Directorate of Infection, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Directorate of Infection, Guy's & St Thomas' NHS Foundation Trust, London, UK.
J Hosp Infect. 2018 Dec;100(4):428-436. doi: 10.1016/j.jhin.2018.03.028. Epub 2018 Mar 28.
Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative amid reported increased incidence of SSIs. Before this time, infection incidence was unclear because data collection was not standardized.
To standardize SSI data collection and establish baseline SSI rates to facilitate deployment of evidence-based targeted interventions within clinical governance structures to improve quality, safety, and efficiency in line with our organizational targets.
We standardized local data collection protocols in line with Public Health England recommendations and identified local champions. We undertook prospective SSI surveillance collaboratively to enable us to identify potential practice concerns and address them more effectively through a series of initiatives. Clinical staff completed dedicated surveillance forms intraoperatively and postoperatively.
Overall adult cardiac SSI rates fell from 5.4% in 2009 to 1.2% in 2016 and coronary artery bypass graft rates from 6.5% in 2009 to 1.7% in 2016 (P < 0.001). Gram-negative bacteria were recognized as important SSI causative organisms and were better controlled after introducing stringent infection control measures.
Comprehensive, evidence-based infection control practices were successfully implemented through a multidisciplinary collaborative approach, which may have great potential to reduce Gram-negative, Staphylococcus aureus, polymicrobial and overall SSI burden and/or associated costs. We now investigate all SSIs using an established SSI detailed investigation protocol to promote continual quality improvement that aligns us perfectly with global efforts to fight antimicrobial resistance.
心脏外科部位感染（SSI）后果严重，对患者和医疗保健提供者都带来了诸多挑战。在我们的医院——伦敦盖伊和圣托马斯 NHS 基金会信托——作为一项患者安全计划，自 2009 年开始对成人心脏 SSI 进行监测，因为当时报告 SSI 的发病率有所增加。在此之前，由于数据收集未标准化，感染发生率尚不清楚。
规范 SSI 数据收集并建立 SSI 基准率，以便在临床治理结构中部署基于证据的靶向干预措施，从而提高质量、安全性和效率，以符合我们的组织目标。
我们按照英国公共卫生署的建议，使本地数据收集协议标准化，并确定了本地拥护者。我们共同开展了前瞻性 SSI 监测，以便能够发现潜在的实践问题，并通过一系列举措更有效地加以解决。临床工作人员在手术中和手术后填写专门的监测表。
2009 年成人心脏 SSI 总发生率从 5.4%降至 2016 年的 1.2%，冠状动脉旁路移植术（CABG）发生率从 2009 年的 6.5%降至 2016 年的 1.7%（P<0.001）。革兰氏阴性菌被认为是重要的 SSI 致病生物体，在引入严格的感染控制措施后得到了更好的控制。
通过多学科协作的方法，成功实施了全面、基于证据的感染控制措施，这可能具有很大的潜力，可以降低革兰氏阴性菌、金黄色葡萄球菌、多种微生物和整体 SSI 负担和/或相关成本。现在，我们使用既定的 SSI 详细调查方案来调查所有 SSI，以促进持续的质量改进，这使我们完全符合全球对抗抗生素耐药性的努力。
