一项综合干预措施可降低良性和恶性指征子宫切除术中手术部位感染的发生率。

A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications.

作者信息

Guo Xiaoyue Mona, Runge Megan, Miller Deborah, Aaby David, Milad Magdy

机构信息

Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

出版信息

Int J Gynaecol Obstet. 2020 Sep;150(3):392-397. doi: 10.1002/ijgo.13257. Epub 2020 Jun 26.

DOI:10.1002/ijgo.13257

PMID:32506459

Abstract

OBJECTIVE

To evaluate the impact of a surgical site infection (SSI) prevention bundle on SSI rates after hysterectomy for benign and malignant indications at an urban academic medical center.

METHODS

The bundled invention was implemented for all abdominal gynecologic surgeries at Prentice Women's Hospital, Chicago, USA, from August 2016 to January 2017, and officially incorporated in department-wide policy from February 1, 2017. SSI data were prospectively collected for any open, vaginal, laparoscopic, or robotic hysterectomy for benign or malignant indications performed from February 2017 to January 2018. A retrospective review of all hysterectomies performed from February 2015 to January 2016 was conducted to establish baseline pre-bundle SSI data.

RESULTS

Among 532 hysterectomies performed post-bundle implementation, there were two SSIs. By contrast, there were 14 SSIs among 515 hysterectomies in the same period before bundle implementation, representing a decrease in SSI rate from 2.7% to 0.4% (odds ratio, 7.41; 95% confidence interval, 1.67-32.75). The two SSIs in the post-bundle period occurred in open hysterectomies, whereas 8 (57.1%) SSIs in the pre-bundle period occurred in minimally invasive hysterectomies.

CONCLUSION

An SSI prevention bundle was effective for reducing the SSI rate in hysterectomy for both benign and malignant indications.

摘要

目的

评估手术部位感染（SSI）预防综合措施对城市学术医疗中心良性和恶性指征子宫切除术后SSI发生率的影响。

方法

2016年8月至2017年1月，美国芝加哥普伦蒂斯女子医院对所有腹部妇科手术实施了综合干预措施，并于2017年2月1日正式纳入科室范围的政策。前瞻性收集2017年2月至2018年1月进行的任何因良性或恶性指征行开腹、经阴道、腹腔镜或机器人辅助子宫切除术的SSI数据。对2015年2月至2016年1月进行的所有子宫切除术进行回顾性分析，以建立综合措施实施前的基线SSI数据。

结果

综合措施实施后进行的532例子宫切除术中，有2例发生SSI。相比之下，综合措施实施前同期的515例子宫切除术中，有14例发生SSI，SSI发生率从2.7%降至0.4%（优势比，7.41；95%置信区间，1.67 - 32.75）。综合措施实施后发生的2例SSI均为开腹子宫切除术，而综合措施实施前8例（57.1%）SSI发生在微创子宫切除术中。