降低经腹全子宫切除术手术部位感染：多学科质量改进活动。

Reducing abdominal hysterectomy surgical site infections: A multidisciplinary quality initiative.

机构信息

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.

出版信息

Am J Infect Control. 2020 Nov;48(11):1292-1297. doi: 10.1016/j.ajic.2020.05.001. Epub 2020 May 8.

DOI:10.1016/j.ajic.2020.05.001

PMID:32389628

Abstract

BACKGROUND

To investigate abdominal hysterectomy surgical site infection (SSI) rates before and after implementation of an SSI care bundle.

METHODS

An SSI bundle for abdominal hysterectomies was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements around preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study around implementation of the SSI care bundle. Women were included if they underwent abdominal hysterectomy between 2012 and 2015. They were then divided into 2 study groups: prebundle and postbundle. The primary study outcome was SSI rate. The superficial SSI rate was the secondary outcome.

RESULTS

The overall SSI rate was 6.18% in the prebundle group, with a median monthly SSI rate of 7.03%. After bundle implementation, the overall SSI rate declined to 2.51% (P = .02). The reduction remained significant after multivariate analysis (adjusted odds ratio 0.38; 95% confidence interval 0.15-0.88; P = .03) indicating a 62% reduction in SSI postbundle as compared to prebundle.When comparing rates based on infection classification, superficial SSIs declined significantly from 3.73% in the prebundle group to 0.90% in the postbundle group (P = 0.02). Patient demographics and pre-existing medical conditions were similar pre- and postbundle. Compliance with bundle elements was high.

CONCLUSIONS

A significant reduction in SSI rate in abdominal hysterectomies was seen following implementation of an infection prevention bundle.

摘要

背景

调查实施手术部位感染（SSI）护理包前后的腹式子宫切除术 SSI 发生率。

方法

我们医院于 2014 年 4 月引入了腹式子宫切除术 SSI 护理包，以降低 SSI 发生率。实践分为术前、术中、术后护理的护理包要素。我们围绕 SSI 护理包的实施进行了回顾性队列研究。如果女性在 2012 年至 2015 年期间接受了腹式子宫切除术，则将其纳入研究。然后，她们被分为 2 个研究组：预包组和后包组。主要研究结果是 SSI 发生率。次要研究结果是浅部 SSI 发生率。

结果

预包组的总 SSI 发生率为 6.18%，中位数每月 SSI 发生率为 7.03%。实施护理包后，总 SSI 发生率下降至 2.51%（P=0.02）。多变量分析后仍显著（调整后的优势比 0.38；95%置信区间 0.15-0.88；P=0.03），表明与预包相比，后包 SSI 减少了 62%。当根据感染分类比较发生率时，浅部 SSI 从预包组的 3.73%显著下降到后包组的 0.90%（P=0.02）。预包和后包患者的人口统计学和既往医疗状况相似。护理包要素的依从性很高。