Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions. Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions. Forty studies were included. Implementation interventions used most frequently (“top five”) were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3–5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant. In SSI prevention in abdominal surgery, mostly standard bundles of implementation interventions are applied. While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results, use of standard interventions such as audit and feedback, organizational culture, monitoring, reminders, and education at least does not seem to represent preventive malpractice. Further research should determine implementation interventions, or bundles thereof, which are most effective in promoting compliance with SSI-preventive measures in abdominal surgery.

中文翻译：

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预防腹部手术中手术部位感染的实施干预措施：系统评价

尽管有循证的预防措施，手术部位感染（SSI）在腹部手术中仍很普遍。由于准则不是自我实施的，并且SSI预防性合规性经常不足，因此已经开发了实施干预措施以促进合规性。本系统综述旨在确定用于腹部手术的实施干预措施，以预防SSI并确定与SSI降低的相关性。文献于2018年4月进行检索（Medline / PubMed和Web of Science核心收藏）。实施干预措施使用EPOC分类法的实施子类别（Cochrane审查小组有效实践和护理组织，EPOC）进行分类。此外，还对实施干预措施数量之间的关联进行了有效性分析，具体组成，以及绝对和相对SSI风险降低。包括四十项研究。最常用的实施干预措施（“前五名”）是审核和反馈（占研究的80％），组织文化（占70％），监控医疗服务的绩效（占65％），提醒（占53％）和教育会议（ 45％）。二十九项研究（72.5％）使用多模式策略（≥3种干预措施）。有效性分析显示，绝对和相对SSI风险显着降低。例如，在数值上，最大的绝对危险度降低10.8％与使用3-5种干预措施的十三项研究有关（p <.001）；但是，这是由于基线水平高于干预较少或干预更多的基线水平。采用前五项干预措施的研究最大的相对风险降低为52.4％，相比之下，则为43。不包括这些的人为1％。此外，采用不同数量的实施干预措施的研究（捆绑规模）之间或包括前五项干预措施的研究（相对于没有）之间的风险降低差异均不显着。在腹部手术的SSI预防中，大多数采用标准的实施干预措施。虽然按干预措施的数量和类型对SSI风险减少的差异进行有效性分析并没有得出结论性结果，但使用标准干预措施（例如审计和反馈，组织文化，监控，提醒和教育）似乎至少不代表预防不良行为。进一步的研究应确定实施干预措施或其组合，