循证护理捆绑包预防脊柱器械手术部位感染。
Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery.
机构信息
Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan.
Department of Infectious Diseases, Infection Control Office, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan.
出版信息
Spine (Phila Pa 1976). 2018 Dec 15;43(24):1765-1773. doi: 10.1097/BRS.0000000000002709.
STUDY DESIGN
A retrospective study, using prospectively collected data.
OBJECTIVE
The aim of this study was to evaluate the impact of evidence-based care bundles for preventing surgical site infections (SSIs) in spinal instrumentation surgery.
SUMMARY OF BACKGROUND DATA
About half of all SSIs are preventable via evidence-based methods. For successful SSI prevention, the bacterial load must be minimized, and methicillin-resistant Staphylococcus aureus (MRSA) protection must be maximized. However, it is difficult to cover all of these requirements by single preventative method.
METHODS
We screened consecutive patients scheduled for spinal instrumentation surgeries at a single tertiary referral hospital for high surgical, SSI, and MRSA colonization risks. Evidence-based care bundles were implemented for high-risk patients and included 1) additional vancomycin prophylaxis, 2) diluted povidone-iodine irrigation, and 3) nasal and body decontamination. Patient demographics, comorbidities, operative features, and SSIs reported to the Japanese Nosocomial Infections Surveillance system were prospectively obtained in the same method by the same assessor and were used for the analyses. The results were compared before and after the application of the bundle.
RESULTS
There were 1042 spinal instrumentation surgeries (741 before and 301 after care bundles) performed from November 2010 to December 2015. Of 301 surgeries, 57 cases (18.9%) received care bundles. There were no significant differences in patient backgrounds before and after the intervention. The SSI rate decreased significantly from 3.8% to 0.7% (P < 0.01) after the intervention, with an overall 82% relative risk reduction. A significant protective effect was observed in the multivariate analysis (adjusted odds ratio 0.18, 95% confidence interval: 0.04-0.77, P = 0.02). There were no MRSA-related SSIs among those that received care bundles, even though MRSA was the predominant pathogen in the study population.
CONCLUSION
Evidence-based care bundles, applied in selected high-risk spinal instrumentation cases, minimized bacterial load, maximized MRSA protection, and significantly reduced SSI rates without topical vancomycin powder.
LEVEL OF EVIDENCE
研究设计
回顾性研究，使用前瞻性收集的数据。
目的
本研究旨在评估预防脊柱器械手术部位感染（SSI）的循证护理包对预防 SSI 的影响。
背景资料概要
所有 SSI 中有近一半可以通过循证方法预防。为了成功预防 SSI，必须最大限度地减少细菌负荷，并最大限度地保护耐甲氧西林金黄色葡萄球菌（MRSA）。然而，单一预防方法很难覆盖所有这些要求。
方法
我们对一家三级转诊医院计划进行脊柱器械手术的连续患者进行筛选，以确定高手术、SSI 和 MRSA 定植风险。为高风险患者实施循证护理包，包括 1）额外的万古霉素预防，2）稀释聚维酮碘冲洗，3）鼻腔和身体去污。患者的人口统计学特征、合并症、手术特点以及向日本医院感染监测系统报告的 SSI 均以相同的方法由同一评估者前瞻性获得，并用于分析。比较了应用捆绑包前后的结果。
结果
2010 年 11 月至 2015 年 12 月期间共进行了 1042 例脊柱器械手术（741 例在护理包之前，301 例在护理包之后）。在 301 例手术中，有 57 例（18.9%）接受了护理包。干预前后患者背景无显著差异。干预后 SSI 发生率从 3.8%显著降至 0.7%（P < 0.01），总体相对风险降低 82%。多变量分析显示有显著保护作用（调整后的优势比 0.18，95%置信区间：0.04-0.77，P = 0.02）。尽管 MRSA 是研究人群中的主要病原体，但接受护理包的患者中没有发生与 MRSA 相关的 SSI。
结论
在选定的高风险脊柱器械病例中应用循证护理包可最大限度地减少细菌负荷，最大限度地保护 MRSA，并显著降低 SSI 发生率，而无需局部万古霉素粉。
证据水平
4 级
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