老年患者骨科植入物手术医院内获得性感染分析及防控对策

Hospital acquired infection following orthopaedic implant surgery in elderly patients and its prevention and control countermeasures

目的：分析老年患者骨科植入物手术医院内获得性感染（ HAI ）的发生率及危险因素，探讨防控对策。方法回顾分析2013年7月1日至2015年6月30日期间在广州军区广州总医院行骨科植入物手术的老年患者1338例。统计分析HAI的发病情况及危险因素。结果发生HAI 103例，感染率7．7％。最常见的HAI部位为下呼吸道，占总感染的36．97％，其次为泌尿系统和手术深部切口，分别占35．29％和10．08％。共检出细菌数116株，多重耐药菌占63．79％，其中排在前5位细菌分别是大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和屎肠球菌。性别、年龄、手术类型、合并基础疾病、手术时间、术中输血量、术中输液量、住院时间和术前住院时间、侵入性操作和美国麻醉师协会（ ASA）评分与骨科植入物手术HAI发生率密切相关（P＜0．05）。结论为降低骨科老年患者植入物手术HAI的发生率，应注重老年患者骨科围手术期的各个环节：术前应做好充分评估，有效控制基础疾病；术中应尽量缩短手术时间，减少术中出血及输液量；术后需加强对呼吸机、中心静脉导管、导尿管等侵入性操作的流程管理。

Objective To analyze the incidence and risk factors of hospital acquired infection （ HAI） in the elderly patients with orthopaedic implant surgery , and to investigate the prevention and control countermeasures .Methods Clinical data of 1338 elderly patients underwent orthopaedic implant surgery in Guangzhou General Hospital from July 2013 to June 2015 were collected and analyzed retrospectively .The incidence and risk factors of HAI were studied and analyzed .Results There were 103 patients suffering from HAI, with an infection rate of 7.7%.The common sites of HAI were lower respiratory tract （36.97%）, followed by urinary system （35.29%） and deep surgical site （10.08%）.In the 116 obtained strains of pathogenic bacteria , multidrug resistant bacteria accounted for 63.79%, and the top 5 strains were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus faecium.Univariate analysis showed gender , age, operation type, complicated basic diseases, operation time, intra-operative transfusion volume , length of hospital stay , preoperative hospitalization days , invasive procedure and American Society of Anesthesiologists （ASA） score were closely associated with HAI in the elderly receiving orthopaedic implants （P〈0.05）. Conclusion To decrease the incidence of HAI for the elderly patients with orthopaedic implant surgery , clinicians should pay attention to every aspect of orthopaedic surgery , that is, preoperatively , fully evaluating the conditions and effectively controling the underlying diseases in the patients; intra-operatively , trying to shorten the operation time and reducing blood loss and transfusion volume ; and post-operatively , strengthening the process management for ventilator , central venous catheterization , urinary catheterization and other invasive procedures .