Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Surg Infect (Larchmt). 2011 Jun;12(3):163-8. doi: 10.1089/sur.2010.083. Epub 2011 Jul 18.
In response to inconsistent compliance with infection prevention measures, the Centers for Medicare & Medicaid Services collaborated with the U.S. Centers for Disease Control and Prevention on the Surgical Infection Prevention (SIP) project, introduced in 2002.
Quality improvement measures were developed to standardize processes to increase compliance. In 2006, the Surgical Care Improvement Project (SCIP) developed out of the SIP project and its process measures. These initiatives, published in the Specifications Manual for National Inpatient Quality Measures, outline process and outcome measures. This continually evolving manual is intended to provide standard quality measures to unify documentation and track standards of care.
Seven of the SCIP initiatives apply to the peri-operative period: Prophylactic antibiotics should be received within 1 h prior to surgical incision (1), be selected for activity against the most probable antimicrobial contaminants (2), and be discontinued within 24 h after the surgery end-time (3); (4) euglycemia should be maintained, with well-controlled morning blood glucose concentrations on the first two post-operative days, especially in cardiac surgery patients; (6) hair at the surgical site should be removed with clippers or by depilatory methods, not with a blade; (9) urinary catheters are to be removed within the first two post-operative days; and (10) normothermia should be maintained peri-operatively.
There is strong evidence that implementation of protocols that standardize practices reduce the risk of surgical infection. The SCIP initiative targets complications that account for a significant portion of preventable morbidity as well as cost. One of the goals of the SCIP guidelines was a 25% reduction in the incidence of surgical site infections from implementation through 2010. Process measures are becoming routine, and as we practice more evidence-based medicine, it falls to us, the surgeons and scientists, to be active, not only in the implementation and execution of these measures, but in the investigation of clinical questions and the writing of protocols. We are responsible for ensuring that out-of-date practices are removed from use and that new practices are appropriate, achievable, and effective.
为了应对感染预防措施执行不一致的问题，医疗保险和医疗补助服务中心与美国疾病控制与预防中心合作开展了外科感染预防（SIP）项目，该项目于 2002 年推出。
制定了质量改进措施，以规范流程，提高依从性。2006 年，SIP 项目发展成为外科护理改进项目（SCIP）及其流程措施。这些举措发表在《国家住院患者质量措施规格手册》中，概述了流程和结果措施。这本不断发展的手册旨在提供标准质量措施，以统一文件记录并跟踪护理标准。
SCIP 的七个举措适用于围手术期：（1）预防性抗生素应在手术切口前 1 小时内给予；（2）选择针对最可能的抗菌污染物具有活性的抗生素；（3）并在手术结束后 24 小时内停止使用；（4）应保持血糖正常，尤其是心脏手术患者，术后前两天的早晨血糖浓度应得到良好控制；（6）手术部位的毛发应使用理发器或脱毛剂去除，而不是刀片；（9）术后两天内应移除导尿管；（10）应在围手术期保持体温正常。
有强有力的证据表明，实施标准化实践的方案可降低手术感染的风险。SCIP 倡议针对的是导致可预防发病率和成本的重要部分的并发症。SCIP 指南的目标之一是通过 2010 年的实施，将手术部位感染的发生率降低 25%。流程措施已成为常规措施，随着我们更多地采用循证医学，我们作为外科医生和科学家，不仅要积极参与这些措施的实施和执行，还要积极调查临床问题并制定方案。我们有责任确保过时的实践被淘汰，新的实践是适当的、可实现的和有效的。
