Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review.
Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review.
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DOI：
10.1097/sla.0000000000004909
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发表时间：
2022-02-01
影响因子：
9
通讯作者：
ASPIRES study co-investigators
中科院分区：
文献类型：
--
作者：
Ahuja S;Peiffer-Smadja N;Peven K;White M;Leather AJM;Singh S;Mendelson M;Holmes A;Birgand G;Sevdalis N;ASPIRES study co-investigators
手术部位感染(SSI)的预防仍然很重要，特别是在抗菌素耐药的时代。众所周知，对实践和结果的反馈是降低SSI发生率和优化抗生素使用的关键。然而，外科团队反馈的最佳方法、形式和频率仍不清楚。这项研究的目的是了解在常规外科实践中，监测和审计数据是如何反馈的。使用已建立的实施科学框架对数据进行了系统范围审查。检索两个面向健康的电子数据库(MEDLINE、EMBASE)至2019年9月。我们纳入了评估反馈作为预防和管理SSI和/或围手术期抗生素使用的一种策略的研究。我们确定了21项研究：17项集中在SSI发生率和结果上，10项研究描述了SSI的抗菌药管理(重点有一些重叠)。报告了几项干预措施，主要是以反馈为组成部分的多式联运。反馈通常以书面形式提供(62%)，要么是个性化的(38%)，要么是集体的(48%)。只有25%的研究报告反馈下传到一线围手术期工作人员。在65%的研究中，使用了1至5种实施策略，而只有5%的研究报告使用了15种以上的实施策略。在报告手术中抗生素使用的研究中，大多数(71%)讨论了手术抗生素预防的依从性。我们的发现强调了向参与病人护理的各级围手术期护理提供者提供反馈的必要性。今后在这一领域的研究应更详细地报告实施参数。
Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice. A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively. We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis. Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail.