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Lancet Infect Dis:多模式干预能否改善非洲国家手术部位感染情况?

2018-05-18 应颖秋 环球医学网

2018年5月,发表在《Lancet Infect Dis》的一项由瑞士、英国、肯尼亚、乌干达等国家进行的前-后队列研究,考察了多模式感染控制和患者安全性干预能否改善非洲国家手术部位感染的情况。

2018年5月,发表在《Lancet Infect Dis》的一项由瑞士、英国、肯尼亚、乌干达等国家进行的前-后队列研究,考察了多模式感染控制和患者安全性干预能否改善非洲国家手术部位感染的情况。

背景:手术部位感染(SSIs)是发展中国家最频繁发生的医疗卫生相关感染。特定的预防措施有效性较高,但实施不佳。研究者旨在考察多模式干预对非洲国家SSIs的影响。

方法:2013年7月1日至2015年12月31日,研究者在5所非洲医院开展了一项前-后队列研究。多模式干预包括实施或加强多项SSI预防措施,联合旨在改善团队工作和安全环境的调整方法。主要结局为首次发生SSI,次要结局为术后30天内死亡。前瞻性收集SSI预防措施依从数据。校正主要混杂后,在一个混合效果logistic回归模型中,评估干预对术后30天内SSI风险和死亡的影响。

结果:四所医院完成基线和随访;三所医院为可持续期提供合适(即,充分的量与质)的数据。对4322个手术进行随访(基线1604个,随访期1827个,持续期891个)。干预后SSI累计发生率显着降低,从8.0%(95%置信区间[CI],6.8~9.5;n=129)降低至3.8%(3.0~4.8;n=70;p<0.0001),该降低在持续期维持(3.9%,2.8~5.4;n=35)。在随访期和持续期观察到预防措施依从性具有一致的巨大改善。随访期SSI的概率显着低于干预前(比值比[OR] 0.40,95% CI 0.29~0.54;p<0.0001),但死亡的概率没有显着降低(0.72,0.42~1.24;p=0.2360)。

阐释:在非洲医院中实施这些措施是可行的。观察到所有围手术期干预实践 有所改善。观察到干预对总SSI风险有显着影响,但不同部位有一些异质性。需要进一步的大型试验研究,以证实这些结果,并改善这种复杂方案的持续性和长期效果。

原始出处:
Allegranzi B, Aiken AM, Zeynep Kubilay N, et al.A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.Lancet Infect Dis. 2018 May;18(5):507-515. doi: 10.1016/S1473-3099(18)30107-5. Epub 2018 Mar 5.

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    2018-07-22 howi
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    2018-05-21 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1661434, encodeId=a27d16614348d, content=<a href='/topic/show?id=017899514a0' target=_blank style='color:#2F92EE;'>#非洲国家#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99514, encryptionId=017899514a0, topicName=非洲国家)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Aug 26 10:58:00 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012680, encodeId=3bbe2012680c7, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Wed Jan 23 07:58:00 CST 2019, time=2019-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1829630, encodeId=b32518296305e, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Jul 22 20:58:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317092, encodeId=65ee31e0928f, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Mon May 21 06:03:11 CST 2018, time=2018-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370540, encodeId=9ae313e0540da, content=<a href='/topic/show?id=00505450e5f' target=_blank style='color:#2F92EE;'>#手术部位感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54507, encryptionId=00505450e5f, topicName=手术部位感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Sun May 20 02:58:00 CST 2018, time=2018-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=316311, encodeId=057b31631126, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Fri May 18 12:04:39 CST 2018, time=2018-05-18, status=1, ipAttribution=)]
    2018-05-18 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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