Division of Gynecologic Oncology, University of Toronto, Toronto, Canada.
Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Gynecol Oncol. 2019 Mar;152(3):480-485. doi: 10.1016/j.ygyno.2018.09.008.
To assess the impact of a surgical site infection (SSI) prevention bundle for Gynecologic Oncology patients at a large academic tertiary centre in Toronto, Canada.
A SSI prevention bundle was implemented in February 2017 including: preoperative chlorhexidine shower, prophylactic antibiotics, glycemic control, normothermia, and separate closing tray. Data were collected prospectively using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) institutional data, and chart review of surgeries between January 2016 and September 2017 was performed. The primary outcome was rate of SSIs, secondary outcomes were: superficial, deep and organ space SSIs, sepsis, wound disruption, length of stay, 30-day readmission and reoperation. Logistic regression analysis was conducted to identify predictors of SSIs.
339 baseline and 224 post-intervention patients were included. 53 incurred one or more SSIs: 43 superficial, 6 deep, and 14 organ-space. The bundle decreased overall SSIs by 55% (12.1% to 5.4%, p = 0.008) and superficial SSIs by 54% (9.7% to 4.5%, p = 0.023). Improvement was sustained for 6 quarters. No significant difference was found in other secondary outcomes. On multivariable analysis, surgery in the pre-bundle period, BMI ≥30, laparotomies and longer operative duration were independent risk factors for overall SSIs (OR 2.23, 95% CI 1.06-5.06, -OR 3.01, 95% CI 1.57 - 5.87, OR 3.70, 95% CI 1.56 - 10.18 and - OR 2.16, 95% 1.11 - 4.19, respectively).
This prevention bundle successfully decreased SSIs in patients undergoing gynecologic cancer surgery. We recommend improving quality of care by wide implementation of SSI prevention bundles in Gynecologic Oncology patients.
评估加拿大多伦多一家大型学术三级中心妇科肿瘤患者的外科部位感染（SSI）预防措施的影响。
2017 年 2 月实施了 SSI 预防措施，包括：术前氯己定淋浴、预防性抗生素、血糖控制、体温正常和单独的闭合托盘。使用美国外科医师学院国家外科质量改进计划（NSQIP）机构数据前瞻性收集数据，并对 2016 年 1 月至 2017 年 9 月的手术进行图表审查。主要结果是 SSI 发生率，次要结果是：浅表、深部和器官间隙 SSI、败血症、伤口破裂、住院时间、30 天再入院和再次手术。进行逻辑回归分析以确定 SSI 的预测因素。
纳入了 339 名基线和 224 名干预后患者。53 例发生 1 个或多个 SSI：43 例浅表、6 例深部和 14 例器官间隙。该方案使整体 SSI 发生率降低了 55%（12.1%至 5.4%，p=0.008），浅表 SSI 发生率降低了 54%（9.7%至 4.5%，p=0.023）。这种改善持续了 6 个季度。其他次要结果无显著差异。多变量分析显示，在预防措施实施前进行手术、BMI≥30、剖腹手术和手术时间较长是整体 SSI 的独立危险因素（OR 2.23，95%CI 1.06-5.06，-OR 3.01，95%CI 1.57-5.87，OR 3.70，95%CI 1.56-10.18 和-OR 2.16，95%CI 1.11-4.19）。
该预防措施成功降低了妇科癌症手术患者的 SSI 发生率。我们建议通过在妇科肿瘤患者中广泛实施 SSI 预防措施来提高护理质量。
