应对 COVID-19 大流行期间手术部位感染的增加——在混乱时期寻找机会。

Addressing an increase in surgical site infections during the COVID-19 pandemic-Identifying opportunities during a chaotic time.

机构信息

Colorado School of Public Health, University of Colorado Anschutz, Colorado School of Public Health, Aurora, CO.

Clinical Excellence, St. Vincent Healthcare, Billings, MT.

出版信息

Am J Infect Control. 2023 Dec;51(12):1309-1313. doi: 10.1016/j.ajic.2023.06.015. Epub 2023 Jun 22.

DOI:10.1016/j.ajic.2023.06.015

PMID:37355097

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10286569/

Abstract

BACKGROUND

Health care systems saw increases in device-associated infections and decreases in surgical site infections (SSI) during the COVID-19 pandemic. However, following an increase in SSIs, an acute care hospital assessed the risk and preventative factors of SSIs among patients.

METHODS

A retrospective cohort study on surgeries performed between January 2020 and September 2021 analyzed associations of SSI with risk and preventive factors utilizing χ, t-tests, and odds ratios. A secondary analysis was utilized to determine the association of case urgency and prevention practice performance.

RESULTS

There was a significant difference in the administration of correct perioperative antibiotic selection between SSI (78.1%) and non-SSI (86.2%) along with 2.9 greater odds of developing an SSI with incorrect perioperative antibiotics. Patients who had urgent cases were significantly less likely than elective to receive preoperative chlorhexidine gluconate wipes (81.6%, 61.5%, respectively), correct antibiotic selection and timing (93.2%, 70.8%, respectively) and chlorhexidine and alcohol skin preparation (81.6%, 67.5%, respectively).

DISCUSSION

Disruption of perioperative workflow during the COVID-19 pandemic likely resulted in an increase in SSI. Numerous opportunities were identified for focused prevention efforts.

CONCLUSIONS

The next steps include implementing strategies to improve SSI prevention and establish a culture that can withstand workflow disruptions to maintain a safe environment during significant changes.

摘要

背景

在 COVID-19 大流行期间，医疗保健系统中与器械相关的感染增加，手术部位感染（SSI）减少。然而，在 SSI 增加后，一家急症护理医院评估了患者 SSI 的风险和预防因素。

方法

对 2020 年 1 月至 2021 年 9 月期间进行的手术进行回顾性队列研究，利用 χ、t 检验和优势比分析 SSI 与风险和预防因素的关联。进行了二次分析，以确定病例紧急情况和预防实践表现的关联。

结果

SSI（78.1%）和非 SSI（86.2%）之间正确使用围手术期抗生素选择存在显著差异，使用不正确的围手术期抗生素时，发生 SSI 的几率增加 2.9 倍。紧急手术的患者与择期手术相比，接受术前葡萄糖酸洗必泰擦拭（分别为 81.6%、61.5%）、正确的抗生素选择和时机（分别为 93.2%、70.8%）以及洗必泰与酒精皮肤准备（分别为 81.6%、67.5%）的可能性显著降低。