Application of health failure mode and effect analysis to prevent surgical site infection in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision_West China Medical Journal

Authors：

FU Tingting ¹ , YANG Xiao ¹ , XU Zhi ² , XIAO Bo ³ , ZENG Yijun ⁴ , KUAI Juan ⁴ , ZHONG Xiaohui ³ ,  LIU Tianhu ⁵

1. Department of Hospital Acquired Infection Prevention and Control, the 3RD Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
2. Department of Respiratory Medicine, the 3RD Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
3. Department of Orthopedics, the 3RD Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
4. Department of Neurosurgery, the 3RD Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
5. Department of Cardiovascular Medicine, the 3RD Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People’s Hospital, Chengdu, Sichuan 611730, P. R. China;

Corresponding author：

LIU Tianhu, Email: lthzg@163.com

Keywords：

Health failure mode and effect analysis; bone fracture surgery; craniotomy surgery; class Ⅰ incision; surgical site infection

DOI：

10.7507/1002-0179.202401032

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Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.

Citation： FU Tingting, YANG Xiao, XU Zhi, XIAO Bo, ZENG Yijun, KUAI Juan, ZHONG Xiaohui, LIU Tianhu. Application of health failure mode and effect analysis to prevent surgical site infection in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. West China Medical Journal, 2024, 39(8): 1246-1251. doi: 10.7507/1002-0179.202401032 Copy

1.	中华医学会外科学分会外科感染与重症医学学组, 中国医师协会外科医师分会肠瘘外科医师专业委员会. 中国手术部位感染预防指南. 中华胃肠外科杂志, 2019, 22(4): 301-314.
2.	Chadwick L, Fallon EF. Evaluation and critique of healthcare failure mode and effect analysis applied in a radiotherapy case study. Hum Factors and Ergon Manuf Serv Ind 2013, 23(2): 116-127.
3.	Cronrath P, Lynch TW, Gilson LJ, et al. PCA over sedation: application of healthcare failure mode effect (HFMEA) analysis. Nurs Econ, 2011, 29(2): 79-87.
4.	管咏梅, 沈南平, 何萍萍. 应用医疗失效模式与效应分析降低气管插管非计划性拔管率. 上海交通大学学报 (医学版), 2011, 31(9): 1355-1357.
5.	蒋谷芬, 彭丽丽. 应用医疗失效模式与效应分析预防住院老年患者跌倒. 中华护理杂志, 2011, 46(3): 273-274.
6.	匡季秋, 邓世洲, 刘帆, 等. 基于失效模式及效应分析模型的医院感染风险管理与预警体系构建研究. 中华医院感染学杂志, 2015, 25(21): 4976-4978.
7.	Hover AR, Sistrunk WW, Cavagnol RM, et al. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections. Am J Med Qual, 2024, 29(6): 517-521.
8.	徐世兰, 吴佳玉. 医院评审评价之医院感染管理常见问题解答. 成都: 四川大学出版社, 2017: 68.
9.	Fiani B, Cathel A, Sarhadi KJ, et al. Neurosurgical post-operative wound infections: a retrospective study on surgical site infections for quality improvement. Int Wound J, 2020, 17(4): 1039-1046.
10.	Fang C, Zhu T, Zhang P, et al. Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control, 2017, 45(11): e123-e134.
11.	Meng F, Cao J, Meng X. Risk factors for surgical site infections following spinal surgery. J Clin Neurosci, 2015, 22(12): 1862-1866.
12.	Saruwatari R, Yamada K, Sato K, et al. Risk factors for surgical site infection in spinal surgery and interventions: a retrospective study. Kurume Med J, 2023, 68(3.4): 201-207.
13.	Zhou J, Wang R, Huo X, et al. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2020, 45(3): 208-216.
14.	张露, 彭杨, 张军, 等. 骨科Ⅰ类切口手术部位感染相关危险因素调查分析. 中国医药科学, 2022, 12(12): 108-111.
15.	李艳玲, 罗少媚, 林国凤, 等. 骨科患者手术部位切口感染的危险因素分析及防控措施. 抗感染药学, 2019, 16(3): 454-457.
16.	黄萍萍, 张海伟, 董世阳, 等. 神经外科患者术中低体温风险预测模型的构建及应用. 现代临床护理, 2022, 21(9): 62-66.
17.	吴洋, 来瑞平, 张爽, 等. 骨科手术部位感染病原菌及影响因素. 中华医院感染学杂志, 2024(16): 2472-2476.
18.	姜晓敏. 术中综合保温护理对老年腹部手术病人凝血功能及术后并发症的影响. 全科护理, 2020, 18(34): 4759-4761.
19.	许东升. 目标性监测的应用对外科一类手术切口感染的影响. 中国医药指南, 2023, 21(24): 101-103.
20.	Khani-Jazani R, Molavi-Taleghani Y, Seyedin H, et al. Risk assessment of drug management process in women surgery department of qaem educational hospital (QEH) using HFMEA method (2013). Iran J Pharm Res, 2015, 14(2): 495-504.
21.	曾彦超, 易凤琼, 林祥容, 等. 手术室5S管理在神经外科手术部位感染中的作用. 海南医学, 2017, 28(24): 4119-4121.
22.	张甜, 钟瑜, 卜云芸. 基于六西格玛管理循证感控策略捆绑对妇科患者手术部位感染控制的效果研究. 基层医学论坛, 2021, 25(24): 3429-3430.

