Morris Arthur J, Roberts Sally A, Grae Nikki, Hamblin Richard, Shuker Carl, Merry Alan F
Clinical Microbiologist, Auckland City Hospital, Auckland; Clinical Lead, NZ SSII Programme.
Clinical Microbiologist, Auckland City Hospital, Auckland; Clinical Lead, Health Quality & Safety Commission Infection Prevention and Control Programmes.
N Z Med J. 2018 Jul 27;131(1479):45-56.
The New Zealand Surgical Site Infection Improvement (SSII) Programme was established in 2013 to reduce the incidence of surgical site infections (SSI) in publicly funded hip and knee arthroplasties in New Zealand hospitals.
The programme pursued a three-pronged strategy: 1. Surveillance of SSI with a nationwide system 2. Promotion of consistent adherence to evidence-based practices proven to reduce SSI 3. Monitoring and publicly reporting changed practice and outcome data.
Between quarter 3 2013 and quarter 4 2016 there has been a nationwide increase in compliance with all process measures: correct timing for antibiotic prophylaxis; use of the recommended antibiotic in the recommended dose and alcohol-based skin antisepsis. The SSI rate in hip and knee arthroplasties has shown a significant improvement. The nationwide median rate has fallen to 0.91% since June 2015, compared with 1.36% during the baseline period of April 2013 to March 2014 (p<0.01). This equates to approximately 55 fewer infections between August 2015 and June 2017, savings of NZD$2.2 million in avoided treatment and avoided disability-adjusted life years (DALYs) of NZD$5 million.
The introduction of a nationwide SSI reduction programme for hip and knee arthroplasties resulted in an increase in compliance across the country with best practice that was associated with a reduction in incidence of SSI since June 2015 from the baseline period of April 2013 to March 2014, sustained to June 2017.
新西兰手术部位感染改善（SSII）计划于2013年设立，旨在降低新西兰医院公费髋关节和膝关节置换手术的手术部位感染（SSI）发生率。
该计划采取了三管齐下的策略：1. 通过全国性系统对SSI进行监测；2. 促进始终如一地坚持已被证明可降低SSI的循证实践；3. 监测并公开报告实践变化和结果数据。
在2013年第3季度至2016年第4季度期间，全国范围内所有流程措施的合规性均有所提高：抗生素预防的正确时机；按推荐剂量使用推荐的抗生素以及使用酒精基皮肤消毒剂。髋关节和膝关节置换手术的SSI率有显著改善。自2015年6月以来，全国中位数率降至0.91%，而在2013年4月至2014年3月的基线期为1.36%（p<0.01）。这相当于在2015年8月至2017年6月期间感染减少了约55例，避免了220万新西兰元的治疗费用，并避免了500万新西兰元的伤残调整生命年（DALYs）。
针对髋关节和膝关节置换手术引入全国性的SSI降低计划，使全国范围内最佳实践的合规性提高，这与自2015年6月起（相对于2013年4月至2014年3月的基线期）SSI发生率降低相关，并持续至2017年6月。
