外科监护治疗改良方案 Surgical Care Improvement Projectppt课件.pptVIP

Organizations can make an impact in reducing their rate of surgical site infections by implementing processes surrounding these four aspects of surgical care. * An easier way to remember the aspects of care that the clinician impacts is this: C = Clipping rather than using razors A = Antibiotic timing, selection and duration T = Thermia, that is, patients will do better if their body temperature remains close to normothermia S = Sugar or glucose, control the glucose levels of all cardiac patients * There are three aspects of prophlyactic antibiotic administration: timely administration, using the appropriate antibiotic, and discontinuing the drug. It is important to note that when discussing antibiotics the quality measures are about the use of prophylactic antibiotics. This discussion is not appropriate for patients with pre-existing or postoperative infections. * The first quality measure is the proportion of patients that received antibiotics within one hour before the surgical incision. The exception to this is patients who require treatment with either vancomycin or flouroquinolones. Because those antibiotics must be infused over a one-hour time frame, they may be started within two hours before the incision. But for all other antibiotics, the performance measure looks at whether the antimicrobial is started within one hour before the incision is made. It is important to note that this measure focuses only on the start time, it does not address whether the drug was completely infused. Published studies as early as the late 1950s demonstrated that giving antibiotics within a one-hour time frame before the incision is made results in the lowest infection rates. A study by John Burke in 1961 demonstrated that antibiotics given up to about four hours after the incision were really no better than doing nothing at all to prevent infections. Antibiotics given at any significant length of time after the incision was made did not prevent surgical site infection