PDF(Pubmed)
Abstract：
UNASSIGNED: The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital.
UNASSIGNED: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis.
UNASSIGNED: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation.
UNASSIGNED: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.
UNASSIGNED: We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis.
UNASSIGNED: Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation.
UNASSIGNED: A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.
摘要：
■检查深部胸骨伤口感染（DSWI）预防的大多数研究都集中在一次改善1个变量。关于临床和环境干预相结合的协同作用的数据很少。这篇文章描述了一个跨学科的，在一家大型社区医院消除DSWIs的多模式方法。
■我们开发了一种强大的，多学科感染预防小组在围手术期各阶段的护理中评价和行动，取得心脏手术DSWI率0，定名为：I讨厌感染小组。该团队确定了改善护理和最佳实践的机会，并持续实施更改。
■与患者相关的干预措施包括术前耐甲氧西林金黄色葡萄球菌的鉴定，个体化围手术期抗生素,抗菌药物给药策略，和维持正常体温。手术相关干预涉及血糖控制，胸骨粘合剂,药物和止血，用于高危患者的刚性胸骨固定术，葡萄糖酸氯己定敷料在侵入性线上，和使用一次性保健设备。与环境相关的干预措施包括优化手术室通风和末端清洁，减少空气中的粒子数，减少步行交通。一起,这些干预措施使DSWI的发生率从干预前的1.6%连续12个月下降至0%.
■一个多学科团队专注于消除DSWI确定已知的危险因素，并在护理的每个阶段实施基于证据的干预措施，以改善风险。虽然每个个体干预对DSWI的影响仍然未知，使用捆绑感染预防方法在实施后的前12个月将发病率降低至0.
■我们开发了一种强大的，多学科感染预防小组在围手术期各阶段的护理中评价和行动，取得心脏手术DSWI率0，定名为：I讨厌感染小组。该团队确定了改善护理和最佳实践的机会，并持续实施更改。
■与患者相关的干预措施包括术前耐甲氧西林金黄色葡萄球菌的鉴定，个体化围手术期抗生素,抗菌药物给药策略，和维持正常体温。手术相关干预涉及血糖控制，胸骨粘合剂,药物和止血，用于高危患者的刚性胸骨固定术，葡萄糖酸氯己定敷料在侵入性线上，和使用一次性保健设备。与环境相关的干预措施包括优化手术室通风和末端清洁，减少空气中的粒子数，减少步行交通。一起,这些干预措施使DSWI的发生率从干预前的1.6%连续12个月下降至0%.
■一个多学科团队专注于消除DSWI确定已知的危险因素，并在护理的每个阶段实施基于证据的干预措施，以改善风险。虽然每个个体干预对DSWI的影响仍然未知，使用捆绑感染预防方法在实施后的前12个月将发病率降低至0.