1. 中华医学会外科学分会外科感染与重症医学学组, 中国医师协会外科医师分会肠瘘外科医师专业委员会. 中国手术部位感染预防指南. 中华胃肠外科杂志, 2019, 22(4): 301-314.
2. Chadwick L, Fallon EF. Evaluation and critique of healthcare failure mode and effect analysis applied in a radiotherapy case study. Hum Factors and Ergon Manuf Serv Ind 2013, 23(2): 116-127.
3. Cronrath P, Lynch TW, Gilson LJ, et al. PCA over sedation: application of healthcare failure mode effect (HFMEA) analysis. Nurs Econ, 2011, 29(2): 79-87.
4. 管咏梅, 沈南平, 何萍萍. 应用医疗失效模式与效应分析降低气管插管非计划性拔管率. 上海交通大学学报 (医学版), 2011, 31(9): 1355-1357.
5. 蒋谷芬, 彭丽丽. 应用医疗失效模式与效应分析预防住院老年患者跌倒. 中华护理杂志, 2011, 46(3): 273-274.
6. 匡季秋, 邓世洲, 刘帆, 等. 基于失效模式及效应分析模型的医院感染风险管理与预警体系构建研究. 中华医院感染学杂志, 2015, 25(21): 4976-4978.
7. Hover AR, Sistrunk WW, Cavagnol RM, et al. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections. Am J Med Qual, 2024, 29(6): 517-521.
8. 徐世兰, 吴佳玉. 医院评审评价之医院感染管理常见问题解答. 成都: 四川大学出版社, 2017: 68.
9. Fiani B, Cathel A, Sarhadi KJ, et al. Neurosurgical post-operative wound infections: a retrospective study on surgical site infections for quality improvement. Int Wound J, 2020, 17(4): 1039-1046.
10. Fang C, Zhu T, Zhang P, et al. Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control, 2017, 45(11): e123-e134.
11. Meng F, Cao J, Meng X. Risk factors for surgical site infections following spinal surgery. J Clin Neurosci, 2015, 22(12): 1862-1866.
12. Saruwatari R, Yamada K, Sato K, et al. Risk factors for surgical site infection in spinal surgery and interventions: a retrospective study. Kurume Med J, 2023, 68(3.4): 201-207.
13. Zhou J, Wang R, Huo X, et al. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2020, 45(3): 208-216.
14. 张露, 彭杨, 张军, 等. 骨科Ⅰ类切口手术部位感染相关危险因素调查分析. 中国医药科学, 2022, 12(12): 108-111.
15. 李艳玲, 罗少媚, 林国凤, 等. 骨科患者手术部位切口感染的危险因素分析及防控措施. 抗感染药学, 2019, 16(3): 454-457.
16. 黄萍萍, 张海伟, 董世阳, 等. 神经外科患者术中低体温风险预测模型的构建及应用. 现代临床护理, 2022, 21(9): 62-66.
17. 吴洋, 来瑞平, 张爽, 等. 骨科手术部位感染病原菌及影响因素. 中华医院感染学杂志, 2024(16): 2472-2476.
18. 姜晓敏. 术中综合保温护理对老年腹部手术病人凝血功能及术后并发症的影响. 全科护理, 2020, 18(34): 4759-4761.
19. 许东升. 目标性监测的应用对外科一类手术切口感染的影响. 中国医药指南, 2023, 21(24): 101-103.
20. Khani-Jazani R, Molavi-Taleghani Y, Seyedin H, et al. Risk assessment of drug management process in women surgery department of qaem educational hospital (QEH) using HFMEA method (2013). Iran J Pharm Res, 2015, 14(2): 495-504.
21. 曾彦超, 易凤琼, 林祥容, 等. 手术室5S管理在神经外科手术部位感染中的作用. 海南医学, 2017, 28(24): 4119-4121.
22. 张甜, 钟瑜, 卜云芸. 基于六西格玛管理循证感控策略捆绑对妇科患者手术部位感染控制的效果研究. 基层医学论坛, 2021, 25(24): 3429-3430.

West China Medical Journal

Application of health failure mode and effect analysis to prevent surgical site infection in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision

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