预防骨植入术患儿手术部位感染循证实践方案的构建

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

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。

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.