全球基于循证的手术部位感染实施策略及其效果评估现况

Implementation of evidence-based strategies for surgical site infections around the globe and their effects

  • 摘要:
    目的 评估实施策略在手术部位感染(SSI)防控中的应用效果, 并综述其研究进展。
    方法 采用范围综述的方法, 对Web of Science、PubMed、Cochrane、知网和万方等数据库进行系统检索, 依据文献纳排标准筛选后, 对纳入文献进行分析和规范化报告。
    结果 共纳入47篇文献, 多数研究采用综合循证干预措施(EBP)(≥2种), 并采用多模式实施策略(≥3项)来促进SSI防控EBP的落实。在WHO多模式策略框架下, 分别有42、39、39、24项研究应用了系统变革、教育与培训、监测与反馈及提醒与沟通这四类实施策略, 而仅有9项研究应用营造安全文化策略。采用四项实施策略组合的研究占比最高(31.91%, 15/47), 以“系统变革+教育与培训+监测与反馈+提醒与沟通”为常见组合(29.79%, 14/47), 且四项实施策略组合在EBP依从性提升中表现突出。26项研究(55.32%)干预后SSI发生率下降(P<0.05)。
    结论 实施策略对SSI防控EBP的成功实施是至关重要的, 多模式实施策略是促进EBP落实的常见方法, 未来需进一步规范实施科学方法的应用和完善实施策略的效果评估, 为EBP在临床实践中的持续、广泛应用提供参考。

     

    Abstract:
    OBJECTIVE To evaluate the application effect of implementation strategies in the prevention and control of surgical site infection (SSI), and to review its research progress.
    METHODS A scoping review method was employed, involving systematic searches across databases such as Web of Science, PubMed, Cochrane, CNKI and Wanfang. After screening based on the inclusion and exclusion criteria, the included literature was analyzed and reported in a standardized manner.
    RESULTS A total of 47 articles were included. Most studies adopted comprehensive evidence-based practices (EBP) (≥2 types) and employed multimodal implementation strategies (≥3 items) to facilitate the implementation of SSI prevention and control EBP. Within the framework of the WHO multimodal strategy, 42, 39, 39 and 24 studies respectively applied the four implementation strategies of system change, education and training, monitoring and feedback and reminder and communication, while only 9 studies applied the strategy of creating a safety culture. The highest proportion of studies (31.91%, 15/47) employed a combination of four implementation strategies, with the common combination being "system change + education and training + monitoring and feedback + reminder and communication" (29.79%, 14/47), and this combination of four implementation strategies demonstrated outstanding performance in enhancing EBP compliance. Totally 26(55.32%) showed decrease in the incidence of SSI after intervention(P < 0.05).
    CONCLUSIONS Implementation strategies are crucial for the successful implementation of SSI prevention and control EBP. Multimodal implementation strategies are common approaches to facilitate the implementation of EBP. In the future, it is necessary to further standardize the application of scientific methods and improve the effect evaluation of implementation strategies, providing a reference for the sustained and widespread application of EBP in clinical practice.

     

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