清洁手术术中追加抗菌药物对手术部位感染预防控制效果的研究

Effect of intraoperative re-dosing of antibiotics on prevention and control of surgical site infections in patients undergoing clean surgery

目的了解某三级甲等医院术中追加抗菌药物对清洁手术手术部位感染预防控制的效果。方法根据流行病学类实验的研究方法,进行自身前后比较：第一阶段（2012年1月1日-2013年12月31日）对全院清洁手术（Ⅰ类切口）患者开展手术部位感染前瞻性、目标性监测,了解清洁手术手术部位感染率;第二阶段（2014年1月1日-2015年12月31日）,采取干预措施、提高术中追加抗菌药物的比例,以降低手术部位感染率,根据干预前后的结果评价手术部位感染预防控制效果。结果观察期间,清洁手术患者共计23 622例次,65岁以上患者占43.9%;女性14 418例次,占57.9%;ASA评分为Ⅰ-Ⅱ的占88.6%;择期手术23 434台,占99.2%;清洁手术预防使用抗菌药物的比例为26.9%;切皮前0.5~2h用药比例为93.4%;术后24h停药比例为65.3%;上述三项指标干预前后的差异无统计学意义;干预前后SSI发生率从0.7%降至0.4%,RR值为1.608（95%CI：1.130~2.288）;≥3h的手术,干预前后的SSI发生率从5.9%降至1.8%,RR值为3.432（95%CI：1.764~6.675）;术中追加药物比例从44.2%提高到70.7%,差异有统计学意义（χ2=89.861,P〈0.05）。结论通过术中追加抗菌药物,可以有效降低清洁手术手术部位感染,为管理层采取进一步的预防控制措施提供参考。

OBJECTIVE To understand the effect of intraoperative re-dosing of antibiotics on prevention and control of surgical site infections in patients undergoing clean surgery in a three-A general hospital.METHODS By means of epidemiological experiment,a self comparison was conducted,the first stage was from Jan 1,2012 to Dec 31,2013,the prospective,targeted monitoring of surgical site infections was carried out for the patients who underwent the clean surgery（the typeⅠincision）so as to understand the incidence of the surgical site infections.The second stage was from Jan 1,2014 to Dec 31,2015,the intervention measures were taken and the proportion of intraoperative re-dosing of antibiotics was raised so as to reduce the incidence of surgical site infections.The effects on prevention and control of the surgical site infections were evaluated before and after the interventions were taken.RESULTS Of totally 23 622case-times of patients who underwent the clean surgery during the observation period,43.9% were more than 65 years old,57.9%（14 418case-times）were females,88.6% were with the ASA score varying from ⅠtoⅡ,and 99.2%received 23 434 selective surgeries.The proportion of the antibiotics prophylaxis for the clean surgery was 26.9%,the proportion of the drug administration at 0.5-2hours before skin incision was 93.4%,and the proportion of drug withdrawal after the surgery for 24 hours was 65.3%;there was no significant difference in the three above indexes before and after the intervention.The incidence of SSI dropped from 0.7% before the intervention to 0.4% after the intervention,with the RR value 1.608（95%CI：1.130-2.288）.The incidence of SSI in the patients with operation duration no less than 3hours dropped from5.9% before the intervention to 1.8% after the intervention,with the RR value 3.432（95%CI：1.764-6.675）.The proportion of the intraoperative re-dosing of antibiotics ascended from 44.2% to 70.7%,and there was significant difference（χ2=89.861,P〈0.05）.CONCLUSIONS The intraoperative re-dosing of antibiotics can effectively reduce the incidence of the surgical site infections in the patients undergoing the clean surgery and provide guidance for further prevention and control of the surgical site infections.