McCahill Laurence E, Ahern John W, Gruppi Linda A, Limanek James, Dion Gail A, Sussman Jessica A, McCaffrey Christina B, Leary Diane B, Lesage Margaret B, Single Richard M
Department of Surgical Oncology, University of Vermont, and Fletcher Allen Health Care, Burlington, VT 05405, USA.
Arch Surg. 2007 Apr;142(4):355-61. doi: 10.1001/archsurg.142.4.355.
The Center for Medicare and Medicaid Services instituted standardized reporting of measures aimed at surgical infection prevention (SIP). The complexity and number of medical personnel involved in antibiotic administration requires multiple disciplines to successfully improve compliance.
Survey study.
Tertiary care university hospital.
All patients undergoing the following operations from July 2004 through December 2005 were monitored for compliance with SIP: (1) coronary artery bypass graft, (2) other cardiac, (3) vascular, (4) hysterectomy, (5) colon resection, (6) hip arthroplasty, and (7) knee arthroplasty.
A team including a surgeon, an anesthesiologist, nurses (preoperative, operating room, and floor), a pharmacist, a hospital infection control committee member, and quality improvement and operations specialists was created in July 2004. Hospital guidelines for SIP were defined, personnel roles defined and processes standardized, and communication/education for health care professionals was enhanced.
Compliance with 3 SIP measures over 3 consecutive periods of 6 months each: (1) percentage of patients receiving antibiotics within 1 hour of incision, (2) percentage of patients with appropriately selected antibiotics, and (3) percentage of patients with antibiotics discontinued within 24 hours of operation end time.
One thousand seventy-two patients were monitored. Measure 1 compliance improved from 72.25% to 83.78% (P<.001, Cochran-Armitage trend test); improvement or high performance (>90% compliance) was demonstrated in 5 of 7 services. Measure 2 compliance remained uniformly high (approximately 98%). Measure 3 compliance improved from 54.5% to 87.16% (P<.001); improvement was seen in 5 of 7 services.
The clearly defined roles of a cross-disciplinary team and the process improvements discussed in this article can easily be implemented in other institutions. These elements were integral to our success in improving the timely delivery and discontinuation of prophylactic surgical antibiotics.
医疗保险和医疗补助服务中心制定了旨在预防手术感染（SIP）的措施的标准化报告。参与抗生素管理的医务人员的复杂性和数量要求多个学科共同努力以成功提高依从性。
调查研究。
三级医疗大学医院。
对2004年7月至2005年12月期间接受以下手术的所有患者进行SIP依从性监测：（1）冠状动脉搭桥术，（2）其他心脏手术，（3）血管手术，（4）子宫切除术，（5）结肠切除术，（6）髋关节置换术，以及（7）膝关节置换术。
2004年7月成立了一个团队，成员包括一名外科医生、一名麻醉师、护士（术前、手术室和病房）、一名药剂师、医院感染控制委员会成员以及质量改进和运营专家。明确了医院SIP指南，界定了人员职责并规范了流程，加强了对医护人员的沟通/教育。
在连续3个为期6个月的时间段内对3项SIP措施的依从性：（1）切口后1小时内接受抗生素治疗的患者百分比，（2）选用合适抗生素的患者百分比，以及（3）手术结束时间后24小时内停用抗生素的患者百分比。
共监测了1072例患者。措施1的依从性从72.25%提高到83.78%（P<0.001, Cochran-Armitage趋势检验）；7个科室中有5个科室表现出改善或达到了较高水平（依从性>90%）。措施2的依从性一直保持在较高水平（约98%）。措施3的依从性从54.5%提高到87.16%（P<0.001）；7个科室中有5个科室有改善。
本文中讨论的跨学科团队的明确角色和流程改进可以很容易地在其他机构实施。这些要素是我们成功改善预防性手术抗生素的及时使用和停用的不可或缺的部分。
