Identification of key potential infection processes and risk factors in the computed tomography examination process by FMEA method under COVID-19

Purpose: To identify the key infection processes and risk factors in Computed Tomography (CT) examination process within the standard prevention and control measures for the COVID-19 epidemic, aiming to mitigate cross-infection occurrences in the hospital.

Method: The case hospital has assembled a team of 30 experts specialized in CT examination. Based on the CT examination process, the potential failure modes were assessed from the perspective of severity (S), occurrence probability (O), and detectability (D); they were then combined with corresponding risk prevention measures. Finally, key infection processes and risk factors were identified according to the risk priority number (RPN) and expert analysis.

Results: Through the application of RPN and further analysis, four key potential infection processes were identified, including "CT request form (A₁)," "during the scan of CT patient (B₂)," "CT room and objects disposal (C₂)," and "medical waste (garbage) disposal (C₃)". In addition, eight key risk factors were also identified, including "cleaning personnel does not wear masks normatively (C₃₂)," "nurse does not select the vein well, resulting in extravasation of the peripheral vein for enhanced CT (B₂₅)," "patient cannot find the CT room (A₁₃)," "patient has obtained a CT request form but does not know the procedure (A₁₂)," "patient is too unwell to continue with the CT scan (B₂₄)," "auxiliary staff (or technician) does not have a good grasp of the sterilization and disinfection standards (C₂₁)," "auxiliary staff (or technician) does not sterilize the CT machine thoroughly (C₂₂)," and "cleaning personnel lacks of knowledge of COVID-19 prevention and control (C₃₃)".

Conclusion: Hospitals can publicize the precautions regarding CT examination through various channels, reducing the incidence of CT examination failure. Hospitals' cleaning services are usually outsourced, and the educational background of the staff employed in these services is generally not high. Therefore, during training and communication, it is more necessary to provide a series of scope and training programs that are aligned with their understanding level. The model developed in this study effectively identifies the key infection prevention process and critical risk factors, enhancing the safety of medical staff and patients. This has significant research implications for the potential epidemic of major infectious diseases.