“结构-过程-结果”联动视域下围术期感染防控体系的构建与效果评价

Development of a mechanism for perioperative infection prevention and controlfrom “structure-process-outcome” linkage perspective and its effect

  • 摘要: 目的 基于“感术行动”实践经验,系统探讨围术期感染防控长效机制的构建路径,总结可推广的管理启示。方法 采用前后对照设计,选取南京市溧水区人民医院2024年7月-2025年6月9 532例择期手术患者,分为对照组(2024.7-12,n=4728)与干预组(2025.1-6,n=4804)。干预组实施以Donabedian三维质量模型为框架的系统化、全流程综合干预,涵盖标准化术前准备、术中无菌与体温管理、术后管路与加速康复措施,并建立多部门协同与信息化监测机制。结果 过程性指标方面,干预组术中主动保温率由93.55%提升至99.21%(P<0.001),呼吸功能训练有效执行率由23.82%提升至53.46%(P<0.001),术中低体温发生率由0.08%降至0.04%,但差异无统计学意义(P=0.410)。干预组较对照组各项感染防控指标显著改善:术前皮肤清洁合格率由45.60%提升至86.74%,去除毛发正确率由43.78%提升至73.42%(均P<0.001);总体手术部位感染率由1.04%降至0.37%(P<0.001);术后肺炎发生率由1.18%降至0.65%(P=0.006);抗菌药物规范使用率显著提高,术前0.5~1 h给药率达99.24%(对照组95.15%),Ⅰ类切口24 h内停药率达98.30%(对照组94.46%)(均P<0.001)。结论 “感术行动”通过构建系统化、标准化、信息化的围术期感染防控体系,能有效降低感染发生率,其经验可为基层医疗机构提供可复制推广的管理范本。

     

    Abstract: OBJECTIVE To systematically explore the development pathway of a long-term mechanism for perioperative infection prevention and control based on the practical experience of the "Perioperative Infection Control Initiative", thereby summarizing generalizable management insights. METHODS Based on a before-and-after comparative design, we enrolled a total of 9 532 elective surgery patients at Nanjing LiShui People's Hospital from Jul. 2024 to Jun. 2025. The patients were divided into a control group (from Jul. 2024 to Dec. 2024, n=4 728) and an intervention group (from Jan. 2025 to Jun. 2025, n=4 804). The intervention group received systematic, full-process comprehensive interventions based on the Donabedian three-dimensional quality model, covering standardized preoperative preparation, intraoperative aseptic and temperature management, postoperative catheter care, and enhanced recovery measures. A multi-departmental collaboration and an informatized monitoring mechanism were also established. RESULTS In terms of process indicators, the intervention group showed significant improvements: the intraoperative active warming rate increased from 93.55% to 99.21% (P<0.001), the effective execution rate of respiratory function training rose from 23.82% to 53.46% (P<0.001), and the incidence of intraoperative hypothermia decreased from 0.08% to 0.04%, though the difference was not statistically significant (P=0.410). Compared with the control group, the intervention group demonstrated significant improvements in infection prevention and control indicators: preoperative skin cleaning compliance increased from 45.60% to 86.74%, and correct hair removal practices improved from 43.78% to 73.42% (both P<0.001). The overall surgical site infection rate decreased from 1.04% to 0.37% (P<0.001), and the postoperative pneumonia rate dropped from 1.18% to 0.65% (P=0.006). The standardized use of antimicrobial agents significantly improved, with preoperative administration within 0.5-1 hour reaching 99.24% (vs. 95.15% in the control group) and discontinuation within 24 hours for type I incisions reaching (98.30% vs. 94.46% in the control group) (both P<0.001). CONCLUSIONS The "Perioperative Infection Control Initiative," through the establishment of a systematic, standardized, and informatized perioperative infection prevention and control system, effectively reduces infection rates. Its experience provides a replicable and scalable management model for primary hospitals.

     

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