基于HFMEA的术前专岗管理模式在手术部位感染防控中的应用效果OA

Objective To explore the effect of preoperative dedicated role for intravenous infusion and temperature management(hereinafter referred to as dedicated-role management)on the prevention and control of surgical site infection(SSI)based on healthcare failure mode and effect analysis(HFMEA).Methods The risk priority number(RPN)and action priority(AP)were combined to identify high-risk failure modes for SSI in perioperative patients based on HFMEA.A historical control design was adopted.Patients who underwent elective surgery and received routine perioperative management at the First Affiliated Hospital of Nanjing Medical University from January 1 to December 31,2023 were included in the control group,while patients who underwent elective surgery from January 1 to December 31,2024 were included in the intervention group.The intervention group received a structured new process centered on dedicated-role management.The SSI incidence,perioperative hypothermia incidence,correct rate of prophylactic antimicrobial administration 0.5 h-1 h before surgery,and interval between consecutive surgeries were compared between the two groups.After the intervention,the high-risk failure modes were reas-sessed to evaluate the effectiveness of this management model.Results A total of 6 high-risk failure modes with RPN≥125 were identified,of which 3 were classified as high priority and 3 as medium priority according to AP.After the implementation of dedicated-role management,all indicators in the intervention group improved compared with those in the control group:the incidence of SSI decreased from 0.72％to 0.48％(P=0.006),the incidence of perioperative hypothermia decreased from 3.61％to 1.19％(P＜0.001),and the correct rate of prophylactic anti-biotic administration increased from 35.88％to 94.52％(P＜0.001).The interval between consecutive surgeries decreased from(50.04±25.48)min to(45.64±16.57)min(P＜0.001).Reassessment showed that the RPN values of all 6 failure modes were＜125 and their AP classifications were all reduced to low priority.Conclusion HFMEA can effectively identify high-risk failure modes for SSI in perioperative patients.On this basis,establishing preoperative dedicated-role management,through centralized and precise administration of antimicrobial agents combined with active temperature management,can significantly reduce the risk of SSI and perioperative hypothermia.