以质量求发展，以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (12): 50-55.doi: 10.16460/j.issn1008-9969.2023.12.050

• 循证护理 • 上一篇    下一篇

预防骨植入术患儿手术部位感染循证实践方案的构建

阳丽芬1,2a, 张美雪2a, 李夕然3, 吴剑平2b, 王宁3   

  1. 1.南方医科大学 护理学院,广东 广州 510440;
    2.广州市妇女儿童医疗中心 a.手术室;b.儿童骨科,广东 广州 510630;
    3.南方医科大学第七附属医院 全科医学中心,广东 佛山 528200
  • 收稿日期:2022-11-01 出版日期:2023-06-25 发布日期:2023-07-10
  • 通讯作者: 王宁（1966-）,女,澳大利亚籍,教授,硕士研究生导师。E-mail：nwang57@hotmail.com
  • 作者简介:阳丽芬（1989-）,女,湖南耒阳人,本科学历,硕士研究生在读,主管护师。
  • 基金资助:
    广州市卫生健康科技项目（20231A011039）

Construction of evidence-based practice protocol for prevention of surgical site infection in children with bone implantation

YANG Li-fen1,2a, ZHANG Mei-xue2a, LI Xi-ran3, WU Jian-ping2b, WANG Ning3   

  1. 1. School of Nuring,Southern Medical University ,Guangzhou 510440,China;
    2a. Operating Room;2b. Dept. of Pediatric Orthopedics, Guangzhou Women and Children's Medical Center, Guangzhou 510630, China;
    3. General Practice Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan 528200, China
  • Received:2022-11-01 Online:2023-06-25 Published:2023-07-10

PDF (PC)

589

赞

摘要： 目的 构建预防骨植入术患儿手术部位感染（surgical site infection,SSI）循证实践方案,为患儿感染预防的临床实践提供参考与指导。方法 以JBI循证卫生保健模式为理论指导,系统检索国内外数据库获取预防骨植入术患儿SSI的相关文献,并对纳入文献进行质量评价,对符合质量标准的文献进行证据提取和汇总,初拟骨植入术患儿SSI的预防循证实践方案,采用德尔菲法通过2轮专家函询形成最终方案。结果 共纳入1篇计算机决策系统文献,6部循证指南,1篇专家共识,4篇系统评价。构建的预防骨植入术患儿SSI的循证实践方案涵盖了术前准备、环境控制、消毒隔离、术中管理、植入物管理、术后护理和组织管理7个维度共32条证据。2轮专家函询的积极度均为100%,权威系数为>0.9,肯德尔和谐系数分别为0.355（P<0.01）和0.352（P<0.01）。结论 基于循证和德尔菲法构建的预防骨植入术患儿SSI的循证实践方案具有科学性和实用性,可为预防骨植入术患儿SSI的临床实践提供参考与指导。

关键词: 儿童, 骨科, 植入物, 手术部位感染, 循证护理, 德尔菲法

Abstract: Objective To construct an evidence-based protocol for the prevention of surgical site infection (SSI) in children with bone implantation, and to provide reference and guidance for clinical practice. Methods Based on the theoretical guidance of JBI evidence-based healthcare model, we systematically searched domestic and international databases to obtain the literature pertaining to the prevention of SSI in children with bone implantation, evaluated the quality of the included literature, extracted and summarized the evidence from eligible literature. The initial version of the protocol was drawn up and a two-round Delphi procedure was carried out to develop the final version of the protocol. Results One evidence summary from a computerized decision-making system, six evidence-based clinical practice guidelines, one expert consensus, and four systematic evaluations were included. The evidence-based protocol for the prevention of SSI in children with bone implantation covered 32 items in 7 dimensions, including preoperative preparation, environmental control, disinfection and isolation, intraoperative management, implant management, postoperative care, and personnel training. The enthusiasm coefficient of the two rounds of expert consultation was 100%, the authority coefficient was>0.9, and the coordination coefficient was 0.355 (P<0.01) and 0.352 (P<0.01) respectively. Conclusion The evidence-based protocol for the prevention of SSI in children with bone implantation is developed based on a systematic review of evidence and Delphi method. It provides reference and guidance for the clinical practice.

