手术部位感染目标性监测及干预效果评价

Targeted monitoring on surgical site infection and effect of intervention

目的了解手术部位感染(SSI)发病情况和集束化干预措施的依从性,评价集束化干预措施对SSI的控制效果。方法选取2013年10月—2014年9月全国29所医院开展的3类手术(大肠手术、腹式子宫切除手术、股骨颈修复手术)作为目标监测对象,其中2013年10月—2014年3月为基线调查期;2014年4—9月为项目干预期。结果共监测6 166例次手术,SSI发病率为1.64%,其中大肠手术、腹式子宫切除术和股骨颈修复手术SSI发病率分别为4.47%、1.03%和0.21%,3类手术P75时间分别为3、2和2 h。干预措施依从性:干预期多数措施依从性较基线期均有不同程度的提高,提高幅度最大的是大肠手术"手术部位含氯己定消毒剂消毒"选项(依从性提高了29.09%),其次为股骨颈修复手术的"术前沐浴"(提高26.24%),大肠手术的"术前沐浴"(提高22.95%)和"手术当日备皮"(提高20.75%)。3类手术SSI发病率干预前后比较,差异均无统计学意义(均P>0.05)。结论不同手术类型SSI发病率不同,干预期部分集束化措施依从性较基线期显著提高,但其干预效果有待进一步研究。

Objective To explore the incidence of surgical site infection （SSI）and compliance to bundled interven-tion measures,and evaluate the effect of bundled interventions on controlling SSI.Methods From October 2013 to September 2014,three types of surgeries （colorectal surgery,abdominal hysterectomy,and femoral neck repair sur-gery）in 29 hospitals in China were monitored,October 2013 to March 2014 was baseline investigated stage,April 2014 to September 2014 was intervention stage.Results A total of 6 166 episodes of surgeries were monitored,the incidence of SSI was 1 .64%,incidence of SSI following colorectal surgery,abdominal hysterectomy,and femoral neck repair surgery were 4.47%,1 .03%,and 0.21 % respectively.The P 75 time of three types of surgeries were 3,2,and 2 hours respectively.Compared with the baseline stage,the compliance to most intervention measures im-proved after intervention,the largest increase in the compliance to interventions was disinfection with chlorhexidine-containing disinfectant at surgical sites of colorectal surgery （increased by 29.09%）,followed by preoperative shower of femoral neck repair surgery （increased by 26.24%）,preoperative shower of colorectal surgery（increased by 22.95%）,and skin preparation on the day of operation （increased by 20.75%）.Incidences of SSI in three types of surgeries were not significantly different before and after intervention（all P 〉0.05）.Conclusion The incidences of SSI are different among different types of surgeries,the compliance to most bundled intervention measures has im-proved to some extent after intervention,but effectiveness of intervention measures needs to be further observed.