手术切口感染的危险因素分析与干预对策

Risk factors for surgical incision infections and intervention measures

目的分析手术切口感染的危险因素,并采取相对应的措施进行预防,以降低感染发生率。方法回顾性分析2009年11月-2012年11月885例在手术室行外科手术患者的临床资料,采用单因素及多因素非条件logistic回归分析,模型筛选采用Stepwise法,研究手术室内感染的危险因素。结果 885例手术患者中共感染8例,感染率为0.9%,而在感染的病原菌中,以金黄色葡萄球菌为主,检出4株占50.0%,其余依次为肺炎克雷伯菌2株占25.0%,假单胞菌属、幽门螺杆菌各1株,各占12.5%,金黄色葡萄球菌与其他病原菌比较差异有统计学意义(P<0.05);单因素分析显示,感染的危险因素包括年龄>60岁、合并外伤及基础疾病、手术时间>4h、抗菌药物使用不规范、急诊手术间、急诊手术、住院时间>15d、侵入性操作(P<0.05),而多因素分析显示,手卫生较差危险性最大(P=0.016)。结论手术切口感染的危险因素较多,临床应采取针对性预防对策,如采用微创操作、选用高标准手术间等,从而有效控制感染率。

OBJECTIVE To analyze risk factors for surgical incision infections, and take corresponding measures to prevent infections, in order to reduce the incidence. METHODS A retrospective analysis in the hospital during Nov. 2009 to Nov. 2012 was conducted on the clinical data of 885 patients who underwent surgical operations in the operating rooms. Risk factors for infections in the operating rooms were analyzed by using nonconditional lo- gistic regression with single factor and multiple factor analysis, the model selection was performed using stepwise method. RESULTS In this study, 8 patients were infected; the infection rate was 0.9%. Staphylococcus aureus was the main infectious pathogen, which was detected in 4 cases （50. 0%）, and the rest were 7 in 2 cases （25.0%）, Pseudornonas genus in 1 case （12.5%）, H. pylori in 1 case （12.5%）. The comparison between S. aureus and other bacterial pathogens had significant differences （P^0.05）. The single factor analysis showed that the hospital infection risk factors included age （more than sixty years）, complicated trauma and underlying diseases, duration of surgery more than 4 h, nonstandarized antibiotics use, emergency operating room, emergency surgery, length of hospital stay more than 15 d, and invasive procedures （P^0.05）, and the muttiple factor analysis showed that the poor hand hygiene was the greatest risk （P= 0. 016）. CONCLUSION There are many risk factors for surgical incision infection, and specific prevention countermeasures such as using minimally invasive operation and choosing high standard operating rooms should be taken so as to effectively control the infection rate.