Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.
Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Antimicrob Resist Infect Control. 2022 Sep 5;11(1):113. doi: 10.1186/s13756-022-01153-4.
Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project.
This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
The incidence of early SSIs decreased from 2.5% in years 1-2 to 1.1% in years 4-5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly.
Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements.
Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016-Retrospectively registered.
急性髋部骨折手术后的手术部位感染（SSI）是一种破坏性的并发症，会增加患者的痛苦和死亡率。本研究的目的是调查 SafeHands 项目实施前后 5 年内急性髋部骨折患者的早期 SSI、败血症、肺炎和尿路感染情况。
这是一项单中心观察性研究，采用 5 年纵向设计，研究了一项针对急性髋部骨折患者临床护理路径的感染预防干预措施的效果。统计分析基于包括 3553 例患者的常规收集的患者结果数据。该研究符合观察性研究的加强报告标准（STROBE）的标准。
早期 SSI 的发生率从第 1-2 年的 2.5%降至第 4-5 年的 1.1%。败血症（2.7%至 1.3%）和尿路感染（14.2%至 4.2%）也观察到类似的结果。多变量回归结果表明，每观察一年，早期 SSI 的可能性就会降低。男性、手术时间、败血症和术前皮肤损伤显著增加了发生 SSI 的几率。
我们的预防方案基于研究人员、管理者和临床医生之间的合作关系以及相关专业人员对变革的坚定承诺，似乎可以有效地降低髋部骨折手术后潜在破坏性 SSI 和其他医院获得性感染的发生率。外部和内部促进因素的使用对于实现个人和组织学习以及克服改进障碍至关重要。
ClinicalTrials.gov 标识符：NCT02983136 于 2016 年 12 月 6 日注册-回顾性注册。
