Fitzgerald Leah, Kurtz Jennifer, Knepper Bryan C, Reese Sara M, Miller Amber, Kleiner Catherine, Young Heather L
Department of Anesthesia, Denver Health Medical Center, Denver, Colorado.
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado.
Surg Infect (Larchmt). 2020 Feb;21(1):48-53. doi: 10.1089/sur.2019.080. Epub 2019 Aug 20.
The U.S. Centers for Disease Control and Prevention recommend bathing prior to surgery, surgical skin antisepsis, peri-operative antibiotic administration, normothermia throughout the procedure, serum glucose concentration <200 mg/dL throughout the procedure, and hyperoxygenation in the immediate post-operative period to prevent surgical site infection (SSI). We developed interventions to standardize skin antisepsis and peri-operative antibiotic administration at our institution. This is a cross-sectional evaluation of surgical skin antisepsis and antibiotic administration before and after a series of interventions designed to standardize the processes. One hundred twenty-four surgical skin antisepsis opportunities were observed; significant improvement was seen in hand hygiene prior to performing skin antisepsis (compliance changing from 1% to 48%; p < 0.001), sleeves being worn during skin antisepsis (1% versus 67%; p < 0.001), use of the correct cleansing time (47% versus 85%; p < 0.001), allowance for adequate drying time (67% versus 87%; p = 0.02), and use of a cleansing motion from the incision to the periphery (78% versus 95%; p = 0.004). Pre-operative antibiotic order placement, correct antibiotic selection, and optimal antibiotic dose were evaluated in 466 surgical procedures. Significant improvement was seen in both peri-operative order placement (59% versus 70%; p = 0.02) and correct antibiotic selection (52% versus 95%; p < 0.001). An intervention to standardize skin antisepsis and to encourage early ordering of peri-operative antibiotics was successful.
美国疾病控制与预防中心建议手术前进行沐浴、手术皮肤消毒、围手术期使用抗生素、术中全程保持正常体温、术中血清葡萄糖浓度<200mg/dL，以及术后即刻进行高氧治疗以预防手术部位感染（SSI）。我们制定了干预措施，以规范我院的皮肤消毒和围手术期抗生素使用。这是一项横断面评估，旨在评估一系列旨在规范流程的干预措施前后的手术皮肤消毒和抗生素使用情况。观察了124次手术皮肤消毒机会；在进行皮肤消毒前的手部卫生方面有显著改善（依从性从1%提高到48%；p<0.001），皮肤消毒期间穿袖子的情况（1%对67%；p<0.001），正确的清洁时间使用情况（47%对85%；p<0.001），足够的干燥时间（67%对87%；p=0.02），以及从切口向周边的清洁动作使用情况（78%对95%；p=0.004）。在466例手术中评估了术前抗生素医嘱开具、正确的抗生素选择和最佳抗生素剂量。围手术期医嘱开具（59%对70%；p=0.02）和正确的抗生素选择（52%对95%；p<0.001）均有显著改善。一项规范皮肤消毒并鼓励早期开具围手术期抗生素医嘱的干预措施取得了成功。
