Implementation of evidence-based practices for surgical site infection prophylaxis: Results of a pre- and postintervention study

作     者：Forbes, Shawn S. Stephen, Wesley J. Harper, William L. Loeb, Mark Smith, Rhonda Christoffersen, Emily P. McLean, Richard F. 

作者机构：Hamilton Hlth Sci Hamilton ON L8L 2X2 Canada McMaster Univ Dept Surg Div Gen Surg Hamilton ON L8S 4L8 Canada McMaster Univ Dept Med Div Endocrinol Hamilton ON L8S 4L8 Canada McMaster Univ Dept Pathol Hamilton ON L8S 4L8 Canada McMaster Univ Dept Mol Med Hamilton ON L8S 4L8 Canada McMaster Univ Dept Clin Epidemiol & Biostat Hamilton ON L8S 4L8 Canada McMaster Univ Dept Anesthesiol Hamilton ON L8S 4L8 Canada 

出 版 物：《JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS》 (美国外科医生学会志)

年 卷 期：2008年第207卷第3期

页      面：336-341页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Hamilton Health Sciences Department of Anesthesia Research Fund Department of Surgery, University of Toronto 

主　　题：Adult Aged Algorithms Antibiotic Prophylaxis Blood Glucose Body Temperature 成年人 老年人 算法 抗生素预防 血糖 体温 队列研究 结肠切除术 用药计划表 Body temperature Antibiotic Prophylaxis Evidence-Based Practice algorithms Sector Scan Indicator Surgical Wound Infection Surgical site infection Adults Blood Glucose 

摘      要：BACKGROUND: Although evidence-based guidelines for best practices pertaining to surgical site infection (SSI) prophylaxis exist, the feasibility of implementing such practices remains to be demonstrated outside of a controlled clinical trial. This study was designed to assess the safety and feasibility of implementing evidence-based care practices to prevent SSIs. STUDY DESIGN: A prospective, double-cohort (pre- and postintervention) trial in elective, general surgery patients was conducted. All patients undergoing elective, major colorectal or hepatobiliary operations were enrolled. Postintervention cohort patients were exposed to new strategies to improve antibiotic administration times, perioperative normothermia rates, and perioperative glucose control. They were compared with the preintervention cohort, which received standard practice at the time. Outcomes evaluated include timing of antibiotic administration, perioperative temperatures, and postoperative glucose levels. SSI rates between cohorts were also compared. RESULTS: A total of 208 patients were enrolled. The proportion of patients receiving their preoperative antibiotics within 60 minutes improved from 5.9% to 92.6% (p 0.001);perioperative normothermia rates improved from 60.5% to 97.6% (p 0.001) between cohorts. There was no improvement in rates of hyperglycernia. SSI rates improved but did not reach statistical significance (14.3% versus 8.7%;p = 0.21). CONCLUSIONS: Implementation of evidence-based care practices to prevent SSI is both safe and practical outside the setting of a randomized, controlled trial. Sustained compliance remains to be dernonstrated, although practice audits at our institution suggest ongoing success is possible.