目的 评估广东省某三甲医院在处置新型冠状病毒感染医疗废物(简称新冠医疗废物)过程引发医院感染的风险等级,为降低医院感染风险,制定处置措施提供参考依据。方法 运用失效模式-效应分析(FMEA)方法,识别与新冠医疗废物处置过程中引发医院感染的风险,针对风险优先系数(RPN)>200的失效模式提出改进措施。结果 通过FMEA分析,RPN>200的失效模式有病患及家属错误丢弃垃圾(RPN=343)、打包消毒不规范(RPN=336)、个人防护落实不到位(RPN=288)、运送工人发生针刺伤(RPN=240)和未存放在暂存间(RPN=210)。实施针对性措施干预后,7 128.8 kg医疗废物处置得当,无医院感染、锐器伤、医疗废物泄露事件发生。结论 FMEA评估模型可以有效识别与新冠医疗废物处置风险,防止病毒扩散、传播。
Abstract
Objective To evaluate the risk level of hospital infection caused by SARS-Cov-2 in the disposal of medical waste in a grade A tertiary hospital in Guangdong Province,so as to provide a reference for reducing the risk of hospital infection and formulating disposal measures. Methods The failure mode effect analysis (FMEA) method was used to identify the risk of hospital infection in the disposal of medical waste related to SARS-Cov-2 infection,and improvement measures were proposed for the failure mode with risk priority number (RPN)>200. Results Through FMEA analysis,the failure modes with RPN>200 included the wrong disposal of garbage by patients and their families (RPN=343),non-standard packaging and disinfection (RPN=336),inadequate implementation of personal protection (RPN=288),needle injury of transport workers (RPN=240) and and failure to store in temporary storage (RPN=210).After the implementation of targeted measures,7 128.8 kg of medical waste was properly disposed,and there was no hospital infection,sharp injury,or leakage of medical waste. Conclusion FMEA assessment model can effectively identify the risk of medical waste disposal related to SARS-Cov-2 infection,and prevent the spread and transmission of virus.
关键词
FMEA模型 /
新型冠状病毒 /
医疗废物 /
医院感染 /
风险识别
Key words
FMEA model /
SARS-Cov-2 /
Medical waste /
Hospital infection /
Risk identification
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参考文献
[1] 陈伟,王晴,李媛秋,等.我国新型冠状病毒肺炎疫情早期围堵策略概述[J].中华预防医学杂志,2020,3,54(3):1-6.
[2] Zhu N,Zhang D,Wang W,et al.A novel coronavirus from patients with pneumonia in China,2019[J].N Engl J Med,2020,382:727-723.
[3] Li Q,Guan X,Wu P,et al.Early transmission dynamics in Wuhan,China,of novel coronavirus-infected pneumonia[J].N Engl Med J,2020,382:1197-207.
[4] Huang CL,Wang YM,Li XW,et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China[J].Lancet J.2020,395(10223):497-506.
[5] 中华人民共和国国家卫生健康委员会公告.新型冠状病毒感染的肺炎纳入法定传染病管理[EB/OL].(2020-01-20)[2020-02-01].http://www.nhc.gov.cn/jkj/s7916/202001/44a3b8245e8049d2837a4f27529cd386.shtml.
[6] World Health Organization.Directior-General’s opening remarks at the media briefing on COVID-19-11 March 2020[EB/OL].(2020-03-11) [2020-09-15].https://www.who.int/dg/speeches/detail/who-derector-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020).
[7] 黄虞远,张思慧,周娟,等.新型冠状病毒在环境中的存活潜力和感染风险[J].疾病监测,2020,12(35):1-7.
[8] 谭庆,李海峰,吴风富,等.武汉火神山医院医疗废物管理经验[J].中华医院感染学杂志,2020,30(12):1793-1796.
[9] 吴松杰,朱小平,金学兰,等.新型冠状病毒肺炎定点收治医院医疗废物优化处置实践[J].中华医院感染学杂志,2020,30(12):1637-1640.
[10] 陈明壮,查静茹,鲁超,等.新型冠状病毒肺炎疫情期间综合医院医疗废物优化管理实践[J].中国医院管理,2020,3(40):47-49.
[11] Ashlry L,Dexter R,Marshall F,et al.Improving the safety of chemotherapy administration:an oncology nurse-led failure mode and effects analysis[J].Oncol Nurs Forum J.2011,38(6):436-444.
[12] Pentti H,Atte H.Failure mode and effects analysis of software automation systems[J].Myco Res,2002,36(3):190-194.
[13] Derosier J,Stalhandske E,Bagian JP,et al.Using health care Failure Mode and Effects Analysis:the VA National Center for Patient Safety’s prospective risk analysis system[J].J comm J Qual Improv,2002,28(5):248-267.
[14] Duwe B,Fuchs BD,Hasen FJ.Failure mode and effects analysis application to critical care medicine[J].Crit care clin,2005,21(1):21-30.
[15] Lu Y,Teng F,Zhou J,et al.Failure mode and effects analysis in blood transfusion:a proactive tool to reduce risk[J].Transfusion,2013,53(12):3080-3087.
[16] 黄虞远,张思慧,周娟,等.新型冠状病毒在环境中的存活潜力和感染风险[J].疾病监测,2021,36(1):16-22.
[17] Pan Y,Zhang D,Yand P,et al.Viral load of SARS-CoV-2 in clinical Samples[J].Lancet Infect Dis J,2020,20(4):411-412.
[18] Matson MJ,Yinda CK,Seifert SN,et al.Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum[J].Emerg Infect Dis J,2020,26(9):2276-2278.
[19] Guo ZD,Wand ZY,Zhang SF,et al.Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards,Wuhan,China,2020[J].Emerg Infect Dis,2020,26(7):1583-1591.
[20] Chin AWH,Chu JTS,Perera MRA,et al.Stability of SARS-CoV-2 in different environmental conditions[J].Lancet Microbe J,2020,1(1):e10.
[21] 王东方,韦进宝.武汉市医疗废物污染现状及防治对策[J].环境科学与技术,2002,25(5):38-39.
[22] 李桂宝,文勇,文须眉,等.失效模式和效应分析在医疗废物管理中的应用[J].护理实践与研究,2016,13(16):96-98.
[23] 邹雪峰,陈法聪.应用失效模式与效应分析降低医疗废物管理风险的研究[J].广州医科大学学报,2017,45(3):83-85.
基金
广东医学科研基金项目(B2019243);惠州市新冠肺炎应急防治科技专项(2020SC0705005)