手术感染预防计划在低收入环境中的可扩展性和可持续性
Nichole Starr1,2, Natnael Gebeyehu2,3, Maia R Nofal2,4,5
1Department of Surgery, University of California, San Francisco.
JAMA surgery
|November 29, 2023
概括
清洁切割计划在埃塞俄比亚医院显著减少了34%的手术部位感染 (SSI). 这项质量改进计划加强了对感染预防标准的遵守,证明了可扩展性和有效性,减少了患者的发病率.
科学领域:
- 全球健康 全球健康
- 预防传染病 预防传染病
- 外科手术的安全性
背景情况:
- 手术感染是导致患者发病和死亡的主要原因,特别是在资源较低的环境中.
- 清洁切割计划是一项质量改善计划,此前在减少术后感染方面取得了成功,但需要大量的外部支持.
- 改进该计划的实施策略是必要的,以提高其可扩展性和可持续性.
研究的目的:
- 评估改进的清洁切割计划实施对遵守感染预防和控制 (IPC) 标准的影响.
- 根据更新的计划策略,评估术后感染率,特别是手术部位感染 (SSIs).
- 确定Clean Cut计划在资源有限的医院环境中的可扩展性.
主要方法:
- 从2019年1月到2022年2月,在7家埃塞俄比亚医院进行了一项队列研究,实施了改进的Clean Cut战略.
- 改进的战略包括正式的教育材料,自动化数据平台和重组的医院团队,减少对外部支持的依赖.
- 收集了关于患者结果和遵守6个IPC标准的前性数据,并通过医院出院和30天的电话联系进行了后续跟踪.
主要成果:
- 在计划实施后,手术部位感染 (SSI) 的相对风险降低了34.0% (RR,0.66;P <.001).
- 遵守关键的感染预防标准显著改善:使用外科安全检查清单 (16.3%至43.0%),手和皮肤消毒剂 (46.0%至66.0%),及时服用抗生素 (17.8%至39.0%).
- 此外,手术仪器不育率 (38.7%至10.2%),麻布不育率 (35.5%至12.8%) 和布计数 (89.2%至82.5%) 也有所改善.
结论:
- 修改后的Clean Cut实施策略,减少了外部投入和加强了医院的参与,有效地减少了SSI.
- 该计划展示了可扩展性,实现了与试点研究相当的结果,并加强了其在SSI预防方面的价值.
- 更好地遵守感染预防标准直接与手术部位感染的减少有关,这突显了该计划的公共卫生相关性.
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