遵守改善外科护理的项目措施,以及与术后感染的关联
Jonah J Stulberg1, Conor P Delaney, Duncan V Neuhauser
1Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. Jonah.Stulberg@case.edu
JAMA
|June 24, 2010
概括
坚持复合的外科护理改进项目 (SCIP) 评分与手术后感染的减少有关. 然而,个别的SCIP措施没有显示出与减少感染率的显著关联.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 预防传染病 预防传染病
- 手术结果研究研究.
背景情况:
- 手术护理改进项目 (SCIP) 实施了6项感染预防措施,以减少手术并发症.
- 之前的研究并没有明确地将SCIP性能与改善的临床结果联系起来.
研究的目的:
- 调查SCIP感染预防过程护理措施与手术后感染的发生率之间的关联.
- 为了确定是否遵守SCIP指南预测手术部位感染率较低.
主要方法:
- 一项回顾性队列研究分析了2006年7月至2008年3月期间从美国398家医院出院的405,720名患者.
- 基于完全或完全不遵守SCIP感染预防措施,创建了两个复合得分 (S-INF和S-INF-Core).
- 使用分层物流模型来评估SCIP遵守率和感染率之间的关系,并控制医院特征.
主要成果:
- 总共记录了3,996例手术后感染病例.
- 综合S-INF评分预测感染率将从每1000次出院减少14.2至6.8 (aOR,0.85;95%CI,0.76-0.95).
- 综合S-INF-Core评分显示了减少感染的趋势 (11.5到5.3每1000次出院;aOR,0.86;95%CI,0.74-1.01),但这在统计学上并不显著. 单个SCIP措施与较低的感染概率没有显著关联.
结论:
- 遵守全球性,全或无复合的SCIP感染预防得分与手术后感染的可能性较低有关.
- 公开报告的单个SCIP措施与减少的感染率没有显著联系,尽管复合得分的关联.
- 调查结果表明,综合性坚持得分可能比个别测量绩效更能表明减少了手术感染.
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