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目的:运用医疗失效模式与效应分析(Healthcare Failure Mode and Effect Analysis,HFMEA),对医院感染管理进行风险评估,明确医院感染预防控制工作重点。方法:确定“医院感染管理风险评估”主题,组建团队,从医院感染的管理、过程、结果进行风险识别,对风险发生的可能性、后果严重程度及当前体系完整性进行全面综合考量分别等级赋值,对医院临床科室进行风险评估。结果:风险评估分值提示,风险最高的前5位科室分别为综合ICU、胸外科、血液科、肝胆二科、肝胆一科;按照百分位的不同,根据评估分值进行风险等级划分,ICU属于感染极高风险科室;胸外科、血液科、肝胆二科、肝胆一科属于高风险科室。医院感染高风险环节多重耐药菌(MDRO)定值/感染、环境卫生学监测结果超标、中心静脉置管相关血流感染;环境卫生学监测仍然是医院感染管理的重点。结论:应用HFMEA明确医院感染预防控制工作重点,提高了对风险的预见性,有效提升卫生资源的利用和效能。
OBJECTIVE: To assess the risk of nosocomial infection management by using Healthcare Failure Mode and Effect Analysis (HFMEA), and to clarify the focus of hospital infection prevention and control. Methods: Identify the theme of risk assessment of hospital infection management, set up a team to identify risk from the management, process and results of nosocomial infection, and conduct a comprehensive and comprehensive consideration of the possibility of the occurrence of the risk, the severity of the consequences and the integrity of the current system Rating assignment, risk assessment of hospital clinical departments. Results: The risk assessment scores suggest that the top five departments with the highest risk are ICU, Thoracic Surgery, Hematology, Hepatobiliary and Encephalopathy, and Hepatobiliary and Rheumatology respectively. According to the different percentiles, the risk grade is divided according to the assessment scores, ICU belongs to the highest risk of infection department; thoracic surgery, hematology, hepatobiliary two subjects, hepatobiliary section belongs to the high risk department. Hospital MDR settings / infection, environmental hygiene monitoring results exceeded, central venous catheter-related bloodstream infections; environmental hygiene monitoring is still the focus of hospital infection management. Conclusion: The application of HFMEA to identify the focus of prevention and control of nosocomial infections has improved the predictability of risks and effectively enhanced the utilization and effectiveness of health resources.