建立預防脊椎手術部位感染臨床照護指引

Establishing Evidence-Based Guidelines for Clinical Care to Prevent Surgical Site Infection after Spinal Surgery

10.6142/VGHN.201912_36(4).0007

楊淑華(Shu-Hua Yang)；溫美蓉(Mei-Rong Weng)；李侑達(Yu-Tai Lee)

脊椎手術 ； 預防手術部位感染 ； 臨床照護指引 ； spinal surgery ； surgical site infection ； prevention ； clinical guidelines

榮總護理

36卷4期（2019 / 12 / 01）

386 - 398

繁體中文

手術部位感染是常見的院內感染之一，不僅造成再入院率增加，還會導致住院天數延長、醫療成本增加，嚴重者甚至造成敗血症及增加死亡風險，如果是脊椎手術部位深部感染將導致身體活動限制，影響生活品質；因此預防手術部位感染是一個重要的議題。本指引透過JBI實證照護架構分四階段進行：第一階段臨床照護指引工作小組的籌組及運作；第二階段進行2002-2019年完整文獻搜尋，依證據評析標準納入8篇臨床照護指引及16篇系統文獻回顧研究，作為發展指引依據；第三階段臨床照護指引草案之效度檢定；第四階段邀請9位專家及42位臨床相關醫療人員進行專家效度問卷及臨床可行性調查，最後建置42項預防脊椎手術部位感染之臨床照護指引。本指引能作為醫療照護成員進行臨床實務之參考，進而降低脊椎手術部位感染的發生率。

Surgical site infection, a common nosocomial infection, prolongs hospital stay and increases readmission rate, medical costs, and sepsis and mortality risks. Deep infection of the spinal surgery site typically limits post-operative physical activity and decreases quality of life. Therefore, the prevention of surgical site infection is a critical problem. In this project, evidence-based guidelines for the prevention of surgical site infection in spinal surgery was constructed using the Joanna Briggs Institute evidence care framework. The clinical guidelines were developed in four phases: Phase I involved convening a team for the project, Phase II involved conducting a comprehensive systematic review including 8 clinical guidelines and 16 systematic review studies published between 2002 and 2019, Phase III involved assessing the validity of the draft clinical guidelines, and Phase IV involved inviting 9 experts and 42 clinically relevant medical personnel to complete expert validity questionnaires and conduct a clinical feasibility investigation. Finally, a 42-item clinical guideline for the prevention of spinal surgical site infection was established. These clinical care guidelines may serve as a reference in clinical practice for medical staff, thereby reducing the incidence of spinal surgical site infection.

