Research On The Hand Hygiene Of ICU Medical Staff Based On The FMEA And PDCA Combined Management Tools

ObjectivesThe purpose of this study was to use FMEA and PDCA combined management tools to intervene in the hand hygiene of ICU medical staff and evaluate the intervention effect,so as to provide reference for the hospital’s hand hygiene management.MethodsThe convenience sampling method was adopted in this research.Between December2016 and July 2017,66 medical staff who were directly involved in the diagnosis and treatment of patients including doctors,nurses and medical practitioners,were selected as research objects in the general ICU of a hospital with class A in the secondary level in Jining City.The method of non-contemporary comparison was carried out.The baseline survey stage was from December 2016 to March 2017,and the intervention stage was from April to July 2017.The hygiene status data of the ICU medical staff hand in the baseline survey stage,including the knowledge of hand hygiene,the hand hygiene compliance rate,the hand hygiene accuracy rate,and the hand hygiene supplies consumption,was obtained by using the“Hand Hygiene Knowledge Questionnaire for Health-Care Workers”,“Hand Hygiene Observation Form for Health-Care Workers”,and the Information system of hospital material storehouse etc.During the intervention period,theFMEA tool was used to draw the hand hygiene flow chart,the team members analyzed the hand hygiene process links and steps,and the brainstorming method was used to discuss and list all the potential failure modes,that is,all the operations that might affect the hand hygiene and the potential failure results were analyzed.According to the RPN score,the high-risk failure mode of priority intervention was determined.Based on the failure reasons and the clinical practice in the ICU,the team members used the PDCA management tools and multidisciplinary collaboration mode to develop effective intervention plans for the high-risk failure mode,and assigned persons to be responsible for the implementation.Finally,the improvement measures of hand hygiene were summarized.In additon,the standard operating procedures of hand hygiene were formed according to the domestic and foreign standards,which were promoted in ICU.The effect of FMEA and PDCA combined management tools in hand hygiene management was verified by comparing the hand hygiene knowledge,the hand hygiene compliance,the hand hygiene accuracy,the consumption of hand hygiene products,and the RPN value of hand hygiene failure mode in the periods before and after the intervention.SPSS 21.0 was used for the statistical analysis,the statistical description of measurement data was expressed as mean±standard deviation,the statistical description of count data was expressed as frequency and percentage,paired t test was used to compare the measurement data before and after,and the X~2 test was used for inter-group comparison of count data.ResultsAfter using the FMEA and PDCA combined management tools to intervene hand hygiene,ICU medical staff’s knowledge of hand hygiene(82.06±7.73 points)was higher than that of before the intervention(62.79±11.59 points)(t=18.866,P<0.001).The hand hygiene compliance of ICU medical staff increased from 63.64%to 84.81%(χ2=1239.089,P<0.001),and the accuracy increased from 86.57%to 95.79%(χ2=438.630,P<0.001).The consumption of hand hygiene products in ICU increased from 51.70ml/bed/day to88.76ml/bed/day.The total RPN value of the hand hygiene failure mode decreased by2227.87 points,and the RPN value of the 7 hand hygiene failure modes significantly decreased(P<0.05).ConclusionsUsing the FMEA and PDCA combined management tools to intervene hand hygiene of ICU medical staff,can effectively improve the level of understanding of hand hygiene knowledge,enhance their attention to hand hygiene,and improve the compliance and accuracy of hand hygiene.Through practical application,the FMEA and PDCA combined management tools for hand hygiene management has high operability and effectiveness,and is worth promoting.