剖宫产术后手术部位感染监测及干预研究

Study on surveillance of surgical site infection following caesarean sections and prevention strategy

目的:掌握剖宫产术后手术部位感染(surgical site infection,SSI)的年发生率,分析综合干预措施开展以来年发生率的变化趋势。方法:采用前瞻性设计,以2008年1月至2013年12月在我院接受剖腹产手术的患者为对象,通过对患者住院期间的监测和出院后的电话随访掌握SSI发生情况。同时建立和开展了以人人参与、多学科结合、综合干预为原则的干预策略。结果:共纳入6 821例剖宫产患者,342例患者发生SSI,总发生率为5.01%。院内监测和院外随访分别为127例(37.2%)和215例(62.8%)。SSI易发生在年龄较大,孕前BMI和ASA评分较高,手术时间较长,及合并糖尿病的患者中。自综合干预措施开展以来,SSI年发生率分别为9.74%、7.28%、5.55%、4.12%、3.05%和2.12%,随时间呈明显的下降趋势(z=9.45,P<0.01)。结论:以人人参与、多学科结合、综合干预为原则建立干预策略,加强对患者出院前后的积极监测是预防SSI发生的关键措施。

Objective：To acquire the accurate incidence rate of surgical site infection （SSI） among patients undergoing caesarean section （CS）,and analyze the variation trend since the implement of a comprehensive infection control program. Methods：This prospective study was conducted among adult patients who had undergone CS in a tertiary care hospital over a 6-year period since 2008. SSI cases among inpatients were identified by daily active surveillance whereas post-discharge surveillance was performed for outpatients through telephonic in-terviews. The variation of SSI occurrence during the study period was analyzed by Cochran-Armitage trend test. Results：A total of 6 821 pa-tients were enrolled and 341 SSI cases were identified during the study period,resulting in a grand mean incidence rate of 5. 0%. Patients with older age,higher pre-pregnancy BMI and ASA score,longer operation time and complicated with diabetes were more likely to suffer from SSI. The annual incidence proportion of SSI was 9. 74%,7. 28%,5. 55%,4. 12%,3. 05% and 2. 12%,respectively during 2008-2013,showing a significant decreasing trend （z=9. 45,P〈0. 01）. Conclusion：The results provide evidence in favor of a significantly decreasing trend in the occurrence of SSI after the implementation of a comprehensive SSI prevention program and surveillance.