Key words: children, orthopedics, implants, surgical site infection, evidence-based nursing, Delphi method

中图分类号: 

  • R473.72
[1] Ban KA, Minei JP,Laronga C,et al.American college of surgeons and surgical infection society:surgical site infection guidelines,2016 Update[J].J Am Coll Surg,2016, 224(1):59-74.DOI:10.1016/j.jamcollsurg.2016.10.029.
[2] Pawłowska I,Ziółkowski G,Wójkowska-Mach J,et al.Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study[J]. Int Orthop, 2019,43(9):2009-2016.DOI:10.1007/s00264-019-04298-x.
[3] McLaren AC, Lundy DW.AAOS Systematic literature review:summary on the management of surgical site infections[J]. J Am Acad Orthop Sur,2019,27(16):e717-e720.DOI:10. 5435/jaaos-d-18-00653.
[4] 阮狄克,李海峰,石磊.脊柱手术部位感染的早期诊断治疗与危险因素分析[J].中国骨伤,2019,32(10):879-881.DOI:10.3969/j.issn.1003-0034.2019.10.001.
[5] 张晶洁,李爽爽,唐绪容,等.儿童手术源性感染相关因素的临床研究[J].重庆医学,2018,47(2):173-176,179.DOI:10.3969/j.issn.1671-8348.2018.02.009.
[6] 朱梦芬. 骨科植入物手术切口感染的危险因素分析及防控措施[J].吉林医药学院学报,2019,40(3):187-188.
[7] Crews JD, Mina M, Johnson E, et al.Risk factors for surgical site infections following vertical expandable prosthetic titanium rib (VEPTR) surgery in children[J].Spine Deforn,2018,6(6):791-796.DOI:10.1016/j.jspd.2018.03.016.
[8] 胡雁,周英凤.循证护理:证据临床转化理论与实践[M].上海:复旦大学出版社,2021:73-131.
[9] Baddour LM, Prevention of prosthetic joint and other types of orthopedic hardware infection.[EB/OL].[2022-02-01].https://www.uptodate.cn/contents/prevention-of-prosthetic-joint-and-other-types-of-orthopedic-hardware-infection.
[10] Berríos-Torres SI, Umscheid CA, Bratzler DW, et al.Centers for disease control and prevention guideline for the prevention of surgical site infection,2017[J]. JAMA Surg,2017,152(8):784-791.DOI:10.1001/jamasurg.2017.0904.
[11] Leaper DJ, Edmiston CE.World health organization:global guidelines for the prevention of surgical site infection[J]. J Hosp Infect,2016,95(2):135-136.DOI: 10.1016/j.jhin.2016.12.016.
[12] Ling ML, Apisarnthanarak A, Abbas A, et al.APSIC guidelines for the prevention of surgical site infections[J].Antimicrob Resist Infect Control, 2019(8):174.DOI: 10.1186/s13756-019-0638-8.
[13] Link T.Guideline implementation: sterile technique[J].Aorn J,2019,110(4): 415-425. DOI:10.1002/aorn.12803.
[14] 白求恩公益基金会,中国康复技术转化及发展促进会,中国研究型医院学会,等.骨科择期手术加速康复预防手术部位感染指南[J].中华骨与关节外科杂志,2020,13(1):1-7. DOI:10.3969/j.issn.2095-9958.2020.01.01.
[15] 郭莉. 中华护理学会手术室护理专业委员会编制.手术室护理实践指南(2021年版)[M].北京:人民卫生出版社,2021:142-155.
[16] Glotzbecker MP, St Hilaire TA,Pawelek JB,et al.Best practice guidelines for surgical site infection prevention with surgical treatment of early onset scoliosis[J]. J Pediatr Orthoped,2019,39(8):e602-e607.DOI:10.1097/bpo.0000000000001079.
[17] Matsumoto H, Simhon ME, Campbell ML,et al.Risk factors associated with surgical site infection in pediatric patients undergoing spinal deformity surgery: a systematic review and Meta-analysis[J]. Jbjs Rev, 2020,8(3):e0163.DOI:10.2106/jbjs.rvw.19. 00163.
[18] Poe-Kochert C, Shimberg JL, Thompson GH, et al.Surgical site infection prevention protocol for pediatric spinal deformity surgery:does it make a difference?[J].Spine deforn,2020,8(5):931-938.DOI:10.1007/s43390-020-00120-6.
