脑室镜引起手术后颅内感染暴发的监测与控制

Monitoring and controlling of outbreak of intracranial infection after neurosurgical operation caused by stereo-encephaloscope

目的调查神经外科手术后颅内感染暴发,找出传染源、传播途径,并采取有效感染控制措施。方法利用医院感染实时监测预警系统对颅脑手术患者进行目标性监测,对发生术后颅内感染患者进行流行病学调查分析。结果 2010年8月神经外科共开展颅内手术165例,术后颅内感染患者14例(开颅手术9例,脑室镜辅助手术5例),感染率为8.5%,超出本科室月平均感染率3.0%～5.0%;某主刀医师当月完成颅内手术15例,6例术后发生颅内感染,感染率为40.0%;其中脑室镜手术共9例,5例术后发生颅内感染,感染率为55.6%。结论脑室镜损坏导致低温等离子灭菌失败,可能是造成此次神经外科手术颅内感染流行的重要原因,更换新脑室镜、严格检测消毒灭菌效果、提高医护人员无菌操作技术有效控制此次医院感染暴发。

OBJECTIVE To investigate the outbreak of intraeranial infection after neurosurgical operation, to research possible infection sources and route of transmission, and to adopt effective infection control measures. METHODS We developed the targeted monitoring method by the real-time monitoring and early warning system to survey the intracranial infection after neurosurgical operation, and did epidemiological survey to intracranial infected cases. RESULTS Totally 165 neurosurgical operations were completed in Aug 2010 and 14 intracranial infected cases were confirmed. So the intracranial infection rate was 8. 5%, which exceeded 3. 0% - 5. 0% prewarning line of this department. The intracranial infection rate of one doctor was 40.0%, and 5 intracranial infected cases by stereo-encephaloscope operation was completed by this doctor. CONCLUSION The failure of subambient temperature plasma sterilizing caused by the damage of stereo-encephaloscope played an important role in the outbreak of intracranial infection. Changing the new stereo-encephaloscope, detecting the effect of sterilization, and enhancing the aseptic technique of the staff, the outbreak can be controlled effectively.