将手术感染预防计划的全球扩展扩展到5个资源较低的国家
, Maia R Nofal1,2,3,4, Assefa Tesfaye3,4,5
1Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
JAMA surgery
|August 13, 2025
概括
在五个低收入国家,Clean Cut计划显著减少了手术部位感染 (SSI). 这项质量改进倡议在多种全球医疗保健环境中展示了可扩展性和有效性.
科学领域:
- 全球健康 全球健康
- 预防传染病 预防传染病
- 改善外科手术的质量
背景情况:
- 手术部位感染 (SSI) 是手术发病率和死亡率的主要原因,特别是在低收入和中等收入国家 (LMICs).
- 清洁切割计划是一项多式联运质量改进计划,此前在减少埃塞俄比亚的SSI费率方面取得了成功.
研究的目的:
- 评估Clean Cut手术感染预防计划在各种LMIC环境中的可扩展性和有效性.
- 评估该计划对SSI率和在不同地理和社会经济环境中遵守感染预防标准的影响.
主要方法:
- 一项准实验性队列研究,从2021年到2024年,涉及利比里亚,马达加斯加,马拉维,印度和玻利维亚五家医院的1865名手术患者.
- 实施涉及埃塞俄比亚临床医生的知识转移,以建立当地专业知识,重点是改善遵守外科手术期间感染预防标准.
- 关于30天SSI率,遵守感染预防实践,死亡,重新手术和停留时间的数据是前性收集的.
主要成果:
- 30天的SSI率从基线时的28.4%显著下降到计划实施后的12.1% (16.3%的减少).
- 该研究观察到遵守关键感染预防标准的显著改善,包括世卫组织外科安全清单,手和皮肤消毒剂以及无菌现场维护.
- 对SSI的相对风险降低了49% (RR,0.51;95% CI,0.38-0.67;P < .001). 这一结果使得SSI的相对风险降低了49% (RR,0.51;95% CI,0.38-0.67;P < .001).
结论:
- 清洁切割手术感染预防计划是可扩展的,有效地降低SSI率在不同的LMIC医院设置.
- 该研究强调了一种成功的专业知识转移机制,以改善对感染预防标准的遵守,这对于更广泛的实施至关重要.
- 该计划提供了一种可行的策略,以全球打击手术部位感染的负担.
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