外科手术部位感染率低的原因分析及对策探讨

Analysis and Countermeasures of Low Surgical Site Infection Rate

目的分析外科手术部位感染率过低的原因,掌握手术部位感染诊断标准,减少医院感染漏报,及时发现医院感染流行趋势,采取控制措施,防止医院感染暴发。方法选择开展较多、手术部位一旦发生感染对患者安全威胁性较大的手术:包括胆囊切除或(和)胆管手术,结肠、直肠切除术,阑尾切除术,疝手术,乳房切除术,剖宫产,子宫切除术及附件切除术,全髋关节置换术,食道贲门手术,腰椎间盘摘除术,监测时间为2011年1月1日-6月30日及2012年1月1日-6月30日,共监测1 180例手术,对手术部位感染率进行对比分析。结果 2011年半年监测手术部位感染率1.99%,调整感染率4.74%;比国内报道低6～9倍;通过分析原因,对医院感染诊断标准再培训、加强病原微生物送检等,2012年半年监测手术部位感染率4.68%,调整感染率32.12%;与2011年比较差异有统计学意义(χ2=141.841,P=0.000)。结论手术部位感染率偏低的原因是医生漏报所致;采取整改措施后,提高了手术部位感染的识别能力,减少了漏报,对及时发现医院感染暴发具有重要意义。

Objective To analyze the reasons for low rates of surgical site infection,master the diagnostic criteria for surgical site infections,reduce nosocomial infection underreporting,and detect nosocomial infection trends in time,in order for hospitals to carry out control measures against the outbreak of nosocomial infections.Methods Most-performed surgeries with safety threat to patients when the surgical sites were infected were chosen to be studied,which included cholecystectomy or（and） bile duct surgery,colon,rectal resection,appendectomy,hernia surgery,mastectomy surgery,caesarean production,hysterectomy and oophorectomy,total hip arthroplasty,esophagus cardia surgery,and lumbar discectomy.Monitoring time was from January 1st to June 30th in 2011 and 2012.A total of 1 180 cases of surgery were monitored,and surgical site infection rates were analyzed and compared.Results The half-year surgical site infection rate in 2011 was 1.99%,and the adjusted infection rate was 4.74%,6 to 9 times lower than reported rates in our country.After analyzing reasons for the low rate,we retrained on nosocomial infection diagnostic criteria and strengthened pathogenic microorganism censorship.In 2012,the half-year surgical site infection rate was 4.68%,and the adjusted infection rate was 32.12%,which was significantly different from the year 2011（χ^2=141.841,P=0.000）.Conclusions Excessively low surgical site infection rate is caused by underreporting by the doctors.Through corrective measures,doctors＇ ability of identifying surgical site infection can be promoted,and underreporting can be reduced,which is significant in detecting the outbreak of nosocomial infections.