食管癌手术部位感染目标性监测分析

Targeted monitoring of surgical site infections due to esophageal cancer surgery

目的评价食管癌手术部位感染(SSI)的相关因素、围手术期抗菌药物应用及采取干预措施后感染控制效果,以控制SSI的发生,规范围手术期抗菌药物的使用。方法采用前瞻性调查方法,按预先设计的"手术切口调查表",由医院感染管理专职人员每天对食管癌手术患者手术部位及相关危险因素进行评估;调查分两个阶段,2011年1-6月为评估阶段(第1阶段);2011年7-12月为干预阶段(第2阶段),根据第1阶段发现的危险因素进行干预,比较两个阶段持续变化,以及采取干预措施后的效果。结果 2011年1-12月共监测食管癌手术患者323例,发生SSI 9例,感染率为2.79%;围手术期抗菌药物第2阶段较第1阶段有了明显的规范,术前30min～2h用药由第1阶段的62.18%提高至第2阶段的92.22%;术后使用抗菌药物49～72h,由第1阶段的2.56%提高至第2阶段的4.19%;>72h由第1阶段的97.44%下降至第2阶段的95.81%;三联抗菌药物使用由第1阶段的8.97%减少至第2阶段的2.99%。结论食管癌手术部位感染目标性监测有效降低了SSI的发生率,抗菌药物的围手术期使用得到了明显规范。

OBJECTIVE To evaluate the related factors of esophageal surgical site infections（SSI）,the use of perioperative antimicrobial agents and the effect on infection control after taking interventions so as to control the incidence of SSI and standardize the use of antibiotics during the perioperative period.METHODS By means of the prospective survey,the surgical sites and the related risk factors were evaluated every day by the hospital infection professional personnel with pre-designed urgical incision questionnaire.The survey consisted of two stages：Jan-Jun 2011 for the assessment stage and Jul-Dec for the intervention stage.The interventions were performed in response to the risk factors detected in the first stage,the sustained changes during the two stages were compared,and the effects after taking the interventions were evaluated.RESULTS Of totally 323 esophageal cancer patients monitored from Jan to Dec,2011,SSI occurred in 9 patients with the infection rates of 2.79%.The use of antibiotics during the second stage was significantly standardized as compared with the first stage.The utilization rate of antibiotics 30min-2 h before surgery increased from 62.18% in the first stage to 92.22% in the second stage.The utilization rats of antibiotics 49-72 h after the surgery increased from 2.56% in the first stage to 4.19% in the second stage,and the utilization rate of antibiotics more than 72 h after the surgery decreased from 97.44% in the first stage to 95.81% in the second stage.The utilization rate of three-drug declined from 8.97% in the first stage to 2.99% in the second stage.CONCLUSION The targeted monitoring of SSI of esophageal cancer surgery can effectively reduce the incidence of SSI and make the use of antibiotics significantly standardized.