Abstract Background Care bundles are used widely to prevent surgical-site infections (SSIs). Recent systematic reviews suggested larger effects from bundles with more interventions. These reviews were largely based on uncontrolled before–after studies and did not consider their biases. The aim of this meta-analysis was to determine the effectiveness of care bundles to prevent SSIs and explore characteristics of effective care bundles. Methods A systematic review, reanalysis, and meta-analysis of available evidence were undertaken. RCTs, controlled before–after studies, and uncontrolled before–after studies with sufficient data for reanalysis as interrupted time series studies (ITS) were eligible. Studies investigating the use of a care bundle, with at least one intraoperative intervention, compared with standard care were included. Results Four RCTs, 1 controlled before–after study, and 13 ITS were included. Pooled data from RCTs were heterogeneous. Meta-analysis of ITS resulted in a level change of −1.16 (95 per cent c.i.−1.78 to −0.53), indicating a reduction in SSI. The effect was larger when the care bundle comprised a higher proportion of evidence-based interventions. Meta-regression analyses did not show statistically significant associations between effect estimates and number of interventions, number of evidence-based interventions, or proportion of evidence-based interventions. Conclusion Meta-analysis of ITS indicated that perioperative care bundles prevent SSI. This effect is inconsistent across RCTs. Larger bundles were not associated with a larger effect, but the effect may be larger if the care bundle contains a high proportion of evidence-based interventions. No strong evidence for characteristics of effective care bundles was identified.

中文翻译：

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预防手术部位感染的围手术期护理包：荟萃分析

摘要 背景护理包广泛用于预防手术部位感染 (SSI)。最近的系统评价表明，干预措施越多，捆绑的效果就越大。这些评论主要基于不受控制的前后研究，并且没有考虑其偏见。本荟萃分析的目的是确定护理组合预防 SSI 的有效性，并探索有效护理组合的特征。 方法对现有证据进行了系统审查、重新分析和荟萃分析。随机对照试验、前后对照研究以及作为中断时间序列研究 (ITS) 具有足够数据进行重新分析的非对照前后研究均符合资格。纳入了调查使用至少一项术中干预的护理包与标准护理进行比较的研究。 结果纳入 4 项 RCT，其中 1 项为研究前后对照，13 项为 ITS。随机对照试验的汇总数据存在异质性。ITS 的荟萃分析导致水平变化为 -1.16（95% ci−1.78 至 -0.53），表明 SSI 降低。当护理包包含较高比例的循证干预措施时，效果更大。荟萃回归分析并未显示效果估计与干预数量、循证干预数量或循证干预比例之间存在统计学显着关联。 结论ITS 的荟萃分析表明，围手术期护理捆绑可以预防 SSI。这种效果在各个随机对照试验中并不一致。较大的护理包与较大的效果无关，但如果护理包包含高比例的循证干预措施，效果可能会更大。没有发现有力的证据证明有效护理包的特征。