Al Salmi Hanadi, Elmahrouk Ahmed, Arafat Amr A, Edrees Azzahra, Alshehri Mashael, Wali Ghassan, Zabani Ibrahim, Mahdi Nasser A, Jamjoom Ahmed
1 Infection Control and Epidemiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
2 Department of Cardiovascular Diseases, Cardiothoracic Surgery Section, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Int Med Res. 2019 Aug;47(8):3491-3501. doi: 10.1177/0300060519836511. Epub 2019 Mar 21.
Surgical site infection (SSI) is a serious complication after coronary artery bypass grafting (CABG). This study was performed to evaluate evidence-based practice and structured problem-solving to reduce SSI after CABG.
An infection control strategy including supervised chlorhexidine gluconate (CHG) showers was implemented from January 2017 to March 2018 for 119 patients undergoing CABG. The controls comprised 244 patients who underwent CABG from 2014 to 2016. Risk factors for SSI were identified, and a problem-focused strategy was used to control SSI. Propensity score matching was used to study the effect of CHG showers on SSI.
SSI occurred in 25 patients (10.25%) in the control group, and the significant risk factors were the postoperative blood glucose level, transfer from an outside hospital, emergency operation, redo sternotomy, a higher American Society of Anesthesiologists score, and the duration of surgery. After implementation of the program, the SSI rate significantly decreased to 3.36%. Patients who had undergone preoperative CHG showers had a significantly lower SSI rate (1.69%) than the matched controls (13.56%).
SSI after CABG can be reduced using evidence-based practice and structured problem-solving to identify risk factors. A preoperative CHG shower is associated with a lower SSI rate after CABG.
手术部位感染（SSI）是冠状动脉旁路移植术（CABG）后的一种严重并发症。本研究旨在评估循证实践和结构化问题解决方法对降低CABG术后SSI的效果。
2017年1月至2018年3月，对119例行CABG的患者实施了包括监督使用葡萄糖酸氯己定（CHG）沐浴在内的感染控制策略。对照组包括2014年至2016年行CABG的244例患者。确定SSI的危险因素，并采用以问题为重点的策略控制SSI。采用倾向评分匹配法研究CHG沐浴对SSI的影响。
对照组25例（10.25%）发生SSI，显著危险因素为术后血糖水平、从外院转入、急诊手术、再次胸骨切开术、较高的美国麻醉医师协会评分和手术时间。实施该方案后，SSI发生率显著降至3.36%。术前接受CHG沐浴的患者SSI发生率（1.69%）显著低于匹配对照组（13.56%）。
采用循证实践和结构化问题解决方法识别危险因素可降低CABG术后SSI。术前CHG沐浴与CABG术后较低的SSI发生率相关。
