Center for Implementation Science, Health Service and Population Research Department, King's College London, UK.
Faculty of Medicine, Department of Infectious Disease, Imperial College London, UK.
Ann Surg. 2022 Feb 1;275(2):e345-e352. doi: 10.1097/SLA.0000000000004909.
Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice.
A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively.
We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis.
Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail.
外科部位感染（SSI）的预防仍然很重要，尤其是在抗菌药物耐药的时代。据了解，对实践和结果的反馈是降低 SSI 发生率和优化抗生素使用的关键。然而，对于外科团队来说，反馈的最佳方法、格式和频率仍不清楚。本研究的目的是了解监测和审核数据如何在常规外科实践中反馈。
使用既定的实施科学框架对数据进行了系统的范围综述编码。对 2019 年 9 月前的两个电子健康导向数据库（MEDLINE、EMBASE）进行了搜索。我们纳入了评估反馈作为预防和管理 SSI 和/或围手术期使用抗生素策略的研究。
我们确定了 21 项研究：17 项研究集中在 SSI 发生率和结果上，10 项研究描述了 SSI 的抗菌药物管理（重点有一些重叠）。报道了几种干预措施，大多数是多模式的，反馈是其中的一个组成部分。反馈通常以书面形式提供（62%），要么是个体化的（38%），要么是小组形式的（48%）。只有 25%的研究报告反馈下传到一线围手术期工作人员。在 65%的研究中，使用了 1 到 5 种实施策略，而只有 5%的研究报告使用了超过 15 种实施策略。在报告手术中抗生素使用的研究中，大多数（71%）讨论了手术抗生素预防的依从性。
我们的研究结果强调需要向参与患者护理的围手术期所有医护人员提供反馈。该领域的未来研究应更详细地报告实施参数。
