降低感染率的围手术期策略：综合性循证医学路径.docVIP

Perioperative Strategies for Decreasing InfectionA Comprehensive Evidence-Based Approach降低感染率的围手术期策略：综合性循证医学路径 Joseph A. Bosco, III, MD1, James D. Slover, MD, MS1 and Janet P. Haas, RN, PhD2?1 Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for J.A. Bosco III: joseph.bosco@. E-mail address for J.D. Slover: james.slover@2 Infection Prevention and Control, Westchester Medical Center, 100 Woods Road, Macy Pavilion SW246, Valhalla, NY 10595. E-mail address: Haasj@?An Instructional Course Lecture, American Academy of Orthopaedic Surgeons?Introduction?引言?Surgical site infections associated with orthopaedic surgical procedures are devastating complications. They increase morbidity, mortality, and cost and result in outcomes that are worse than those in uninfected cases1. Decreasing the incidence of surgical site infections is not only of interest to patients and surgeons, it is also a major focus of several groups of interested parties. These range from payers, including the Centers for Medicare and Medicaid Services (CMS, Baltimore, Maryland), to institutions represented by the Surgical Care Improvement Project (SCIP), a multiple-institution partnership between major public and private health-care organizations, including the Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, Illinois). Decreasing the incidence of surgical site infections is, and will continue to be, a major focus in medicine.?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，Oakbrook Terrace, 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。To effectively prevent surgical site infections, the clinician must consider preoperative, intraoperative, and postoper