Erritty Matthew, Hale Joann, Thomas James, Thompson Anna, Wright Ria, Low Anna, Carr Megan, George Richard, Williams Lisa, Dumitrescu Alexandra, Rees Jacqui, Irukulla Shashi, Fry Christopher H, Fluck David, Han Thang S
Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK.
Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK.
Int J Gynaecol Obstet. 2023 Jun;161(3):963-968. doi: 10.1002/ijgo.14605. Epub 2022 Dec 16.
To reduce average surgical-site infection (SSI) rates to less than 7.5%, as well as other complications by incrementally implementing an SSI prevention care bundle in maternity: (1) ChloraPrep; (2) PICO dressings, performing elective cesarean sections in a main theater rather than a labor ward and warming blankets; (3) vaginal cleansing; and (4) Hibiscrub.
In this prospective cohort study, the association between categorical variables was assessed by χ tests, temporal trends in the monthly percentage change of SSI were measured using the Joinpoint Regression Program v4.7.0.0.
In all, 1682 women (mean age 33.1 ± 5.2 years) underwent either elective (53.9%) or emergency (46.1%) cesarean section. After a small initial increase (10.0%-11.8%), SSI progressively declined to 4.4% (χ = 22.1, P < 0.001), as did sepsis, reoperation or readmission for SSI: from 12.5% to 0.5% (χ = 90.1, P < 0.001). The rates of SSI fell progressively with the cumulative introduction care bundle components. The average monthly percentage change was -14.0% (95% confidence interval -21.8% to -5.4%, P = 0.004), and the average SSI rate was kept below 7.5% for the last 12 months of the study.
The maternal SSI prevention care bundle is simple and inexpensive; it effectively reduces SSI after a cesarean section and should be offered routinely to women undergoing cesarean section.
通过在产科逐步实施手术部位感染（SSI）预防护理包，将平均手术部位感染率降低至7.5%以下，并减少其他并发症。该护理包包括：（1）氯己定醇；（2）聚氨酯泡沫敷料，在主手术室而非产房进行择期剖宫产并使用保温毯；（3）阴道清洁；（4）氯己定。
在这项前瞻性队列研究中，通过χ检验评估分类变量之间的关联，使用Joinpoint Regression Program v4.7.0.0测量SSI每月百分比变化的时间趋势。
共有1682名女性（平均年龄33.1±5.2岁）接受了择期（53.9%）或急诊（46.1%）剖宫产。在最初小幅上升（10.0%-11.8%）后，SSI逐渐下降至4.4%（χ=22.1，P<0.001），脓毒症、因SSI再次手术或再次入院的情况也从12.5%降至0.5%（χ=90.1，P<0.001）。随着护理包各组成部分的逐步引入，SSI发生率逐渐下降。平均每月百分比变化为-14.0%（95%置信区间-21.8%至-5.4%，P=0.004），在研究的最后12个月中，平均SSI率保持在7.5%以下。
产妇SSI预防护理包简单且成本低廉；它能有效降低剖宫产后的SSI，应常规提供给接受剖宫产的女性。
