摘要
目的 探究基于基础数据分析的失效模式与效应分析法(FMEA)应用在预防乳腺手术患者切口感染中的临床效果。方法 回顾2016年1月-2018年12月瑞安市人民医院3 732例行乳腺手术的患者作为对照组,分析该组患者发生术后切口感染的情况,初步了解切口感染的影响因素;选取2019年1月-2020年7月该院2 229例行乳腺手术的患者作为研究组,研究组在对照组常规诊疗的基础上组建失效模式与效应分析团队,使用FMEA理论结合Logistic回归分析结果进行风险评估,查找乳腺手术患者切口感染的失效模式,计算风险优先指数(RPN),对高风险失效模式实施干预措施,比对两组患者手术切口感染发生率。结果 研究组术后切口感染率为0.18%(4/2 229)低于对照组的0.86%(32/3 732),差异有统计学意义(χ^(2)=9.587,P=0.002);研究组术中止血材料使用、未使用葡萄糖氯已定消毒湿巾擦拭手术部位、皮下积液、术前未沐浴、术后引流不通畅、皮肤消毒效果未达标、换药操作不规范RPN值均较对照组降低(P<0.05)。结论 基于基础数据分析的FMEA风险评估可前瞻发现乳腺手术发生切口感染的关键环节,有效降低术后切口感染率。
OBJECTIVE To explore the clinical effect of failure mode and effect analysis(FMEA) established on basic data analysis on the prevention of incision infection in patients undergoing breast surgery. METHODS Total of 3732 patients who underwent breast surgery in Ruian People’s Hospital from Jan 2016 to Dec 2018 were enrolled and divided into the control group. The incidence of postoperative incision infection was analyzed to preliminarily understand the influencing factors for the incision infection. And 2229 patients with breast surgery in our hospital from Jan 2019 to Jul 2020 were in the experimental group. The failure mode and effect model were established in the experimental group on the basis of conventional diagnosis and treatment in the control group. FMEA theory combined with logistic regression analysis were used for risk assessment to find the failure mode of incision infection in patients with breast surgery, calculate the risk priority number(RPN), implement intervention measures for high-risk failure mode, and compare the incidence of incision infection between the two groups. RESULTS The postoperative wound infection rate in the experimental group was 0.18%(4/2 229), which was significantly lower than that in the control group [0.86%(32/3 732)](χ^(2)=9.587, P=0.002). The RPN values of the use of intraoperative hemostatic materials, no use of glucose chlorhexidine disinfection wipes to wipe the surgical site, subcutaneous effusion, no preoperative shower, poor postoperative drainage, inadequate skin disinfection, non-standard dressing change operation in the study group were all significantly lower than those in the control group(P<0.05). CONCLUSION FMEA risk assessment based on basic data analysis can prospectively find the key links of incision infection in breast surgery, and effectively reduce the rate of postoperative incision infection.
作者
曾小洁
周瑞微
李克诚
杜庆玮
陈培伟
朱秀秀
张雪言
ZENG Xiao-jie;ZHOU Rui-wei;LI Ke-cheng;DU Qing-wei;CHEN Pei-wei;ZHU Xiu-xiu;ZHANG Xue-yan(The Third Affiliated Hospital of Wenzhou Medical University(Ruian People's Hospital),Ruian,Zhejiang 325200,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第4期564-568,共5页
Chinese Journal of Nosocomiology
基金
瑞安市科技局基金资助项目(MS2019001)。
关键词
失效模式与效应分析法
手术部位感染
乳腺手术
风险优先指数
医院感染管理
Failure mode and effect analysis
Surgical site infection
Breast surgery
Risk priority index
Hospital infection management
