在醫院感染控制中的應用現狀與展望. 實用預防醫學, 2017, 24(10): 1277-1280, 封 3.
4.	文進, 謝瑜, 高曉鳳, 等. 美國颶風風險管理的循證評價及其對我國醫療風險管理的啟示——醫療風險系列研究之三. 中國循證醫學雜志, 2006(3): 209-217.
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6.	余元華, 符湘云, 王恵芳, 等. PDCA 循環法在控制 ICU 患者呼吸機相關肺炎中的應用. 臨床和實驗醫學雜志, 2012, 11(4): 275-277.
7.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
8.	AIAG, VDA. 失效模式及影響分析 FMEA 手冊. 5 版. 北京: 中國標準出版社, 2019.
9.	成瑤, 劉丁, 黃慶寧, 等. 醫療失效模式與效應分析在呼吸機相關性肺炎控制中的研究分析. 中華醫院感染學雜志, 2014, 24(11): 2693-2695.
10.	韋燕萍, 高銘云, 劉柳芳, 等. 應用 FMEA 模式降低 PICC 非計劃性拔管風險的臨床研究. 實用醫學雜志, 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.	陶靜, 高蓮蓮, 劉清華, 等. 追蹤方法學聯合失效模式與效應分析在非內分泌科胰島素泵質量管理中的應用. 中華護理雜志, 2016, 51(12): 1417-1421.
13.	胡冬, 陳曦, 胥明勇, 等. 失效模式與效應分析在新型冠狀病毒核酸檢測中的應用. 華西醫學, 2021, 36(8): 1011-1015.
14.	黃菊, 楊堅娥, 黃少君. FMEA 風險評估法在 ICU 多重耐藥菌醫院感染防控中的應用. 中國感染控制雜志, 2019, 18(11): 1079-1083.
15.	胡慧芳, 馬永輝, 孔立, 等. 災害脆弱度分析風險評估法在醫院感染管理中的應用. 中華醫院管理雜志, 2017, 33(11): 822-825.
16.	中華人民共和國衛生部. 衛生部辦公廳關于印發《三級綜合醫院評審標準實施細則(2011 年版)》的通知. 中華人民共和國衛生部公報, 2011(11): 45.
17.	蔡玲, 張映華, 胡蘭文, 等. 基于 FMEA 法在重癥監護病房器械相關感染防控中的應用. 中國感染控制雜志, 2021, 20(6): 494-498.
18.	王海艷, 孫光英, 陳熙. FMEA 模式預測風險度及預防 ICU 導管相關性血源感染的臨床研究. 湖南師范大學學報(醫學版), 2019, 16(5): 54-58.
19.	張研婷, 杜榮, 劉琴, 等. PDCA 在新生兒重癥監護病房醫院感染防控中的應用. 中國感染控制雜志, 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.	陳琳, 聞婷, 忻弘, 等. PDCA 循環管理應用于神經外科多重耐藥菌感染中的臨床效果. 國際護理學雜志, 2020, 39(24): 4533-4536.

1. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
2. 賈寧, 劉丁, 羅愛武, 等. 30 家醫院重癥監護室多藥耐藥菌感染分布特征. 中華醫院感染學雜志, 2017, 27(13): 2885-2888.
3. 歐陽育琪, 向陽. 風險評估在醫院感染控制中的應用現狀與展望. 實用預防醫學, 2017, 24(10): 1277-1280, 封 3.
4. 文進, 謝瑜, 高曉鳳, 等. 美國颶風風險管理的循證評價及其對我國醫療風險管理的啟示——醫療風險系列研究之三. 中國循證醫學雜志, 2006(3): 209-217.
5. 中華人民共和國國家質量監督檢驗檢疫總局, 中國國家標準化管理委員會. 風險評估技術: GB/T 27921－2011. 北京: 中國標準出版社, 2011.
6. 余元華, 符湘云, 王恵芳, 等. PDCA 循環法在控制 ICU 患者呼吸機相關肺炎中的應用. 臨床和實驗醫學雜志, 2012, 11(4): 275-277.
7. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
8. AIAG, VDA. 失效模式及影響分析 FMEA 手冊. 5 版. 北京: 中國標準出版社, 2019.
9. 成瑤, 劉丁, 黃慶寧, 等. 醫療失效模式與效應分析在呼吸機相關性肺炎控制中的研究分析. 中華醫院感染學雜志, 2014, 24(11): 2693-2695.
10. 韋燕萍, 高銘云, 劉柳芳, 等. 應用 FMEA 模式降低 PICC 非計劃性拔管風險的臨床研究. 實用醫學雜志, 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. 陶靜, 高蓮蓮, 劉清華, 等. 追蹤方法學聯合失效模式與效應分析在非內分泌科胰島素泵質量管理中的應用. 中華護理雜志, 2016, 51(12): 1417-1421.
13. 胡冬, 陳曦, 胥明勇, 等. 失效模式與效應分析在新型冠狀病毒核酸檢測中的應用. 華西醫學, 2021, 36(8): 1011-1015.
14. 黃菊, 楊堅娥, 黃少君. FMEA 風險評估法在 ICU 多重耐藥菌醫院感染防控中的應用. 中國感染控制雜志, 2019, 18(11): 1079-1083.
15. 胡慧芳, 馬永輝, 孔立, 等. 災害脆弱度分析風險評估法在醫院感染管理中的應用. 中華醫院管理雜志, 2017, 33(11): 822-825.
16. 中華人民共和國衛生部. 衛生部辦公廳關于印發《三級綜合醫院評審標準實施細則(2011 年版)》的通知. 中華人民共和國衛生部公報, 2011(11): 45.
17. 蔡玲, 張映華, 胡蘭文, 等. 基于 FMEA 法在重癥監護病房器械相關感染防控中的應用. 中國感染控制雜志, 2021, 20(6): 494-498.
18. 王海艷, 孫光英, 陳熙. FMEA 模式預測風險度及預防 ICU 導管相關性血源感染的臨床研究. 湖南師范大學學報(醫學版), 2019, 16(5): 54-58.
19. 張研婷, 杜榮, 劉琴, 等. PDCA 在新生兒重癥監護病房醫院感染防控中的應用. 中國感染控制雜志, 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. 陳琳, 聞婷, 忻弘, 等. PDCA 循環管理應用于神經外科多重耐藥菌感染中的臨床效果. 國際護理學雜志, 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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