外科手术部位感染目标性监测结果分析

Targeted monitoring of surgical site infections

目的探讨外科手术部位感染(SSI)的危险因素,并针对高危因素提出干预措施。方法确定监测对象,填写统一表格,由医院感染管理科专职人员根据病历记载、现场切口查看及出院后电话随访等方式了解SSI情况。结果共监测手术患者625例,SSI发生率为4.48%,以阑尾切除术感染率最高,为12.82%;术中出血量≥1500ml者感染率为20.00%,高于出血量<1500ml者感染率的4.23%(χ2=5.72,P=0.017);开放性切口者感染率23.08%,高于闭合性切口者感染率的4.08%(χ2=10.37,P=0.001);手术前患者具有全身感染者感染率18.42%,高于未合并感染者感染率的3.58%(χ2=18.38,P<0.001);Ⅰ类切口感染率2.06%、Ⅱ类切口感染率3.29%、Ⅲ类切口感染率13.04%、Ⅳ类切口感染率19.23%(χ2=20.70,P<0.001);手术危险指数0分感染率2.44%、1分感染率7.10%、2分感染率8.00%、3分感染率14.29%(χ2=9.75,P=0.021);术前预防性使用抗菌药物时间越临近手术开始时间,感染率越低;术后抗菌药物使用时间>72h者感染率高于使用时间<72h者,28.6%的SSI发生于拆线后,其中Ⅰ、Ⅱ类切口拆线后感染发生比例为35.29%,高于Ⅲ、Ⅳ类切口拆线后的感染发生比例18.18%。结论术中出血量、切口类型、术前有无感染性疾病、切口部位是否为开放性创伤、手术危险指数与SSI的发生密切相关,针对这些危险因素,采取适当的干预措施,有效降低SSI发生率。

OBJECTIVE To investigate the related risk factors of surgical site infections（SSI）,and to put forward the intervention measures for the high risk factors.METHODS The monitoring objects were determined,the unified tables were filled out,and the incidence rates of SSI were investigated by the professional staff＇s checking the medical records,on-site examination of surgical incision,and the phone-call following up after the discharge from the hospital.RESULTS Among 625 patients undergoing surgeries,the incidence rate of the SSI was 4.48%,the infection rate of the patients undergoing appendectomy was the highest（12.82%）.The incidence of SSI in the patients with the blood loss ≥1500 ml was 20.00%,higher than 4.23% in the patients with the blood loss 1500 ml,（χ2=5.72,P=0.017）,the incidence of SSI in the opening incision was 23.08%,higher than 4.08% in the closed incision（χ2=10.37,P=0.001）;the incidence of SSI in the preoperative infections was 18.42%,higher than 3.58% in the patients without preoperative infections（χ2=18.38,P0.001）.The incidence of class Ⅰ incision infections was 2.06%,the incidence of class Ⅱ incision infections was 3.29%,the incidence of class Ⅲ incision infections was 13.04%,the incidence of class Ⅳ incision infections was 19.23%,（χ2=20.70,P0.001）.The incidence of class 0 surgical risk index infections was 2.44%,the incidence of class 1 surgical risk index infections was 7.10%,the incidence of class 2 surgical risk index infections was 8.00%,the incidence of class 3 surgical risk index infections was 14.29%,（χ2=9.75,P=0.021）.The closer the time of preoperative prophylactic use of antibiotics was to the start of the surgery,the lower the incidence of infections,the incidence rate of infections was higher in the patients with the use of antibiotics more than 72 hours after operation than in the patients with less than 72 hours,28.6% of the patients with SSI occurred after the stitches removal,among which the patients with infections took a proportion of 35.29% after the stitches removal of the type Ⅰ and Ⅱ surgical incisions,higher than 18.18% of the type Ⅲ and Ⅳ surgical incisions.CONCLUSION The intraoperativeblood loss,incision types,preoperative infectious diseases,and the incision sites,open trauma,and surgical risk index are the closely associated with the incidence of SSI.The targeted and appropriate interventions,aiming at the risk factors,should be taken to effectively reduce the incidence of SSI.