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.	中華醫學會外科學分會外科感染與重癥醫學學組, 中國醫師協會外科醫師分會腸瘺外科醫師專業委員會. 中國手術部位感染預防指南. 中華胃腸外科雜志, 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.	管詠梅, 沈南平, 何萍萍. 應用醫療失效模式與效應分析降低氣管插管非計劃性拔管率. 上海交通大學學報 (醫學版), 2011, 31(9): 1355-1357.
5.	蔣谷芬, 彭麗麗. 應用醫療失效模式與效應分析預防住院老年患者跌倒. 中華護理雜志, 2011, 46(3): 273-274.
6.	匡季秋, 鄧世洲, 劉帆, 等. 基于失效模式及效應分析模型的醫院感染風險管理與預警體系構建研究. 中華醫院感染學雜志, 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.	徐世蘭, 吳佳玉. 醫院評審評價之醫院感染管理常見問題解答. 成都: 四川大學出版社, 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.	張露, 彭楊, 張軍, 等. 骨科Ⅰ類切口手術部位感染相關危險因素調查分析. 中國醫藥科學, 2022, 12(12): 108-111.
15.	李艷玲, 羅少媚, 林國鳳, 等. 骨科患者手術部位切口感染的危險因素分析及防控措施. 抗感染藥學, 2019, 16(3): 454-457.
16.	黃萍萍, 張海偉, 董世陽, 等. 神經外科患者術中低體溫風險預測模型的構建及應用. 現代臨床護理, 2022, 21(9): 62-66.
17.	吳洋, 來瑞平, 張爽, 等. 骨科手術部位感染病原菌及影響因素. 中華醫院感染學雜志, 2024(16): 2472-2476.
18.	姜曉敏. 術中綜合保溫護理對老年腹部手術病人凝血功能及術后并發癥的影響. 全科護理, 2020, 18(34): 4759-4761.
19.	許東升. 目標性監測的應用對外科一類手術切口感染的影響. 中國醫藥指南, 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.	曾彥超, 易鳳瓊, 林祥容, 等. 手術室5S管理在神經外科手術部位感染中的作用. 海南醫學, 2017, 28(24): 4119-4121.
22.	張甜, 鐘瑜, 卜云蕓. 基于六西格瑪管理循證感控策略捆綁對婦科患者手術部位感染控制的效果研究. 基層醫學論壇, 2021, 25(24): 3429-3430.

1. 中華醫學會外科學分會外科感染與重癥醫學學組, 中國醫師協會外科醫師分會腸瘺外科醫師專業委員會. 中國手術部位感染預防指南. 中華胃腸外科雜志, 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. 管詠梅, 沈南平, 何萍萍. 應用醫療失效模式與效應分析降低氣管插管非計劃性拔管率. 上海交通大學學報 (醫學版), 2011, 31(9): 1355-1357.
5. 蔣谷芬, 彭麗麗. 應用醫療失效模式與效應分析預防住院老年患者跌倒. 中華護理雜志, 2011, 46(3): 273-274.
6. 匡季秋, 鄧世洲, 劉帆, 等. 基于失效模式及效應分析模型的醫院感染風險管理與預警體系構建研究. 中華醫院感染學雜志, 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. 徐世蘭, 吳佳玉. 醫院評審評價之醫院感染管理常見問題解答. 成都: 四川大學出版社, 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. 張露, 彭楊, 張軍, 等. 骨科Ⅰ類切口手術部位感染相關危險因素調查分析. 中國醫藥科學, 2022, 12(12): 108-111.
15. 李艷玲, 羅少媚, 林國鳳, 等. 骨科患者手術部位切口感染的危險因素分析及防控措施. 抗感染藥學, 2019, 16(3): 454-457.
16. 黃萍萍, 張海偉, 董世陽, 等. 神經外科患者術中低體溫風險預測模型的構建及應用. 現代臨床護理, 2022, 21(9): 62-66.
17. 吳洋, 來瑞平, 張爽, 等. 骨科手術部位感染病原菌及影響因素. 中華醫院感染學雜志, 2024(16): 2472-2476.
18. 姜曉敏. 術中綜合保溫護理對老年腹部手術病人凝血功能及術后并發癥的影響. 全科護理, 2020, 18(34): 4759-4761.
19. 許東升. 目標性監測的應用對外科一類手術切口感染的影響. 中國醫藥指南, 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. 曾彥超, 易鳳瓊, 林祥容, 等. 手術室5S管理在神經外科手術部位感染中的作用. 海南醫學, 2017, 28(24): 4119-4121.
22. 張甜, 鐘瑜, 卜云蕓. 基于六西格瑪管理循證感控策略捆綁對婦科患者手術部位感染控制的效果研究. 基層醫學論壇, 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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