Heart & Vascular Program Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md.
J Thorac Cardiovasc Surg. 2024 Nov;168(5):1500-1509. doi: 10.1016/j.jtcvs.2024.03.027. Epub 2024 Apr 3.
Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients' quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery.
Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type.
Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.
Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.
心脏手术后的手术部位感染（SSI）会增加发病率和死亡率，消耗医疗资源，影响康复，并降低患者的生活质量。已经发布了许多指南和专家共识文件，以解决 SSI 的预防和管理问题。我们的目标是将这些文件整合到一个医嘱组中，以促进采用和实施预防和管理心脏手术后 SSI 的循证最佳实践。
咨询了主题专家，将现有的指南和文献翻译成用于减少 SSI 的示例即用型医嘱组。从参考指南和共识手稿中的一致 I 类、IIA 类或等效建议中得出的医嘱以粗体显示在即用型医嘱组中。选择的与 I 类或 IIA 类不一致的医嘱、IIB 类或有其他已发表证据支持的医嘱，以斜体显示。
预防性护理始于医护人员术前识别可改变和不可改变的 SSI 风险。评估工具可用于帮助识别 SSI 风险高的患者。术前建议包括筛查和治疗金黄色葡萄球菌鼻腔携带。术中，定制的预防性静脉内抗生素和将血糖水平维持在 180mg/dL 以下是必不可少的要素。术后护理包括保持正常体温、血糖控制和患者参与。
尽管心脏手术中多学科 SSI 护理途径具有明确的优势，但在其采用和实施方面存在不一致。本文提供了一个医嘱组，其中包含了现有指南中预防心脏手术人群 SSI 的建议。
