消毒倡议：降低妇科肿瘤手术感染发生率
The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology.
作者信息
Taylor Jolyn S, Marten Claire A, Munsell Mark F, Sun Charlotte C, Potts Kimberly A, Burzawa Jennifer K, Nick Alpa M, Meyer Larissa A, Myers Keith, Bodurka Diane C, Aloia Thomas A, Levenback Charles F, Lairson David R, Schmeler Kathleen M
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Ann Surg Oncol. 2017 Feb;24(2):362-368. doi: 10.1245/s10434-016-5517-4. Epub 2016 Aug 29.
BACKGROUND
Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.
METHODS
Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014-30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015-15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle.
RESULTS
A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37-0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38-0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34-0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month.
CONCLUSIONS
This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.
背景
手术部位感染（SSIs）会导致患者发病率增加和医疗成本上升。我们的目标是降低妇科手术后的SSI发生率。
方法
接受腹部妇科恶性肿瘤或良性疾病手术的成年患者接受以下措施：患者教育；术前使用抗菌皂；适当的抗生素预防；手术缝合时更换手套并使用清洁器械；术后48小时使用手术敷料；出院后进行电话随访。回顾性确定基线SSI发生率（2014年4月1日至2014年6月30日），前瞻性确定干预后SSI发生率（2015年2月16日至2015年10月15日）。主要结局是总体SSI发生率，次要结局包括浅表、深部、切口和器官间隙感染发生率，以及该综合措施的成本效益。
结果
本研究共纳入232例基线患者和555例干预后患者。基线组和干预后组在中位体重指数（BMI）、手术方式、术前接受化疗和/或放疗情况以及包括肠道手术的病例方面未观察到差异。总体而言，SSI发生率从基线时的[12.5%]显著降至干预后的[7.4%]（比值比[OR]0.56，90%置信区间[CI]0.37 - 0.85；p = 0.01）。浅表和深部感染发生率下降了40%（9.5%对5.9%；OR 0.60，90%CI 0.38 - 0.97；p = 0.04），开放手术后的SSI发生率也下降了（21.4%对13.2%；OR 0.56，90%CI 0.34 - 0.92；p = 0.03）。干预措施的估计成本为每例19.26美元，干预后期间节省的净总额为每月65,625美元。
结论
这种综合干预导致总体SSI发生率显著降低且具有成本效益。SSI下降幅度最大的是切口感染和开放手术后的感染。
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