Hechenbleikner Elizabeth M, Hobson Deborah B, Bennett Jennifer L, Wick Elizabeth C
1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 2 Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Dis Colon Rectum. 2015 Jan;58(1):83-90. doi: 10.1097/DCR.0000000000000259.
Surgical site infections are a potentially preventable patient harm. Emerging evidence suggests that the implementation of evidence-based process measures for infection reduction is highly variable.
The purpose of this work was to develop an auditing tool to assess compliance with infection-related process measures and establish a system for identifying and addressing defects in measure implementation.
This was a retrospective cohort study using electronic medical records.
We used the auditing tool to assess compliance with 10 process measures in a sample of colorectal surgery patients with and without postoperative infections at an academic medical center (January 2012 to March 2013).
We investigated 59 patients with surgical site infections and 49 patients without surgical site infections.
First, overall compliance rates for the 10 process measures were compared between patients with infection vs patients without infection to assess if compliance was lower among patients with surgical site infections. Then, because of the burden of data collection, the tool was used exclusively to evaluate quarterly compliance rates among patients with infection. The results were reviewed, and the key factors contributing to noncompliance were identified and addressed.
Ninety percent of process measures had lower compliance rates among patients with infection. Detailed review of infection cases identified many defects that improved following the implementation of system-level changes: correct cefotetan redosing (education of anesthesia personnel), temperature at surgical incision >36.0°C (flags used to identify patients for preoperative warming), and the use of preoperative mechanical bowel preparation with oral antibiotics (laxative solutions and antibiotics distributed in clinic before surgery). Quarterly compliance improved for 80% of process measures by the end of the study period.
This study was conducted on a small surgical cohort within a select subspecialty.
The infection auditing tool is a useful strategy for identifying defects and guiding quality improvement interventions. This is an iterative process requiring dedicated resources and continuous patient and frontline provider engagement.
手术部位感染是一种潜在可预防的患者伤害。新出现的证据表明，实施基于证据的感染防控流程措施的情况差异很大。
本研究旨在开发一种审计工具，以评估与感染相关流程措施的合规情况，并建立一个识别和解决措施实施缺陷的系统。
这是一项使用电子病历的回顾性队列研究。
我们使用该审计工具，对一家学术医疗中心（2012年1月至2013年3月）接受结直肠手术且有或无术后感染的患者样本中的10项流程措施的合规情况进行评估。
我们调查了59例手术部位感染患者和49例无手术部位感染患者。
首先，比较感染患者与未感染患者对10项流程措施的总体合规率，以评估手术部位感染患者的合规率是否较低。然后，由于数据收集负担，该工具仅用于评估感染患者的季度合规率。对结果进行审查，确定导致不合规的关键因素并加以解决。
90%的流程措施在感染患者中的合规率较低。对感染病例的详细审查发现了许多缺陷，这些缺陷在实施系统层面的改进后得到改善：正确重新给予头孢替坦（对麻醉人员进行教育）、手术切口温度>36.0°C（使用标记来识别术前需要保暖的患者）以及术前使用机械肠道准备联合口服抗生素（术前在诊所分发泻药溶液和抗生素）。到研究期结束时，80%的流程措施的季度合规率有所提高。
本研究是在一个特定亚专业的小型手术队列中进行的。
感染审计工具是识别缺陷和指导质量改进干预措施的有用策略。这是一个迭代过程，需要专门的资源以及患者和一线医疗服务提供者的持续参与。
