School of Nursing & Midwifery, Griffith University, Gold Coast, QLD, Australia.
Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia.
PLoS One. 2018 Sep 13;13(9):e0203354. doi: 10.1371/journal.pone.0203354. eCollection 2018.
Surgical site infections (SSI) occur in up to 10% of surgeries. Wound care practices to prevent infections are guided by Clinical Practice Guidelines (CPGs), yet their contribution to improving patient outcomes relies on their quality and adoption in practice. We critically evaluated the quality of CPGs for SSI prevention during pre-, intra- and post-operative phases of care.
We systematically reviewed the literature from 1990-2018 using the Cochrane Library, CINAHL, EMBASE, MEDLINE, ProQuest databases and five guidelines repositories. We extracted characteristics of each guideline using purposely-developed data collection tools. We assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
Combined searches of databases and repositories yielded 5,910 citations. Of these, we reviewed 215 full text documents. The final sample included 15 documents: 6 complete CPGs, 3 CPG updates, and 6 supplementary documents. The overall %mean scores across AGREE II domains for CPGs were: 1) scope and purpose (%mean ± SD = 86.3±23.5); 2) stakeholder involvement (%mean ± SD = 64±31.0); 3) rigour of development (%mean ± SD = 68.7±30.6); 4) clarity and presentation (%mean ± SD = 88.5±16.7); 5) applicability (%mean ± SD = 44±30.2); and, 5) editorial independence (%mean ± SD = 61±37.6). Based on individual AGREE II domains and overall scores, we appraised 4 out of 6 CPGs (inclusive of updates) as "recommended" for use in practice. Overall agreement among appraisers was excellent (ICC 0.86 [95%CI 0.73-0.94] - 0.98 [95%CI 0.96-0.99]; p <0.001).
International interest in CPG development has resulted in refinements to methodologies, which has led to improvements in the overall quality of the product.
Given the domains that received the lowest scores, it is clear that we need more consumer involvement and better consideration of the implementation challenges with CPG uptake and sustainability.
手术部位感染（SSI）的发生率高达 10%。预防感染的伤口护理实践是由临床实践指南（CPG）指导的，但它们对改善患者预后的贡献取决于其质量和在实践中的应用。我们批判性地评估了围手术期预防 SSI 的 CPG 的质量。
我们使用 Cochrane 图书馆、CINAHL、EMBASE、MEDLINE、ProQuest 数据库和五个指南库，从 1990 年至 2018 年系统地综述了文献。我们使用专门制定的数据收集工具提取每个指南的特征。我们使用评估研究和评估 II（AGREE II）工具评估总体质量。
数据库和存储库的联合搜索产生了 5910 条引文。其中，我们审查了 215 篇全文文献。最终样本包括 15 份文件：6 份完整的 CPG、3 份 CPG 更新和 6 份补充文件。CPG 在 AGREE II 各领域的总体%mean 得分分别为：1）范围和目的（%mean ± SD = 86.3±23.5）；2）利益相关者参与（%mean ± SD = 64±31.0）；3）开发的严谨性（%mean ± SD = 68.7±30.6）；4）清晰度和表达（%mean ± SD = 88.5±16.7）；5）适用性（%mean ± SD = 44±30.2）；和 5）编辑独立性（%mean ± SD = 61±37.6）。根据个别 AGREE II 领域和总体得分，我们评估了 6 份 CPG 中的 4 份（包括更新）为“推荐”在实践中使用。评估者之间的总体一致性非常好（ICC 0.86 [95%CI 0.73-0.94] - 0.98 [95%CI 0.96-0.99]；p <0.001）。
国际上对 CPG 制定的兴趣导致了方法学的改进，从而提高了产品的总体质量。
鉴于得分最低的领域，显然我们需要更多的消费者参与，并更好地考虑与 CPG 采用和可持续性相关的实施挑战。
