综合干预策略对神经外科手术部位感染控制的效果评价

Effect evaluation of comprehensive intervention strategy on surgical site infection control

目的探讨综合干预策略对神经外科手术部位感染(Surgical site infection,SSI)的控制效果,以减少SSI感染率。方法 2010年10月开始,对神经外科病房采取渐进式干预措施,包括举办SSI预防控制宣传活动、全院开展学习卫生部《外科手术部位感染预防与控制技术指南》、医疗主管院长通过查房检查督导感染控制工作、科室内部定期学习交流SSI预防控制知识等,并对医院2009年10月-2010年9月(干预前)、2010年10月-2011年9月(干预后)神经外科手术患者的手术部位感染发生情况进行监测。结果干预前调查1 329例手术患者发生SSI 51例,干预后1 506例手术患者发生SSI 36例,总体SSI发生率由3.84%下降至2.39%,差异有统计学意义(χ2=4.971,P<0.05);其中,表浅切口SSI发生率由0.60%下降至0.40%,差异无统计学意义;器官腔隙SSI发生率由3.24%下降至1.99%,差异有统计学意义(χ2=4.351,P<0.05)。结论综合干预策略能提高医务人员对手术部位感染的预防控制意识,对神经外科手术部位感染控制有效。

OBJECTIVE To evaluate the effects of comprehensive intervention strategy on the control of surgical site infections （SSI）, so as to reduce the SSI. METHODS From Oct. 2010, incremental intervention measures were taken for neurosurgery wards, such as publicity on SSI prevention and control, learning about SSI Prevention and Control Technology Guide in our hospital, supervision of nosocomial infection management by the medical director, learning the knowledge of SSI prevention and control by department personnel regularly. The SSI status and incidence of SSI from Oct. 2009 to Sep. 2010（pre-intervention） and Oct. 2010 to Sep. 2011（post intervention） were monitored using standard methods in neurosurgery wards. RESULTS In the 12 months before interventions, the mean SSI rate was 3.84% （51 of 1329 patients）, which was significantly decreased to 2.39% （36 of 1506 patients） after interventions for the subsequent 12 months, and the difference was statistically significant （χ2=4. 971, P〈0.05）. The superficial SSI rates were 0. 60% （8 of 1329 patients） and 0. 40% （6 of 1506 patients） in pre and post intervention periods respectively, and the difference was not statistically significant. The organ space SSI rate was decreased significantly from 3. 24% （43 of 1329 patients） to 1. 99% （30 of 1506 patients）, and the difference was statistically significant （ 2 _ 4. 351, P 〈 0. 05）. CONCLUSION The comprehensive strategy could improve the realization the knowledge of SSI prevention and control and improve the awareness of the staff of surgical site infection prevention and control.