Abstract:

Objective　To investigate the application effect of tracking methodology combined with failure mode and effect analysis (FMEA) in hand hygiene management for nosocomial infection prevention and control in the post-epidemic era. Methods　A hand hygiene management tracking and inspection team was set up to track and inspect the hand hygiene management process using tracking methods such as data review, on-site interviews, and field inspections. A total of 100 cases of medical personnel who were directly involved in patient diagnosis and treatment operations in Guangdong Second TCM Hospital from January 2022 to June 2023 were selected and were divided into a control group (from January 2022 to September 2022, pre-implementation) and an observation group (from October 2022 to June 2023, post-implementation) with 50 cases in each group. In the control group, there were 31 males and 19 females, aged (31.88±4.56) years, with working duration of (4.72±1.73) years. In the observation group, there were 29 males and 21 females, aged (30.24±6.08) years, with working duration of (4.84±1.63) years. FMEA was applied to carry out risk assessment, and thereafter corresponding interventions were carried out. A hand hygiene tracking and inspection team was established to determine the tracking and inspection process. The members of the inspection team conducted the assessment and inspection on the hand hygiene condition according to the process and recorded the problems found in the inspection. The control group was conducted by means of no intervention and no training before the inspection and random check. The observation group first conducted intensive on-site hand hygiene knowledge training (the training contents included hand hygiene facility requirements, hand hygiene principles, 5 opportunities for hand washing, hand hygiene and nosocomial infection related knowledge, and watching seven-step washing manipulation video, etc.), and then assessed the members after the training. The differences in hand hygiene compliance, correct rate of hand hygiene, awareness rate of hand hygiene knowledge, and qualification rate of hand hygiene disinfection effect monitoring were compared between the two groups. t test and χ² test were used. Results　Hand hygiene assessment, hand hygiene practices, and hand hygiene training were important failure mode risk factors for hand hygiene management. In the control group, the compliance rates of the medical staff before contact with patients, after contact with patients, after contact with body fluids/blood, after contact with surrounding environment, and before aseptic manipulation were 64.0% (32/50), 72.0% (36/50), 84.0% (42/50), 58.0% (29/50), and 80.0% (40/50), and those in the observation group were 72.0% (36/50), 82.0% (41/50), 100.0% (50/50), 90.0% (45/50), and 100.0% (50/50); there were statistically significant differences in the compliance rate between the two groups after contact with body fluids/blood, after contact with surrounding environment, and before aseptic manipulation (χ²=8.696, P=0.003; χ²=13.306, P=0.001; χ²=11.111, P=0.001). The correct rate of hand hygiene, awareness rate of hand hygiene knowledge, and qualification rate of hand hygiene disinfection effect monitoring in the control group were 74.0% (37/50), 80.0% (40/50), and 82.0% (41/50), and those in the observation group were 98.0% (49/50), 100.0% (50/50), and 98.0% (49/50), with statistically significant differences (χ²=11.960, P=0.001; χ²=11.111, P=0.001; χ²=7.111, P=0.008). Conclusion　The application of tracking methodology combined with FMEA can effectively enhance the efficiency of hand hygiene management, warranting further promotion and implementation.

Key words:

Tracking methodology, FMEA, Hand hygiene, Nosocomial infection

摘要：

目的　探讨追踪方法学联合失效模式与效应分析（failure mode and effect analysis，FMEA）在医院感染防控手卫生管理中的应用效果。方法　成立手卫生管理追踪检查小组，运用资料查阅、现场访谈、实地查看等追踪方法，对手卫生管理流程进行追踪检查。本研究为前瞻性非随机对照研究。选取2022年1月至2022年9月在广东省第二中医院直接参与患者诊疗操作的医生、护士作为对照组，选取2022年10月至2023年6月直接参与患者诊疗操作的医生、护士作为观察组，每组50例。对照组中男31例、女19例，年龄（31.88±4.56）岁，工作年限（4.72±1.73）年；观察组中男29例、女21例，年龄（30.24±6.08）岁，工作年限（4.84±1.63）年。应用FMEA进行风险评估，根据评估结果制定整改方案并实施，成立手卫生追踪检查小组，确定追踪检查流程，检查小组成员根据流程对手卫生情况进行考核检查，记录检查中发现的问题。对照组采取检查前不干预、不培训、随机抽查的方式进行；观察组采取先集中现场手卫生知识培训方式，培训内容包括手卫生设施要求、手卫生原则、洗手5个时机、手卫生与医院感染相关知识、观看七步洗手法操作视频等，培训后集中对观察组成员实行考核。比较两组医务人员手卫生依从性、手卫生正确率、手卫生知识知晓率、手卫生消毒效果监测合格率的差异。采用t检验、χ²检验。结果　手卫生评估、手卫生操作、手卫生培训均是手卫生管理重要的失效模式风险因素。对照组医护人员接触患者前、接触患者后、接触体液/血液后、接触周围环境后、无菌操作前的手卫生依从性分别为64.0%（32/50）、72.0%（36/50）、84.0%（42/50）、58.0%（29/50）、80.0%（40/50），观察组分别为72.0%（36/50）、82.0%（41/50）、100.0%（50/50）、90.0%（45/50）、100.0%（50/50），两组接触体液/血液后、接触周围环境后、无菌操作前的依从性比较，差异均有统计学意义（χ²=8.696、P=0.003，χ²=13.306、P=0.001，χ²=11.111、P=0.001）。对照组医护人员的手卫生正确率、手卫生知识知晓率、手卫生消毒效果监测合格率分别为74.0%（37/50）、80.0%（40/50）、82.0%（41/50），观察组分别为98.0%（49/50）、100.0%（50/50）、98.0%（49/50），差异均有统计学意义（χ²=11.960、P=0.001，χ²=11.111、P=0.001，χ²=7.111、P=0.008）。结论　运用追踪方法学联合FMEA可有效改善手卫生管理效能，值得应用推广。

关键词:

追踪方法学, FMEA, 手卫生, 医院感染