[19] Schömig F, Perka C,Pumberger M,et al.Implant contamination as a cause of surgical site infection in spinal surgery:are single-use implants a reasonable solution? - a systematic review[J].Bmc Musculoskelet Disord,2020,21(1):634.DOI:10.1186/s12891-020-03653-z.
[20] Floccari LV, Milbrandt TA.Surgical site infections after pediatric spine surgery[J].Orthop Clin N Am,2016,47(2):387-94.DOI:10.1016/j.ocl.2015.09.001.
[21] 杨丽潇,吴艳妮,周春兰,等.专业型护理硕士研究生临床实践效果评价指标体系构建[J].护理学报,2023,30(3):40-44.DOI:10.16460/j.issn1008-9969.2023.03.040.
[22] 王曾妍,高兴莲,崔宇杨,等.常态化疫情防控时期手术室感染防控四级督导体系的建立与实践[J].护理学报,2022,29(8):27-30.DOI:10.16460/j.issn1008-9969.2022.08.027.
[23] Esposito S, Terranova L, Macchini F,et al.Staphylococcus aureus colonization and risk of surgical site infection in children undergoing clean elective surgery: a cohort study[J].Medicine,2018, 97(27):e11097.DOI:10.1097/md.0000000000011097.
[24] 孙祥耀,海涌.儿童脊柱术后手术区域感染的临床现状[J].中国骨与关节杂志,2017,6(5):352-356.DOI:10.3969/j.issn.2095-252X.2017.05.007.
[25] 任平,顾莺,马丽丽,等. 神经外科患儿手术部位感染预防的循证实践[J]. 护理学杂志,2021,36(21):85-88;101. DOI:10.3870/j.issn.1001-4152.2021.21.085.
[26] 陈慧娟,李燕,张艳.骨科手术间射线暴露和辐射防护研究进展[J].护理研究,2019,33(7):1194-1197.DOI:10.12102/j.issn.1009-6493.2019.07.025.
[27] Singer G, Herron B,Herron D.Exposure from the large C-arm versus the mini C-arm using hand/wrist and elbow phantoms[J].J Hand Surg-am,2011,36(4):628-31.DOI:10.1016/ j.jhsa.2011.01.010.
[28] 周琦,高兴莲,胡娟娟,等.基于Pad清点系统优化骨科外来器械清点方法实践[J].护理学报,2022,29(12):25-27.DOI:10.16460/j.issn1008-9969.2022.12.025.
[29] Rhodes L,Nash C,Moisan A,et al.Does preoperative orientation and education alleviate anxiety in posterior spinal fusion patients?A prospective,randomized study[J]. J Pediatr Orthoped,2015,35(3): 276-9.DOI:10.1097/bpo.000000000000260.
[30] Tan T, Lee H, Huang MS,et al.Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary[J]. Spine J,2019,20(3):435-447.DOI:10.1016/j.spinee.2019.09.013.
[31] Du JY, Poe-Kochert C,Thompson GH,et al.Risk factors for early infection in pediatric spinal deformity surgery: a multivariate analysis[J].Spine Deform,2019,7(3):410-416.DOI:10.1016/j.jspd.2018.09.011.
[32] Balodimou SA, Papageorgiou EG, Dokoutsidou EE, et al.Greek nurses' knowledge on the prevention of surgical site infection: an investigation[J].J Wound Care,2018,27(12):876-884.DOI:10.12968/jowc.2018.27.12.876.
[1] 郭林芳, 张培莉, 侯晓雅, 李滢, 曹敏, 高超越. 肝癌化疗患者线上线下结合营养干预方案的构建[J]. 护理学报, 2025, 32(4): 1-5.
[2] 田美雨, 王翠玲, 高若男, 田佳, 刘怡. 妇科肿瘤科护士性健康照护培训方案的构建[J]. 护理学报, 2025, 32(4): 18-23.
[3] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[4] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[5] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[6] 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[7] 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[8] 全伊萍, 陈霞, 胡琼丹. 脑心健康管理师核心胜任力评价指标体系的构建[J]. 护理学报, 2024, 31(9): 5-9.
[9] 陈莹莹, 丁红, 张根生. 患儿术后谵妄影响因素的研究进展[J]. 护理学报, 2024, 31(9): 32-35.
[10] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[11] 符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[12] 纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[13] 张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[14] 陈芮, 王梅, 唐晓霞, 朱傲雪, 毛惠娜. 基于ERG理论的免疫检查点抑制剂治疗癌症患者护理需求方案的构建[J]. 护理学报, 2024, 31(7): 1-5.
[15] 周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!