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中国全科医学 ›› 2016, Vol. 19 ›› Issue (32): 3956-3960.DOI: 10.3969/j.issn.1007-9572.2016.32.012

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失效模式与效应分析管理模式降低导尿管相关尿路感染风险的应用效果研究

张悦，谭思源，陈艳，等   

  1. 224006 江苏省盐城市第一人民医院护理部（张悦，陈艳），感染管理科（谭思源），ICU（胡清，王念坚）；南通大学附属医院护理部（夏玲） 通信作者：陈艳，224006 江苏省盐城市第一人民医院护理部；E-mail：chenyan9118@sina.com
  • 出版日期:2016-11-15 发布日期:2026-01-26

Application Effect of Failure Mode and Effect Analysis Management Model in Lowering Risk of Catheter-associated Urinary Tract Infection

ZHANG Y，TAN S Y，CHEN Y，et al   

  1. Department of Nursing，Yancheng City No.1 People’s Hospital，Yancheng 224006，China Corresponding author：CHEN Yan，Department of Nursing，Yancheng City No.1 People’s Hospital，Yancheng 224006，China；E-mail：chenyan9118@sina.com
  • Published:2016-11-15 Online:2026-01-26

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摘要： 目的探讨失效模式与效应分析（FMEA）管理模式防范重症监护病房（ICU）导尿管相关尿路感染（CAUTI）风险的应用效果。方法　选取2014年1—5月及2014年7—11月入住盐城市第一人民医院ICU留置导尿管的患者181例，以2014年1—5月留置导尿管的86例患者作为FMEA管理前组，实施临床留置导尿管常规护理方案；以2014年7—11月行留置导尿管的95例患者作为FMEA管理后组，在常规护理的基础上，实施基于FMEA管理模式的风险优先指数（RPN）评分构建预防CAUTI的改善方案。比较两组专家团队失效模式RPN评分、患者CAUTI发生率、发生时间、留置导尿管天数、住院天数、尿培养病原菌菌种及护士依从性的差异。结果　FMEA管理后组RPN评分、CAUTI发生率低于FMEA管理前组（P0.05）；FMEA管理后组留置导尿管天数短于FMEA管理前组（P<0.05）。FMEA管理后组接触患者前、接触患者后、护理导尿管前、护理导尿管后、留取尿标本前、留取尿标本后洗手率高于FMEA管理前组（P<0.05），集尿袋位置、集尿袋放尿、会阴情况、更换集尿袋、拔管评估依从率高于FMEA管理前组（P<0.05）。结论　FMEA管理模式能有效降低CAUTI风险，提高护士预防行为的依从性，值得临床推广并应用。

关键词: 导管相关性感染, 失效模式与效应分析, 依从性, 风险

Abstract: Objective　To explore the application effect of failure mode and effects analysis（FMEA）management model on preventing the risk of catheter-associated urinary tract infection（CAUTI）in intensive care unit（ICU）.Methods　181 patients who underwent indwelling catheter in ICU of Yancheng City No.1 People’s Hospital from January to May in 2014 and from July to November in 2014 were selected.The before FMEA management group，of which 86 patients underwent indwelling catheter from January to May in 2014，received routine care plan of clinical indwelling catheter；while the after FMEA management group，of which 95 patients underwent indwelling catheter from July to November in 2014，adopted the improving plan that based on risk priority number（RPN）score of FMEA management model to construct CAUTI preventions.The two expert teams RPN score of failure mode，incidence of patients developing CAUTI，time of occurrence，number of days with indwelling catheter，length of stay，strains of urine-cultured pathogenic bacteria and compliance of nurses between two groups were compared.Results　RPN score and incidence of CAUTI in the after FMEA management group were lower than those in the before FMEA management group（P<0.05），the time of occurrence of CAUTI in the after FMEA management group delayed comparing with that in the before FMEA management group（P<0.05）.There was no significant difference in length of stay between the two groups（P>0.05）；number of days with indwelling catheter in after FMEA management group was shorter than that in before FMEA management group（P<0.05）.Hand washing rates before contacting with patients，after contacting with patients，before nursing catheter，after nursing catheter，before collecting urine samples and after collecting urine samples in the after FMEA management group were higher than those in the before FMEA management group（P<0.05），compliance rates of location of urine drainage bags，opening urine drainage bags，perineum situation，changing of urine drainage bags and tube drawing in the after FMEA management group were higher than those in the before FMEA management group（P<0.05）.ConclusionFMEA management mode can lower the risk of CAUTI effectively，improve the compliance of nurses’ preventive behaviors.It is worthy of clinical promotion and application.

Key words: Catheter-associated infections, Failure mode and effects analysis, Compliance, Risk

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