手外科开放性创伤术后伤口感染危险因素分析及预防对策

Risk factors of wound infections after open trauma surgery in hand surgery department and prevention countermeasures

目的探讨手外科开放性创伤术后伤口感染的危险因素,总结预防对策,指导临床对其预防。方法选择2010年5月-2012年5月进行手外科手术的50例开放性创伤患者,分析导致伤口感染的危险因素,总结预防伤口感染的相关措施。结果 50例患者中有14例发生手术伤口感染,感染率为28.0%;伤口污染严重与污染较轻的患者感染率分别为42.8%与17.2%;手术时限>8h与≤8h伤口感染率分别为36.3%与21.4%;手术过程中有与无侵入性操作的患者切口感染分别为40.9%与17.9%;手术后存在死腔与无死腔的患者切口感染分别为52.4%与10.3%;术后组织坏死与无坏死的患者感染率分别为45.5%与14.3%;皮肤完整覆盖与未完整覆盖的患者感染率分别为52.2%与7.2%,差异有统计学意义(P<0.05)。结论医护人员应做好各方面的消毒灭菌工作,手术过程中操作要规范合理,护士应协助手术医师尽快顺利的完成手术,并做好术后相关护理工作,以防止手外科手术伤口感染的发生。

OBJECTIVE To discuss the risk factors and prevention countermeasures of hand surgical wound infec- tions so as to summarize preventive countermeasures and provide clinical guidance for its prevention. METHODS Totally 50 cases of hand surgery patients were selected, then the risk factors associated with the wound infections were analyzed, and the prevention countermeasures were concluded. RESULTS There were 14 cases in fifty patients who occurred the wound infection, and the infection rate was 28.0%. The infection rate of the patients with wound seriously polluted was 42. 8%, the patients with lighter wound pollution 17.2% ; the infection rate of the patients with the operation time more than 8h was 36.3%, the patients with the operation time less than 8 h 21.4% ; the infection rate of the patients with invasive operation was 40.9%, the patients without invasive opera- tion 17.9%;the infection rate of the patients with dead space was 52.4%, the patients without the dead cavity 10.3%; the infection rate of the patients with tissue necrosis was 45.5%, the patients without tissue necrosis 14.3%, the infection rate of the patients with skin complete coverage was 7.2%, the patients without skin com- plete coverage 52. 2%, the difference was statistically significant （P〈0.05）. CONCLUSION The medical staff should try their best to complete the disinfection work, remind the surgery physicians of standard surgery opera- tion, assist surgery physicians to complete surgery well, and complete the nursing service so as to avoid the surgi- cal wound infections in hand surgery department.