Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; Hospital Hygiene, Konventhospital Barmherzige Brueder Linz, Linz, Austria.
Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; Hospital Hygiene, Konventhospital Barmherzige Brueder Linz, Linz, Austria.
Am J Infect Control. 2020 Apr;48(4):386-390. doi: 10.1016/j.ajic.2020.01.016. Epub 2020 Feb 21.
To evaluate whether using a comprehensive and multidisciplinary approach to implement an evidence-based bundle can reduce 30-day surgical site infection rates in women undergoing cesarean delivery.
This observational study with a preintervention and postintervention design included 2576 consecutive women undergoing cesarean delivery at our tertiary care hospital between January 1, 2013 and December 31, 2017. The primary outcome was 30-day surgical site infection rate after cesarean delivery defined according to the Centers for Disease Control and Prevention criteria. The preintervention period span from the January 1, 2013 to December 31, 2014. After initiation of a Comprehensive Unit-based Safety Program (ie, a continuous quality improvement program to improve patient safety using a comprehensive and multidisciplinary approach adapted on local demands), we introduced a bundle of evidence-based interventions (including preoperative shower, hair removal with clippers, correct antibiotic prophylaxis, maintaining normothermia, glycemic control, and strict compliance with hygiene standards as well as practice good hand hygiene) per January 1, 2015 into clinical routine. The postintervention period span from January 1, 2015 to December 31 2017.
In the preintervention period the overall surgical site infection rate was 16 of 1,060 cesarean deliveries versus in the postintervention period the overall surgical site infection rate was 9 of 1,516 cesarean deliveries (1.50% vs 0.56%; P = .033). This corresponds to a relative risk reduction of over 60% after implementation of the evidence-based bundle (odds ratio 0.39, 95% confidence interval 0.17-0.89; P = .020).
In the present study, we have adapted the Comprehensive Unit-based Safety Program strategy to implement an evidence based-bundle into clinical routine. Using this comprehensive and multidisciplinary approach, we could markedly reduce 30-day surgical site infections.
评估在剖宫产术中采用综合多学科方法实施基于证据的方案是否可以降低 30 天手术部位感染率。
本观察性研究采用了预干预和后干预设计，纳入了 2013 年 1 月 1 日至 2017 年 12 月 31 日期间在我们的三级保健医院进行剖宫产术的 2576 例连续患者。主要结局是根据美国疾病控制与预防中心标准定义的剖宫产术后 30 天手术部位感染率。预干预期从 2013 年 1 月 1 日至 2014 年 12 月 31 日。在启动综合单位基础安全计划（即使用综合多学科方法持续质量改进计划，以提高患者安全性，该方法适用于当地需求）后，我们于 2015 年 1 月 1 日将一套基于证据的干预措施（包括术前沐浴、电推剪去毛发、正确的抗生素预防、维持正常体温、血糖控制以及严格遵守卫生标准和保持良好的手部卫生）引入临床常规。后干预期从 2015 年 1 月 1 日至 2017 年 12 月 31 日。
在预干预期，1060 例剖宫产中有 16 例发生手术部位感染，而在后干预期，1516 例剖宫产中有 9 例发生手术部位感染（1.50%比 0.56%；P=0.033）。这对应于实施基于证据的方案后超过 60%的相对风险降低（比值比 0.39，95%置信区间 0.17-0.89；P=0.020）。
在本研究中，我们采用综合单位基础安全计划策略将基于证据的方案实施到临床常规中。使用这种综合多学科方法，我们可以显著降低 30 天手术部位感染率。