1. (2017)。護理研究與應用。台北:華杏。
2. Anderson, D. J.,Kirkland, K. B.,Kaye, K. S.,Thacker, P. A.,2nd, Kanafani, Z. A.,Auten, G.,Sexton, D. J.(2007).Underresourced hospital infection control and prevention programs: Penny wise, pound foolish?.Infection Control and Hospital Epidemiology,28(7),767-773.
3. Andrew Glennie, R.,Dea, N.,Street, J. T.(2015).Dressings and drains in posterior spine surgery and their effect on wound complications.Journal of Clinical Neuroscience,22(7),1081-1087.
4. Bachoura, A.,Guitton, T. G.,Smith, R. M.,Vrahas, M. S.,Zurakowski, D.,Ring, D.(2011).Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care.Clinical Orthopaedics Related Research,469(9),2621-2630.
5. Bernatz, J. T.,Anderson, P. A.(2015).Thirty-day readmission rates in spine surgery: Systematic review and metaanalysis.Neurosurgical Focus,39(4),E7.
6. Blood, A. G.,Sandoval, M. F.,Burger, E.,Halverson-Carpenter, K.(2017).Risk and protective factors associated with surgical infections among spine patients.Surgical Infection,18(3),234-249..
7. Centers for Disease Control and Prevention. (2009, March). The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Retrieved from https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf
8. Consoritum, A. N. S. (2017). The AGREE II Instrument. Retrieved from https://www.agreetrust.org/
9. Dao Le, L. K. (2016). Surgical Site Infection: Preoperative Evaluation and Preventive Measures [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resources website: http://joannabriggslibrary.org/
10. Fei, Q.,Li, J.,Lin, J.,Li, D.,Wang, B.,Meng, H.,Yang, Y.(2016).Risk factors for surgical site infection after spinal surgery: A meta-analysis.World Neurosurgery,95,507-515.
11. Fong, E. (2017). Surgical Site Infection: Post- Anesthesia and Post-Operative Management [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resources website: http://joannabriggslibrary.org/
12. Jiang, J.,Teng, Y.,Fan, Z.,Khan, S.,Xia, Y.(2014).Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis.Clinical Orthopaedics and Related Research,472(3),968-975.
13. Joanna Briggs Institute. (2014). JBI levels of evidence. Retrieved from http://joannabriggs.org/jbi-approach.html#tabbednav=Levels-of-Evidence
14. Joaquim, A. F.,Milano, J. B.,Daniel, J. W.,Dantas, F. L. R.,Onishi, F. J.,Bertolini, E. d. F.,Botelho, R. V.(2018).Spine surgery-the use of vancomycin powder in surgical site for postoperative infection prevention.Revista da Associação Médica Brasileira,64(8),663-669.
15. Korol, E.,Johnston, K.,Waser, N.,Sifakis, F.,Jafri, H. S.,Lo, M.,Kyaw, M. H.(2013).A systematic review of risk factors associated with surgical site infections among surgical patients.PLoS One,8(12),e83743.
16. Krueger, R. A.,Casey, M. A.(2009).Focus Groups: A Practical Guide for Applied Research.SAGE Publications.
17. Liu, J. M.,Chen, W. Z.,Fu, B. Q.,Chen, J. W.,Liu, Z. L.,Huang, S. H.(2016).The use of closed suction drainage in lumbar spinal surgery: Is it really necessary?.World Neurosurgery,90,109-115.
18. Liu, Y.,Li, Y.,Miao, J.(2016).Wound drains in posterior spinal surgery: A meta-analysis.Journal of Orthopaedic Surgery and Research,11(1),16.
19. Martin, E. T.,Kaye, K. S.,Knott, C.,Nguyen, H.,Santarossa, M.,Evans, R.,Jaber, L.(2016).Diabetes and risk of surgical site infection: A systematic review and meta-analysis.Infection Control & Hospital Epidemiology,37(1),88-99.
20. Meng, F.,Cao, J.,Meng, X.(2015).Risk factors for surgical site infections following spinal surgery.Journal of Clinical Neuroscience,22(12),1862-1866.
21. Moola, S. (2017). Spinal Surgery: Prevention and Management of Infection [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resources website: http://joannabriggslibrary.org/
22. National Healthcare Safety Network (2017, January 25). Centers for Disease Control and Prevention. Surgical site infection (SSI) event. Retrieved from http://www.cdc.gov/nhsn /pdfs/pscmanual/9pscssicurrent.pdf
23. Nguyen, D. H. (2018). Wound Management: Dressing [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resourceswebsite: http://joannabriggslibrary.org/
24. Nota, S. P. F. T, Braun, Y.,Ring, D.,Schwab, J. H.(2015).Incidence of surgical site infection after spine surgery: What is the impact of the definition of infection?.Clinical Orthopaedics and Related Research,473(5),1612-1619.
25. Parchi, P. D.,Evangelisti, G.,Andreani, L.,Girardi, F.,Darren, L.,Sama, A.,Lisanti, M.(2015).Postoperative Spine Infections.Orthopaedic Reviews,7(3),5900.
26. Parker, M. J.,Livingstone, V.,Clifton, R.,McKee, A.(2007).Closed suction surgical wound drainage after orthopaedic surgery.Cochrane Database System Review,3,Cd001825.
27. Poelstra, K. A.,Stall, A.,Gelb, D.,Ludwig, S. C.(2008).Mechanisms and treatment of postoperative wound infections in instrumented spinal surgery.Current Orthopaedic Practice,19(4),372-375.
28. Shaffer, W. O.,Baisden, J. L.,Fernand, R.,Matz, P. G.(2013).An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery.The Spine Journal,13(10),1387-1392.
29. Sharma, L. (2017). Dressings: Prevention of Surgical Site Infections [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resources website: http://joannabriggslibrary.org/
30. Slade, S. (2017). Wound Management: Hydrogen Peroxide [Evidence summary]. Retrieved from Joanna Briggs Institute EBP Resources website: http://joannabriggslibrary.org/
31. Sørensen, L. T.(2012).Wound healing and infection in surgery: The clinical impact of smoking and smoking cessation: A systematic review and meta-analysis.Archives of Surgery,147(4),373-383.
32. Waly, F.,Alzahrani, M. M.,Abduljabbar, F. H.,Landry, T.,Ouellet, J.,Moran, K.,Dettori, J. R.(2015).The outcome of using closed suction wound drains in patients undergoing lumbar spine surgery: A systematic review.Global Spine Journal,5(6),479-485.
33. Yao, R.,Tan, T.,Tee, J. W.,Street, J.(2018).Prophylaxis of surgical site infection in adult spine surgery: A systematic review.Journal of Clinical Neuroscience,52,5-25.
34. Yilmaz, E.,Blecher, R.,Moisi, M.,Ankush, C.,O'Lynnger, T. M.,Abdul-Jabbar, A.,Oskouian, R. J.(2018).Is there an optimal wound closure technique for major posterior spine surgery? A systematic review.Global Spine Journal,8(5),535-544.
35. Zhang, L.,Li, E. N.(2018).Risk factors for surgical site infection following lumbar spinal surgery:A meta-analysis.Therapeutics and Clinical Risk Management,14,2161-2169.