降低感染率的围手术期策略课程VIP免费

第1页共33页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第1页共33页TheJournalofBoneandJointSurgery(American).2010;92:232-239.PerioperativeStrategiesforDecreasingInfectionAComprehensiveEvidence-BasedApproach降低感染率的围手术期策略：综合性循证医学路径JosephA.Bosco,III,MD1,JamesD.Slover,MD,MS1andJanetP.Haas,RN,PhD21DepartmentofOrthopaedicSurgery,NYUHospitalforJointDiseases,NewYorkUniversityLangoneMedicalCenter,301East17thStreet,NewYork,NY10003.E-mailaddressforJ.A.BoscoIII:joseph.bosco@nyumc.org.E-mailaddressforJ.D.Slover:james.slover@nyumc.org2InfectionPreventionandControl,WestchesterMedicalCenter,100WoodsRoad,MacyPavilionSW246,Valhalla,NY10595.E-mailaddress:Haasj@wcmc.comAnInstructionalCourseLecture,AmericanAcademyofOrthopaedicSurgeonsIntroduction引言Surgicalsiteinfectionsassociatedwithorthopaedicsurgicalproceduresaredevastatingcomplications.Theyincreasemorbidity,mortality,andcostandresultinoutcomesthatareworsethanthoseinuninfectedcases1.Decreasingtheincidenceofsurgicalsiteinfectionsisnotonlyofinteresttopatientsandsurgeons,itisalsoamajorfocusofseveralgroupsofinterestedparties.Theserangefrompayers,includingtheCentersforMedicareandMedicaidServices(CMS,Baltimore,Maryland),toinstitutionsrepresentedbytheSurgicalCareImprovementProject(SCIP),amultiple-institutionpartnershipbetweenmajorpublicandprivatehealth-careorganizations,includingtheJointCommissiononAccreditationofHealthcareOrganizations(OakbrookTerrace,Illinois).Decreasingtheincidenceofsurgicalsiteinfectionsis,andwillcontinuetobe,amajorfocusinmedicine.对于骨科手术而言，手术部位的感染是一种毁灭性的并发症，往往会导致致残率、致死率以及医疗费用的增加，并且与没有发生感染的病例相比，最终的治疗结果通常也会更差【1】。减少手术部位的感染率，不仅对患者和医生都很有意义，也是利益相关的各方非常关注的问题。如出资方，包括医疗保险与医疗辅助服务中心（CMS，Baltimore,Maryland）；以外科医疗改良项目（SCIP）为代表的相关机构；介于大众公共机构与私人医疗保健机构之间的多机构合作组织，包括医疗机构评审联合委员会（JCAHO，OakbrookTerrace,Illinois）等。减少手术部位的感染率现在是，将来也仍会是，医学领域关注的焦点问题。Toeffectivelypreventsurgicalsiteinfections,theclinicianmustconsiderpreoperative,intraoperative,andpostoperativefactorsandinterventions.Preoperativestrategiesforreductionofinfectionratesincludeidentificationofhigh-riskpatients,screeninganddecolonizationofpatientswithmethicillin-sensitiveStaphylococcusaureusandmethicillin-resistantStaphylococcusaureuscolonization,preoperativepreparationofthepatientwithchlorhexidinegluconate,utilizationofproperhair-removaltechniques,andaddressingpreexistingdentalandnutritionalissuespriortosurgery.为了有效地防止手术部位的感染，临床医生必须审慎地考虑到手术前、手术中以及手术后的相关因素和干预措施。降第2页共33页第1页共33页编号：时间：2021年x月x日书山有路勤为径，学海无涯苦作舟页码：第2页共33页低感染的术前策略包括识别高风险的患者，对甲氧西林敏感的金黄色葡萄球菌和耐甲氧西林的金黄色葡萄球菌定植的患者进行筛查，并清除定植菌，术前应用洗必泰葡萄糖酸盐进行清洗，应用合适的方法去除毛发，术前妥善处理先前存在的牙齿及营养相关的问题。Thereareavarietyofperioperativestrategiesthatcanandshouldbeemployedtodecreasetheriskofsurgicalsiteinfections.Intraoperativeinterventionsthathavebeenshowntodecreasesurgicalsiteinfectionratesincludetheproperselection,timing,anddosesofprophylacticantibioticsandutilizationofbestpracticesfo...