目的:用于规范围手术期护理的基于知识的工具,如脑积水临床研究网络(HCRN)的分流感染预防方案,已证明他们有能力减少基于外科医生和基于中心的结果差异并改善患者护理。仅仅是高质量证据的存在,然而,由于实施差距,不一定转化为改善患者预后。为了进一步了解如何在脑积水儿童的常规临床护理中使用基于知识的工具,HCRN质量(HCRNq)网络于2019年启动。重点是脑脊液分流感染,作者提供了有关CSF分流器感染率的基线数据,以及目前在HCRNq站点使用的分流器感染预防措施.
方法:基线分流手术实践,感染率,和危险因素数据在HCRNq中前瞻性收集。没有推荐标准感染方案,但如果在>80%的分流外科手术中使用6种常见分流感染预防方法中的至少3种,则意味着在现场使用方案.对分流器感染危险因素进行单变量和多变量分析。
结果:30个站点在2019年11月至2021年6月之间累积了2437个程序的数据。所有部位的未调整感染率为3.9%(范围0%-13%),分流插入之间没有差异,分流修正,或感染后的分流插入。仅15/30中心和60%的分流手术暗示了协议的使用。关于单变量分析,碘/DuraPrep(OR0.57,95%CI0.37-0.88,p=0.02)和在分流的任何节段(或两者)使用抗生素浸渍的导管降低了感染风险(OR0.53,95%CI0.34-0.82,p=0.01).基于碘的制备溶液(OR0.56,95%0.36-0.86,p=0.02)和抗生素浸渍导管的使用(OR0.52,95%CI0.34-0.81,p=0.01)在多变量模型中保持显著性,但在本基线分析中没有证实方案使用与感染风险之间的关系.
结论:作者已经证明,在HCRNq站点接受CSF分流手术的儿童与其他大型北美多中心队列具有相似的人口统计学特征,观察到的基线感染率和危险因素相似。许多中心已经实施了标准化的分流感染预防措施,但仍有相当大的实践差异。因此,通过持续的标准化护理,这些中心有机会降低分流术感染率.
OBJECTIVE: Knowledge-based tools used to standardize perioperative care, such as the shunt infection prevention protocol of the Hydrocephalus Clinical Research Network (HCRN), have demonstrated their ability to reduce surgeon-based and center-based variations in outcomes and improve patient care. The mere presence of high-quality evidence, however, does not necessarily translate into improved patient outcomes owing to the implementation gap. To advance understanding of how knowledge-based tools are being utilized in the routine clinical care of children with hydrocephalus, the HCRN-Quality (HCRNq) network was started in 2019. With a focus on CSF shunt infection, the authors present baseline data regarding CSF shunt infection rates and current shunt infection prevention practices in use at HCRNq sites.
METHODS: Baseline shunt surgery practices, infection rate, and risk factor data were prospectively collected within HCRNq. No standard infection protocol was recommended, but site use of a protocol was implied if at least 3 of 6 common shunt infection prevention practices were used in > 80% of shunt surgical procedures. Univariable and multivariable analyses of shunt infection risk factors were performed.
RESULTS: Thirty sites accrued data on 2437 procedures between November 2019 and June 2021. The unadjusted infection rate across all sites was 3.9% (range 0%-13%) and did not differ among shunt insertion, shunt revision, or shunt insertion after infection. Protocol use was implied for only 15/30 centers and 60% of shunt operations. On univariable analysis, iodine/DuraPrep (OR 0.57, 95% CI 0.37-0.88, p = 0.02) and the use of an antibiotic-impregnated catheter in any segment of the shunt (or both) decreased infection risk (OR 0.53, 95% CI 0.34-0.82, p = 0.01). Iodine-based prep solutions (OR 0.56, 95% 0.36-0.86, p = 0.02) and the use of antibiotic-impregnated catheters (OR 0.52, 95% CI 0.34-0.81, p = 0.01) retained significance in the multivariable model, but no relationship between protocol use and infection risk was demonstrated in this baseline analysis.
CONCLUSIONS: The authors have demonstrated that children undergoing CSF shunt surgery at HCRNq sites share similar demographic characteristics with other large North American multicenter cohorts, with similar observed baseline infection rates and risk factors. Many centers have implemented standardized shunt infection prevention practices, but considerable practice variation remains. As such, there is an opportunity to decrease shunt infection rates in these centers through continued standardization of care.