Surgical Microbiology Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Surg Infect (Larchmt). 2011 Jun;12(3):169-77. doi: 10.1089/sur.2011.036. Epub 2011 Jul 18.
Surgical site infections (SSIs) are associated with substantial patient morbidity and death. It is estimated that 750,000-1 million SSIs occur in the U.S. each year, utilizing 3.7 million extra hospital days and costing more than $1.6 billion in excess hospital charges.
Review of pertinent English-language literature.
The Surgical Care Improvement Project (SCIP) was embraced as a "one-size-fits-all" strategy to reduce postoperative infectious morbidity 25% by 2010. Unfortunately, the evidence suggests that SCIP by itself has had little efficacy in reducing the overall risk of SSI. Whereas the SCIP initiative represents a first national effort to focus on reducing postoperative infectious morbidity and deaths, it fails to consider salient risk factors such as body mass index and selected surgical practices, including tourniquet application prior to incision.
Rather than focus on a single risk-reduction strategy, future efforts to improve surgical outcomes should embrace a "SCIP-plus" multi-faceted, tiered interventional strategy that includes pre-admission antiseptic showering, state-of-the-art skin antisepsis, innovative antimicrobial technology, active staphylococcal surveillance, and pharmacologic-physiologic considerations unique to selective patient populations.
手术部位感染（SSI）与患者发病率和死亡率显著相关。据估计，美国每年发生 75 万至 100 万例 SSI，额外增加 370 万天住院时间，额外增加超过 16 亿美元的医院费用。
回顾相关的英文文献。
外科护理改进项目（SCIP）被视为一种“一刀切”的策略，旨在到 2010 年将术后感染性发病率降低 25%。不幸的是，证据表明，SCIP 本身在降低 SSI 的总体风险方面效果甚微。虽然 SCIP 倡议代表了首次全国性努力，旨在关注降低术后感染性发病率和死亡率，但它没有考虑到相关的风险因素，如体重指数和某些外科手术实践，包括在切开前使用止血带。
未来改善手术结果的努力不应仅关注单一的降低风险策略，而应采用“SCIP 加”多方面、分层的干预策略，包括入院前抗菌沐浴、最新的皮肤消毒、创新的抗菌技术、积极的葡萄球菌监测以及针对特定患者群体的药理学-生理学考虑。
