Schriefer Jan, Hilt Suzanne, Sanders James, Michels Julie, Wolcott Kori, Ruddy Connor, Hanson Jenna
Jan Schriefer, DrPH, MSN, MBA, Associate Professor of Pediatrics and Professor of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. James Sanders, MD, Professor of Orthopedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. Julie Michels, MS, RN-BC, Pediatric Surgery QA/PI Specialist, University of Rochester School of Medicine and Dentistry, Rochester, NY. Kori Wolcott, BSN, RN, Pediatric Surgical Clinical Reviewer, Pediatric Surgery QA Liaison, University of Rochester School of Medicine and Dentistry, Rochester, NY. Connor Ruddy, Student Intern, from Loyola University Chicago, Chicago, IL. Jenna Hanson, Student Intern, from Colorado College, Colorado Springs, CO.
Orthop Nurs. 2017 Jan/Feb;36(1):49-59. doi: 10.1097/NOR.0000000000000312.
Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients. Bundle elements included use of chlorhexidine gluconate wipes the night before surgery and the day of surgery, use of preoperative nutrition screens, development and use of a prophylactic antibiotic dosing chart, use of methicillin-resistant Staphylococcus aureus screening, maintenance of normal patient temperature, and use of nasal swabs in the operating room. The SSI rate dropped from a baseline figure of 4% in 2013 (n = 154) and 3.2% in 2014 (n = 189) to 0.0% (n = 198) in 2015 after the bundles were implemented. Both compliance with the bundle and SSI rates must be monitored monthly. Staff and providers should be offered monthly feedback on SSI rates and care bundle compliance. If an SSI does occur, a root-cause analysis is performed with the multidisciplinary care team using a standardized review form.
手术部位感染（SSIs）每例估计花费27,288美元。罗切斯特大学医学中心对国家外科质量改进计划数据的分析表明，与同行和基线相比，手术部位感染率可以降低。本研究的目的是通过实施“一揽子措施”或一系列做法将手术部位感染数量降至零。与多学科护理团队举行了会议，该团队包括外科医生以及儿科药房、儿科传染病、麻醉和护理部门的工作人员，为所有儿科骨科手术患者制定了一套护理方案。方案内容包括在手术前一晚和手术当天使用葡萄糖酸氯己定擦拭巾、进行术前营养筛查、制定和使用预防性抗生素给药图表、进行耐甲氧西林金黄色葡萄球菌筛查、维持患者正常体温以及在手术室使用鼻拭子。在实施这些方案后，手术部位感染率从2013年的基线数字4%（n = 154）和2014年的3.2%（n = 189）降至2015年的0.0%（n = 198）。必须每月监测方案的依从性和手术部位感染率。应每月向工作人员和医疗服务提供者提供有关手术部位感染率和护理方案依从性的反馈。如果确实发生了手术部位感染，使用标准化审查表与多学科护理团队一起进行根本原因分析。
