Premier, Inc., Charlotte, North Carolina, USA.
Infection Preventionist Consultants, Boston, Massachusetts, USA.
Surg Infect (Larchmt). 2023 May;24(4):382-389. doi: 10.1089/sur.2022.411. Epub 2023 Apr 5.
National and international recommendations for the prevention of surgical site infection (SSI) were published six years ago, but little is known about implementation in colon surgeries. We conducted an observational study to evaluate the implementation of seven SSI-prevention elements in colon surgeries. Study coordinators recorded the implementation using an electronic case report. Surgeons completed a survey that identified key drivers of implementation. Three peer-to-peer calls and a study coordinator survey provided insights on the obstacles and drivers to implementation. The elements ranged in compliance from 100% to below 1%. Absence of documentation in the electronic medical record (EMR), conflicting local policies, and a lack of standardization of processes and products were significant obstacles in implementation. Standardizing peri-operative procedures may be accomplished by implementing guidelines. Using implementation science to reduce variability and stocking leads to product standardization with items that support evidence-based practices. Administration, material management, and surgical leadership all have a duty to the patient to reduce obstacles to implement evidence-based practices. Our study reveals variability in in the integration of published guidelines into clinical practice. Every surgical patient deserves the best possible care by using evidence-based guidelines and practices centered on reducing SSIs.
国家和国际预防手术部位感染(SSI)的建议是六年前发布的,但对于结肠手术中实施情况的了解甚少。我们进行了一项观察性研究,以评估结肠手术中预防 SSI 的七个要素的实施情况。研究协调员使用电子病例报告记录实施情况。外科医生完成了一项调查,以确定实施的关键驱动因素。三次同行间电话会议和研究协调员调查提供了有关实施障碍和驱动因素的见解。这些要素的合规性从 100%到不足 1%不等。电子病历(EMR)中缺乏文件记录、地方政策相互冲突以及手术流程和产品缺乏标准化是实施的重大障碍。通过实施指南,标准化围手术期操作可能会实现。使用实施科学来减少变异性并储备库存,可实现支持循证实践的产品标准化。管理、物资管理和外科领导都有责任为患者减少实施循证实践的障碍。我们的研究揭示了已发布指南在临床实践中的整合存在差异。每个手术患者都应该通过使用基于循证的指南和以降低 SSI 为中心的实践来获得最佳的护理。