Wassef Mona, Mukhtar Ahmed, Nabil Ahmed, Ezzelarab Moushira, Ghaith Doaa
Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt.
Infect Drug Resist. 2020 Jan 28;13:229-236. doi: 10.2147/IDR.S236814. eCollection 2020.
Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance.
We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University.
Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing and multidrug resistant colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection.
Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. was the most prevalent organism during phase I (34.7%). On the other hand, was the commonest organism to be isolated during phase III with (38.5%) preceding (30%).
Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.
手术部位感染（SSIs）是最常报告的医院获得性感染之一，与抗生素耐药性的显著传播相关。
我们旨在评估一种基于集束干预措施的方法，以降低开罗大学急诊医院急性外科重症监护病房的手术部位感染发生率。
我们的前瞻性研究从2018年3月持续至2019年2月，并采用了风险评估。该研究分为三个阶段。第一阶段：（集束干预前阶段）为期5个月；进行数据收集、手术部位感染的主动监测、使用显色培养基筛查产OXA - 48和多重耐药定植菌。第二阶段：（集束干预实施阶段）采用6 - S集束干预措施，包括教育、培训以及与感染控制团队合作使用葡萄糖酸氯己定进行术后沐浴。最后，第三阶段：（实施后阶段）用于评估依从性、定植率和感染率。
第一阶段纳入177例患者，而第三阶段包括93例患者。观察到定植率从24%显著降至15%（p<0.001）。同样，手术部位感染率从27%降至15%（p = 0.02）。进行了逻辑回归以调整集束干预实施中的混杂因素，我们发现手术部位感染的比值比降低了70%（比值比 = 0.3）置信区间（95%CI 0.14 - 0.6），其中Apache II评分（p = 0.04）、伤口类型；II型（p = 0.002）、III型（p = 0.001）以及手术持续时间（p = 0.04）是手术部位感染的独立危险因素。在第一阶段，[具体细菌名称1]是最常见的微生物（34.7%）。另一方面，在第三阶段，[具体细菌名称2]是最常分离出的微生物（38.5%），先于[具体细菌名称3]（30%）。
我们的研究表明，实施包含循证干预措施的多学科集束干预与定植率和手术部位感染率的显著降低相关，并且获得了工作人员的认可且依从性可接受。
