绩效反馈对腹式子宫切除术中伤口感染率的影响。

The effect of performance feedback on wound infection rate in abdominal hysterectomy.

作者信息

Rodríguez J F García, Trobo A Rivera, García M V Lorenzo, Martínez M J Carballo, Millán C Parada, Vázquez M Calaza, Rodríguez J Ferro, Pérez-Mendaña J M

机构信息

Infectious Diseases Unit, Hospital A. Marcide, A Courña, Spain.

出版信息

Am J Infect Control. 2006 May;34(4):182-7. doi: 10.1016/j.ajic.2005.09.011.

DOI:10.1016/j.ajic.2005.09.011

PMID:16679174

Abstract

BACKGROUND

In many hospitals, infection of the surgical wound is the most common nosocomial infection. Its presence implies patient morbidity, a mortality risk, and an increase in procedure costs because of prolonged hospitalization.

OBJECTIVES

Our objective was to ascertain the effect of an infection control program, using performance feedback, on wound infection (WI) rate in abdominal hysterectomy.

METHODS

All patients undergoing abdominal hysterectomy in our center (Hospital A. Marcide, Ferrol, Spain) between 1999 and 2004 were prospectively followed up to determine the WI rate. A complete set of parameters, including age, underlying illnesses, cancer, diabetes mellitus, immunosuppressive therapy, albumin, American Society of Anesthesiologists preoperative assessment score (ASA) risk, days in hospital presurgery, date of surgery, hygiene and perioperative antimicrobial prophylaxis, type of surgical operation, duration of surgery, surgeon, and WI, were collected in each case. After data collection for 1999 concluded, we communicated surgical WI rates to surgeons every year. A logistic regression analysis was performed to compare WI rates with those observed in 1999.

RESULTS

A total of 980 females was enrolled in the prospective surveillance: mean age, 50.7 +/- 10.7 years. Cases included 25.8% cancer, 4.9% diabetes, 0.5% immunosuppressive therapy, 26.6% ASA 1, 58.4% ASA 2, 13.9% ASA 3. In 9 patients, emergency surgery was performed and, in 971 patients, surgery was scheduled: Total abdominal hysterectomy, 878; subtotal abdominal hysterectomy, 65; Wertheim-Meigs, 37. The factors associated with WI were albumin (OR, 0.97; 95% CI: 0.94-0.99) and antimicrobial prophylaxis (OR, 0.08; 95% CI: 0.02-0.32). The mean values for albumin and the number of patients with antimicrobial prophylaxis fluctuated from year to year. The WI rate improved from 10.7% (95% CI: 5.8-15.6) in 1999 to 6% (-43.9%) in 2004.

CONCLUSION

Performance feedback of surgical wound infection rates to individual surgeons reduces these rates.

摘要

背景

在许多医院，手术伤口感染是最常见的医院感染。其存在意味着患者发病、有死亡风险，并且由于住院时间延长会增加手术费用。

目的

我们的目的是确定使用绩效反馈的感染控制计划对腹部子宫切除术中伤口感染（WI）率的影响。

方法

对1999年至2004年期间在我们中心（西班牙费罗尔的A. Marcide医院）接受腹部子宫切除术的所有患者进行前瞻性随访，以确定WI率。收集了包括年龄、基础疾病、癌症、糖尿病、免疫抑制治疗、白蛋白、美国麻醉医师协会术前评估评分（ASA）风险、术前住院天数、手术日期、卫生状况和围手术期抗菌预防、手术类型、手术持续时间、外科医生以及WI在内的一整套参数。在1999年的数据收集结束后，我们每年将手术WI率告知外科医生。进行逻辑回归分析以比较WI率与1999年观察到的WI率。

结果

共有980名女性纳入前瞻性监测：平均年龄50.7±10.7岁。病例包括25.8%患有癌症、4.9%患有糖尿病、0.5%接受免疫抑制治疗、26.6%为ASA 1级、58.4%为ASA 2级、13.9%为ASA 3级。9例患者进行了急诊手术，971例患者进行了择期手术：全腹子宫切除术878例；次全腹子宫切除术65例；韦特海姆 - 梅格斯手术37例。与WI相关的因素是白蛋白（比值比[OR]，0.97；95%置信区间[CI]：0.94 - 0.99）和抗菌预防（OR，0.08；95% CI：0.02 - 0.32）。白蛋白的平均值和接受抗菌预防的患者数量逐年波动。WI率从1999年的10.7%（95% CI：5.8 - 15.6）降至2004年的6%（-43.9%）。