Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126, Turin, Italy.
Int J Surg. 2020 Oct;82:8-13. doi: 10.1016/j.ijsu.2020.07.064. Epub 2020 Aug 21.
Surgical site infections (SSIs) are an extremely serious complication of hip arthroplasty, estimated to affect up to nearly 3% of procedures. In Italy, SSIs are monitored through a national surveillance system (Sistema Nazionale Sorveglianza delle Infezioni del Sito Chirurgico, SNICh). Several studies suggest bundled interventions are effective in reducing SSI rates in orthopaedic surgery.
A bundled intervention was implemented in 2012 in 34 out of the 49 hospitals of the North-West of Italy participating in SNICh. A cohort study was conducted between January 1st, 2012 and December 31st, 2019 to evaluate the impact of the intervention on SSI rates after hip arthroplasty. The four elements of the bundle are: appropriate preoperative shower, preoperative hair removal, perioperative normothermia, antibiotic prophylaxis. Data on compliance with the bundle and the occurrence of infection were collected.
In total, 18,791 procedures were included in the study. Full bundle compliance was achieved in 27.9% of procedures. The percentage of fully compliant procedures significantly increased over time from introduction of the bundled intervention (R 0.799, p-value 0.003). Multivariable analysis found a significant association between full bundle compliance and reduced SSI rate, with a reduction of the odds of infection of 31% (95% CI 0.5-0.96; p 0.026).
Results of this study support bundled interventions as an effective implementation strategy for infection prevention and control practices in hip replacement surgery. This simple bundle protocol could be easily implemented in settings with limited resources.
手术部位感染（SSI）是髋关节置换术的一种极其严重的并发症，据估计，近 3%的手术会受到影响。在意大利，SSI 通过国家监测系统（Sistema Nazionale Sorveglianza delle Infezioni del Sito Chirurgico，SNICh）进行监测。多项研究表明，捆绑式干预措施在减少骨科手术中的 SSI 发生率方面是有效的。
2012 年，意大利西北部的 49 家参与 SNICh 的医院中的 34 家实施了捆绑式干预措施。一项队列研究于 2012 年 1 月 1 日至 2019 年 12 月 31 日进行，以评估干预措施对髋关节置换术后 SSI 发生率的影响。捆绑式干预措施的四个要素是：术前适当沐浴、术前剃毛、围手术期体温正常、抗生素预防。收集了关于捆绑式干预措施的依从性和感染发生的数据。
共有 18791 例手术纳入研究。完全符合捆绑式干预措施的比例为 27.9%。完全符合捆绑式干预措施的比例随着时间的推移显著增加（R 0.799，p 值 0.003）。多变量分析发现，完全符合捆绑式干预措施与 SSI 发生率降低之间存在显著关联，感染的可能性降低了 31%（95%CI 0.5-0.96；p=0.026）。
本研究结果支持捆绑式干预措施作为预防和控制髋关节置换术感染的有效实施策略。这种简单的捆绑式方案可以在资源有限的情况下轻松实施。
