The Application Of Failure Mode And Effect Analysis Risk Management In Catheter-Associated Urinary Tract Infection

Objective:To investigate the effect of Failure Mode and Effect Analysis(FMEA)in the risk management of Catheter-Associated Urinary Tract Infection(CAUTI)and to establish an effective intervention strategy for catheter maintenance.Reduce the incidence of CAUTI,provide theoretical basis and practical guidance for clinical catheter care practice.Methods:(1)Questionnaire survey: Consulted domestics and foreign relevant literature and refered to experts opinions to design the questionnaire.Questionnaires were distributed in two forms,namely volume and e-questionnaires,and a sample of three hospitals in the province's top three general hospitals was collected by convenience sampling.The ICU nurses who met the inclusion criteria were surveyed on the current practice of urinary catheter-related urinary tract infection prevention.(2)Using FMEA to construct urethral catheter maintenance strategy: Through the determination of topics and the formation of CAUTI multidisciplinary expert group Teams,develop catheter maintenance procedures,conduct hazard analysis,and formulate intervention strategies in 5 steps,screen high risk links in the catheter maintenance process,and formulate appropriate intervention strategies.(3)The clinical application of FMEA: In the application of FMEA,the patients with ICU indwelling catheterization who were admitted to the neurosurgery department of a Grade A general hospital from January 1,2017 to June 30,2017 were selected as the control group,patient data were collected and catheterization Nursing practice.From August 01,2017 to January 31,2018,patients were enrolled in the intervention group.The intervention strategies based on FMEA were implemented.The effects of catheterization nursing practice,RPN score and CAUTI incidence were compared between the two groups to evaluate the effect of FMEA.Results:(1)Questionnaire surveyA total of 210 ICU nurses were investigated in 3 hospitals.97.62% nurse contact catheter drainage system after the implementation of hand hygiene,but in contact before the system is only 35.71% of the nurses wash their hands;the catheter maintenance process,46.67% of the nurses with saline cleansing,40.95% nurses used iodophor;indwelling catheterization in patients with fecal incontinence after only 30% nurses will be disinfected after cleaning the vast majority of nurses;the urine specimen collection method is correct;the replacement time of catheter,urine collecting bags are not uniform.(2)Using FMEA to construct urethral catheter maintenance strategyThe catheter maintenance process includes assessment,perineum nursing,drainage and replacement,urine samples were collected 4 main processes and 14 sub processes;implementation of the hazard analysis identified 13 potential failure modes,and the RPN score determined requiring intervention 11 high risk failure mode,failure analysis to develop appropriate intervention strategies.(3)The clinical application of FMEAThe intervention group the incidence rate of CAUTI is lower than the control group,the chi square test,the difference was statistically significant(P < 0.001);the intervention group indwelling catheter time,ICU stay days,total hospitalization days were significantly less than the control group,the Mann Whitney U test,the differences were statistically significant(P < 0.05);the intervention group compared with the control group,the nurse operation compliance rate increased,the chi square test,two group compliance rate was statistically significant(P < 0.001),and the RPN of the two groups were compared,found 11 potential failure modes in the RPN score after the intervention were significantly decreased by MannWhitney U test,there was statistical significance two group differences(P < 0.001).Conclusion:(1)The current practice of ICU nurses in preventing urinary catheter-related urinary tract infections needs further improvement.Hospital and department managers need to continuously update and standardize urinary catheter care routines,strengthen training,and effectively supervise the execution of nurses in accordance with relevant guidelines at home and abroad.Situation,continuously narrowing the gap between clinical practice and evidence-based guidelines.(2)The FMEA risk management method can effectively reduce the incidence of urinary catheter-associated urinary tract infections,can be used clinically,and continue to improve quality.