Impact Of The Management Mode Based On Healthcare Failure Mode And Effects Analysis Of The Incidence Of Ventilator-Associated Pneumonia

ObjectiveTo investigate the incidence of ventilator-associated pneumonia(VAP) in intensive care unit(ICU) and discuss the distribution and drug-resistance of its major pathogen and the risk factors; to make proper interventional plan by Healthcare Failure Mode and Effects Analysis(HFMEA) and explore the influence of HFMEA on the incidence of VAP in ICU, in order to provide reference for preventing VAP. Methods1. Baseline survey: A total of 417 patients who were undergone mechanical ventilation(MV) for more than 48 hours in ICU of a Class III Grade A Hospital from Jan 2011 to May 2013 were studied. The distribution and drug-resistance characteristics of its major pathogen were analyzed. And Logistic regression was used to analyze the risk factors of VAP.2. Clinical intervention study: 426 patients in accordance with the screening conditions were randomly recruited as the subjects from ICU of a Class III Grade A Hospital from July, 2013 to June, 2014. Patients were numbered in advance, and then divided into two groups(213 cases in each group) based on the table of random number. Finally, a total of 363 cases had completed the study. There were 178 patients in the control group and 185 cases in the experimental group. For the patients in the control group, routine measures for hospital infection were used to prevent VAP, while patients in the experimental group received HFMEA management in addition to the routine measures. Six failure causes were considered as the high-risk factors of VAP infection, including the management and application of breathing machine, hand hygiene compliance, ward disinfection and isolation management, the standardization of aspiration of sputum, countercurrent and inhalation and bed turnover rate. And intervention measures were formulated for each risk to optimize the prevention of VAP. The evaluation and feedback on implementation of intervention measures will be carried out monthly to determine the next focus of improvement. HFMEA team meeting will be held every quarter and the risk priority number will be regarded to determine the key step that needs prior improvement. PDCA will be applied in the process so as to continuously improve the quality. Results1. 417 cases were investigated, where 53 cases appeared VAP. The morbidity of VAP was 12.8%. It was given priority to Gram-negative bacteria infection(accounting for 90.9%), which were mainly acinetobacter baumannii, pseudomonas aeruginosa, and klebsiella pneumoniae. Gram-negative bacilli isolated from specimens of VAP patients were multi-drug resistant, which were highly resisted to piperacillin, cephalosporins of the third generation, gentamicin, amikacin, meropenem, levofloxacin, etc. Logistic regression analysis showed that the independent influencing factors were the number of basic diseases(OR=7.22, P<0.01), duration of MV(OR=10.37, P <0.001), aspiration of subglottic secretion(OR = 0.01, P <0.001) and aspiration(OR = 8.36, P <0.05).2. After intervention, risk priority number in the experimental group fell to 877 points from 2856 points(by 69.3%). VAP incidence was 12.97% in the experimental group, which was lower than in the control group(21.91%). The differences were statistically significant(P<0.05). VAP incidences of the third and fourth quarter in the experiment group were significantly lower than the control group(P<0.05). Quarterly incidence of VAP in experimental group was decreased. VAP incidence of the fourth quarter was the lowest, accounting for 9.09%. Comparison on outcome of the two groups showed the improvement rate and cure rate in the experimental group was increased while the mortality rate was decreased compared with the control group. Conclusions1. The occurrence of VAP is mainly associated with ventilator-related factors, the facilitation of reflux, ICU environment contamination and the patients’ basic diseases.2. HFMEA mode helps doctors and nurses in ICU with risk assessment, promotes standardization of VAP protection process.3. HFMEA mode is conducive to reducing the incidence of VAP and improving the safety of patients with mechanical ventilation in ICU.