Department of Surgery, Amphia Hospital, Breda, The Netherlands.
PLoS One. 2013 Aug 13;8(8):e71566. doi: 10.1371/journal.pone.0071566. eCollection 2013.
Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery.
To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates.
Prospective, quasi-experimental, cohort study.
A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback.
Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009.
The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing vascular surgery.
外科部位感染（SSI）与血管外科患者的严重发病率、死亡率和增加的医疗保健费用有关。
在血管外科实施护理包，并测量其对总体和深部 SSI 发生率的影响。
前瞻性、准实验性队列研究。
2009 年至 2011 年，在布雷达的 Amphia 医院对血管外科手术后的 SSI 进行前瞻性监测。2009 年引入了荷兰医院患者安全计划（DHPSP）制定的护理包。该护理包的内容包括（1）围手术期体温正常，（2）手术前剃毛，（3）使用围手术期抗生素预防，（4）手术室纪律。每 3 个月对手术过程中的随机样本进行一次护理包依从性测量，并将其用于反馈。
护理包的依从性从 2009 年的平均 10%显著提高到 2011 年的 60%。在研究期间，共进行了 720 例血管手术，观察到 75 例（10.4%）SSI。25 例（3.5%）患者发生深部 SSI。发生 SSI 的患者（28.5±29.3 vs 10.8±11.3，p<0.001）和深部 SSI 患者（48.3±39.4 vs 11.4±11.8，p<0.001）的术后住院时间明显更长。发生深部 SSI 的患者死亡率明显更高（调整后的 OR：2.96，95%置信区间 1.32-6.63）。多变量分析显示，随着时间的推移，SSI 发生率显著且独立下降，与护理包的引入相一致。与 2009 年相比，2011 年的 SSI 发生率降低了 51%。
随着时间的推移，护理包的实施与依从性的提高相关，并使血管手术的 SSI 发生率降低了 51%。该护理包不需要昂贵或潜在有害的干预措施，因此是提高血管外科患者安全性和降低 SSI 发生率的重要工具。
