减少坦桑尼亚产科手术患者的手术部位感染和死亡率：多组分安全手术干预的预评估和后评估。
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
机构信息
JHPIEGO, Dar es Salaam, Tanzania, United Republic of
JHPIEGO, Dar es Salaam, Tanzania, United Republic of.
出版信息
BMJ Glob Health. 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-006788.
INTRODUCTION
Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).
METHODS
We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.
RESULTS
The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.
CONCLUSION
Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
简介
尽管不断有针对产妇健康的干预措施，但坦桑尼亚的产妇死亡率仍然很高。导致产妇死亡的一个主要原因是术后感染。与高收入国家相比，中低收入国家（LMICs），如坦桑尼亚，手术部位感染（SSI）的发生率更高。我们评估了坦桑尼亚多组分安全手术干预的影响，假设它将（1）提高对安全措施的遵守，例如世界卫生组织手术安全检查表（SSC），（2）降低剖宫产（CS）后的 SSI 率，以及（3）降低 CS 相关围手术期死亡率（POMR）。
方法
我们采用了预横断面/后横断面研究设计，在实施前和实施后 18 个月评估 WHO SSC 的使用、SSI 发生率和 CS 相关 POMR。我们的干预措施包括对跨专业手术团队进行培训，促进使用世界卫生组织 SSC，并为所有 CS 患者引入感染预防（IP）包。我们通过随机抽取 279 名 CS 患者的个人档案来评估 WHO SSC 的使用和 SSI 发生率。我们通过查看登记册和病房轮值报告来获得 CS 手术的数量和 CS 相关死亡人数。我们使用 STATA V.15 通过两比例 z-检验比较了实施前后具有特征个体的比例，p≤0.05 具有统计学意义。
结果
CS 中 SSC 的使用率从 3.7%（5/136）增加到 95.1%（136/143），p<0.001。同样，CS 后 SSI 的女性比例从基线时的 14%降至 1%（p=0.002）。实施安全手术干预后，SSI 发生率的变化具有统计学意义（p<0.001）。实施安全手术干预后，CS 相关 POMR 下降了 38.5%（p=0.6）。
结论
我们的研究结果表明，我们的干预措施提高了世界卫生组织 SSC 的使用率，降低了 SSI 的发生率，并降低了 CS 相关 POMR。我们建议在其他中低收入国家复制这些干预措施。
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