Parizh David, Ascher Enrico, Raza Rizvi Syed Ali, Hingorani Anil, Amaturo Michael, Johnson Eric
NYU Lutheran, Brooklyn, NY, USA.
Vascular. 2018 Feb;26(1):47-53. doi: 10.1177/1708538117719155. Epub 2017 Jul 14.
Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures.
In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p < 0.005). Conclusions Preventative measures, in the form of a standardized protocol, to decrease surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.
目的 采用质量改进措施降低单机构下肢开放性血管重建手术的手术部位感染率。
为降低患者发病率，我们制定并实施了血管外科预防性手术部位感染方案。手术部位感染会导致住院时间延长、辅助手术及额外费用增加。我们采取针对性干预措施以应对使患者易发生术后并发症的常见风险因素。方法 对2012年至2016年期间所有下肢血管重建手术后的手术部位感染进行回顾性研究。2015年1月启动质量改进方案。主要结局是评估方案实施前与实施后手术部位感染率的降低情况。次要结局评估患者人口统计学特征、缝合方法、围手术期抗生素覆盖情况及管理结局。结果 该方案的实施使手术部位感染率从6.4%降至1.6%（p = 0.0137）。对患者人口统计学特征和合并症进行评估，结果显示感染组与未感染组之间无统计学显著差异。与吻合器缝合相比，采用单股缝线缝合伤口与手术部位感染率降低相关（p < 0.005）。结论 以标准化方案形式采取的预防措施对于降低血管外科患者的手术部位感染是有效且必要的。我们的数据表明，将耐甲氧西林金黄色葡萄球菌和革兰氏阴性菌覆盖纳入外科护理改进项目围手术期指南可能有益。
