患者参与在降低手术部位感染中的作用：一个流程改进项目。
The Role of Patient Engagement in Surgical Site Infection Reduction: A Process Improvement Project.
机构信息
Jill Cox, PhD, RN, APN-C, CWOCN, FAAN, is Wound/Ostomy/Continence Advanced Practice Nurse, Englewood Health, Englewood, NJ, USA, and Clinical Professor, Rutgers University School of Nursing, New Jersey. Also at Englewood Health, Lisa Douglas, MSN, RN-BC, is Nurse Manager, Surgical Unit; Valerie Wemmer, BSN, RN, is Staff Nurse, Surgical Unit; and Kathleen Kaminsky, MS, RN, NE-BC, is Senior Vice President for Patient Care Services/Chief Nursing Officer. The authors have disclosed no financial relationships related to this article. Submitted November 15, 2022; accepted in revised form December 15, 2022.
出版信息
Adv Skin Wound Care. 2023 Nov 1;36(11):599-603. doi: 10.1097/ASW.0000000000000055.
BACKGROUND
Surgical site infections (SSIs) are the second most common healthcare-associated infection, with prevention being a high-priority goal for all healthcare organizations. Although routine surveillance and standardized prevention protocols have long been used, patient engagement is an additional intervention that should be considered and may be beneficial in SSI prevention.
OBJECTIVE
To determine if the development of a standardized patient education discharge plan for management of a surgical site and/or surgical drain would contribute to a reduction in SSI rates in inpatients undergoing colorectal, plastic, or general surgery.
METHODS
A preintervention/postintervention design was used. Before intervention, patients and surgeons were surveyed regarding various discharge practices related to surgical incision/drain care. The intervention consisted of implementing a standardized discharge plan including standardized education and patient discharge kits. After implementation, patients were surveyed regarding discharge practices. Patient survey responses and SSI rates were compared between the preintervention and postintervention time frames.
RESULTS
Rates of SSIs decreased across all three surgical specialties during the project period: colorectal SSIs decreased from 3.2% to 2.7%, plastics from 1.2% to 0.5%, and general from 0.86% to 0.33%. Improvements were also realized in patient survey responses to various aspects of surgical incision/drain care.
CONCLUSIONS
Patient engagement may be an important strategy to integrate with SSI evidence-based care bundles. Active engagement of surgical patients perioperatively has the potential to improve the patient experience, which ultimately can result in improved healthcare outcomes for this population.
背景
手术部位感染（SSI）是第二大常见的医疗保健相关感染，预防是所有医疗保健组织的首要目标。尽管常规监测和标准化预防方案早已被广泛采用，但患者参与是另一种干预措施，应该被考虑，并且可能对预防 SSI 有益。
目的
确定制定标准化的患者教育出院计划，以管理手术部位和/或手术引流，是否有助于降低接受结直肠、整形或普通外科手术的住院患者的 SSI 发生率。
方法
采用了干预前后设计。在干预之前，对患者和外科医生进行了有关各种与手术切口/引流护理相关的出院实践的调查。干预措施包括实施标准化的出院计划，包括标准化的教育和患者出院包。实施后，对患者进行了有关出院实践的调查。在干预前后的时间段内，比较了患者调查结果和 SSI 发生率。
结果
在整个项目期间，所有三个外科专业的 SSI 发生率均有所下降：结直肠 SSI 从 3.2%降至 2.7%，整形从 1.2%降至 0.5%，普通外科从 0.86%降至 0.33%。患者对手术切口/引流护理各个方面的调查回答也有所改善。
结论
患者参与可能是整合 SSI 循证护理包的重要策略。手术患者围手术期的积极参与有可能改善患者体验，最终可以改善该人群的医疗保健结果。
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