全关节置换术部位感染的预防：国际三级护理中心调查。
Prevention of surgical site infection in total joint arthroplasty: an international tertiary care center survey.
机构信息
Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Department of Orthopedics Clinical Sciences Lund, Lund University, Lund, Sweden ; The Swedish Knee Arthroplasty Register, Lund, Sweden.
出版信息
HSS J. 2014 Feb;10(1):45-51. doi: 10.1007/s11420-013-9369-1. Epub 2013 Dec 3.
BACKGROUND
Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population.
QUESTIONS/PURPOSES: What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA?
PATIENTS AND METHODS
A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared.
RESULTS
Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention.
CONCLUSION
Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.
背景
预防策略对于降低全关节置换术（TJA）的感染率至关重要，但针对预防手术部位感染（SSI）的基于循证共识的指南仍存在差异，不一定能代表这一特定患者群体。
问题/目的：基于循证共识的指南推荐了哪些预防假体周围关节感染的感染预防措施？这些建议与来自 TJA 最大国际三级转诊中心的骨科医生的感染预防策略专家共识相比如何？
患者和方法
按照 Merollini 等人的描述进行了共识指南的综述。四项临床指南符合纳入标准：美国疾病控制与预防中心、英国骨科协会、国家临床卓越研究所和澳大利亚国家卫生与医疗研究委员会（NHMRC）。从这些指南中提取了 28 条预防感染的建议，用于创建一个基于证据的假体周围关节感染预防策略调查，该调查由 28 名来自国际骨科中心协会成员的骨科医生进行了填写。然后将现有共识指南和专家意见之间的结果进行了比较。
结果
调查医生认为指南中推荐的策略，如预防性抗生素、患者和医务人员的术前皮肤准备以及无菌手术服装等策略具有重要意义。其他策略，如超洁净空气/层流、抗生素骨水泥、伤口冲洗和术前血糖控制，也被调查医生认为非常重要，但在现有的 SSI 预防指南中并未推荐或未得到统一解决。
结论
目前的基于循证的指南不完整，应该更新证据，专门针对接受 TJA 的患者的需求。
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