Andersson Annette Erichsen, Bergh Ingrid, Karlsson Jón, Eriksson Bengt I, Nilsson Kerstin
University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
Patient Saf Surg. 2012 Jun 14;6(1):11. doi: 10.1186/1754-9493-6-11.
Current knowledge suggests that, by applying evidence-based measures relating to the correct use of prophylactic antibiotics, perioperative normothermia, urinary tract catheterization and hand hygiene, important contributions can be made to reducing the risk of postoperative infections and device-related infections. The aim of this study was to explore and describe the application of intraoperative evidence-based measures, designed to reduce the risk of infection. In addition, we aimed to investigate whether the type of surgery, i.e. total joint arthroplasty compared with tibia and femur/hip fracture surgery, affected the use of protective measures.
Data on the clinical application of evidence-based measures were collected structurally on site during 69 consecutively included operations involving fracture surgery (n = 35) and total joint arthroplasties (n = 34) using a pre-tested observation form. For observations in relation to hand disinfection, a modified version of the World Health Organization hand hygiene observation method was used.
In all, only 29 patients (49%) of 59 received prophylaxis within the recommended time span. The differences in the timing of prophylactic antibiotics between total joint arthroplasty and fracture surgery were significant, i.e. a more accurate timing was implemented in patients undergoing total joint arthroplasty (p = 0.02). Eighteen (53%) of the patients undergoing total joint arthroplasty were actively treated with a forced-air warming system. The corresponding number for fracture surgery was 12 (34%) (p = 0.04).Observations of 254 opportunities for hand hygiene revealed an overall adherence rate of 10.3% to hand disinfection guidelines.
The results showed that the utilization of evidence-based measures to reduce infections in clinical practice is not sufficient and there are unjustifiable differences in care depending on the type of surgery. The poor adherence to hand hygiene precautions in the operating room is a serious problem for patient safety and further studies should focus on resolving this problem. The WHO Safe Surgery checklist "time out" worked as an important reminder, but is not per se a guarantee of safety; it is the way we act in response to mistakes or lapses that finally matters.
目前的知识表明，通过应用与正确使用预防性抗生素、围手术期正常体温、导尿和手部卫生相关的循证措施，可为降低术后感染和器械相关感染的风险做出重要贡献。本研究的目的是探索和描述旨在降低感染风险的术中循证措施的应用。此外，我们旨在调查手术类型，即全关节置换术与胫骨和股骨/髋部骨折手术相比，是否会影响保护措施的使用。
使用预先测试的观察表，在连续纳入的69例涉及骨折手术（n = 35）和全关节置换术（n = 34）的手术过程中，在现场结构化收集循证措施临床应用的数据。对于手部消毒观察，使用了世界卫生组织手部卫生观察方法的修改版。
总共59例患者中只有29例（49%）在推荐的时间范围内接受了预防用药。全关节置换术和骨折手术之间预防性抗生素使用时间的差异显著，即在接受全关节置换术的患者中实施了更准确的用药时间（p = 0.02）。18例（53%）接受全关节置换术的患者接受了强制空气升温系统的积极治疗。骨折手术的相应数字为12例（34%）（p = 0.04）。对254次手部卫生机会的观察显示，手部消毒指南的总体遵守率为10.3%。
结果表明，在临床实践中利用循证措施减少感染的情况并不充分，并且根据手术类型在护理方面存在不合理的差异。手术室中对手部卫生预防措施的依从性差是患者安全的一个严重问题，进一步的研究应侧重于解决这个问题。世界卫生组织安全手术检查表中的“暂停”起到了重要的提醒作用，但本身并不能保证安全；最终重要的是我们对错误或失误的应对方式。
