A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study
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DOI：
10.1016/s1473-3099(18)30107-5
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发表时间：
2018-05-01
影响因子：
56.3
通讯作者：
Berenholtz, Sean M.
中科院分区：
文献类型：
--
作者：
Allegranzi, Benedetta;Aiken, Alexander M.;Berenholtz, Sean M.
背景：手术部位感染（ssi）是发展中国家最常见的卫生保健相关感染。具体的预防措施非常有效，但往往执行不力。我们的目的是确定多模式干预对非洲ssi的影响。方法在2013年7月1日至2015年12月31日期间，我们在五家非洲医院进行了前后队列研究。多模式干预包括实施或加强多种SSI预防措施，并结合旨在改善团队合作和安全气候的适应性方法。主要结局是首次发生SSI，次要结局是术后30天内死亡。前瞻性地收集SSI预防措施依从性的数据。在调整关键混杂因素后，采用混合效应logistic回归模型评估干预对术后30天内SSI风险和死亡的影响。结果4家医院完成了基线和随访；三份报告为可持续性期间提供了适当（即数量和质量足够）的数据。对4322例手术进行了随访（基线时为1604例，随访时为1827例，持续期为891例）。干预后SSI的累积发生率显著降低，从8。0% (95% CI 6.8 - -9.5; n = 129)到3.8% (3.0 - -4.8;n = 70; p
Background Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa.Methods We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders.Findings Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8 .0% (95% CI 6.8-9.5; n=129) to 3.8% (3.0-4.8; n=70; p