一项随机对照研究表明，针对基本预防措施的优化的术中感染控制程序可以减少金黄色葡萄球菌的传播和手术部位的感染。在这项研究中，我们探讨了手术室感染异质性的潜在局限性以及在临床实践中采用行为干预措施后对行为干预措施的依从性。
实施后前瞻性病例队列研究。
一家大型教学医院的23个手术室。
共801例手术患者[425例（53%）女性；350例（44%）ASA>2，年龄54.6±15.9岁]进行了主要结果分析，804例进行了次要结果分析。
一个多方面的,基于证据的术中感染控制程序，涉及手卫生，血管护理,对23个手术室环境实施了环境清洁改进。细菌传播监测用于为干预优化提供每月反馈。
S.金黄色葡萄球菌传播（原发性）和手术部位感染（继发性）。
评估了感染控制优化之前（3.5个月）和之后（4.5个月）的金黄色葡萄球菌传播和手术部位感染的发生率。优化是通过持续减少麻醉工作区细菌库分离计数来定义的。使用具有稳健误差方差的泊松回归来估计术中金黄色葡萄球菌传播和手术部位感染的发生率风险比（IRR）作为优化的自变量。
优化与金黄色葡萄球菌传播减少相关[24％之前（85/357）至9％之后（42/444），IRR0.39，95％CI0.28至0.56，P<.001]和手术部位感染[前8％（29/360）和后3％（15/444）（IRR0.42，95％CI0.23至0.77，P=.005；根据美国麻醉师协会的身体状况进行了调整，aIRR0.45，95%CI0.25至0.82，P=.009]。
针对基本预防措施的优化的术中感染控制程序是减少金黄色葡萄球菌传播和手术部位感染发展的有效且可行的方法。
A randomized controlled study demonstrated that an optimized intraoperative infection control program targeting basic preventive measures can reduce Staphylococcus aureus transmission and surgical site infections. In this study we address potential limitations of operating room heterogeneity of infections and compliance with behavioral interventions following adoption into clinical practice.
A post-implementation prospective
case-cohort study.
Twenty-three operating rooms at a large teaching hospital.
A total of 801 surgical patients [425 (53%) women; 350 (44%) ASA > 2, age 54.6 ± 15.9 years] were analyzed for the primary and 804 for the secondary outcomes.
A multifaceted, evidence-based intraoperative infection control program involving hand hygiene, vascular care, and environmental cleaning improvements was implemented for 23 operating room environments. Bacterial transmission monitoring was used to provide monthly feedback for intervention optimization.
S. aureus transmission (primary) and surgical site infection (secondary).
The incidence of S. aureus transmission and surgical site infection before (3.5 months) and after (4.5 months) infection control optimization was assessed. Optimization was defined by a sustained reduction in anesthesia work area bacterial reservoir isolate counts. Poisson regression with robust error variances was used to estimate the incidence risk ratio (IRR) of intraoperative S. aureus transmission and surgical site infection for the independent variable of optimization.
Optimization was associated with decreased S. aureus transmission [24% before (85/357) to 9% after (42/444), IRR 0.39, 95% CI 0.28 to 0.56, P < .001] and surgical site infections [8% before (29/360) and 3% after (15/444) (IRR 0.42, 95% CI 0.23 to 0.77, P = .005; adjusted for American Society of Anesthesiologists\' physical status, aIRR 0.45, 95% CI 0.25 to 0.82, P = .009].
An optimized intraoperative infection control program targeting improvements in basic preventive measures is an effective and feasible approach for reducing S. aureus transmission and surgical site infection development.
