FMEA联合PDCA循环管理在重症监护病房多重耐药菌防控中的应用OA

Objective To explore the application effect of failure mode and effect analysis(FMEA)combined with PDCA cycle management on reducing multidrug-resistant organism(MDRO)associated infection in the intensive care unit(ICU).Methods A quasi-experimental study with before-after control was carried out.Patients admitted to the ICU from March to December 2023 were assigned to the control group(n=171),and those hospitalized between March and December 2024 served as the intervention group(n=162).FMEA was adopted to identify high-risk links,with risk priority number(RPN)≥18 defined as the threshold for high-risk items.Rectification strategies were formulated for high-risk factors,and continuous quality improvement was implemented via the PDCA cycle.Risk reassessment and dynamic scheme adjustment were performed quarterly.Infection-related core indicators and process quality indicators were compared between the two groups.Results The top two high-risk factors included poor compliance and incorrect operation of hand hygiene(mean RPN=22.42)and nonstandard use of protective equipment for patients colonized or infected with MDROs(mean RPN=19.27),both exceeding the high-risk cut-off(RPN≥18).After intervention,their RPN values decreased by 45.45%and 66.06%,respectively.The overall nosocomial infection incidence dropped from 11.11%to 3.09%(OR=0.26,P=0.005).The MDRO-related healthcare-associated infection incidence per 1 000 patient days decreased from 3.95‰ to 0.89‰(IRR=0.23,P=0.005).The pathogenic specimen submission rate prior to therapeutic antibiotic administration rose from 89.26%to 97.62%(P=0.009).Conclusion The integrated management strategy combining FMEA and the PDCA cycle can systematically identify and intervene in weak points of MDRO prevention in the ICU,and effectively lower the risk of MDRO nosocomial infection,which deserves clinical promotion.