骨外科患者术后医院感染因素及围手术期干预措施研究

Factors influencing postoperative nosocomial infection in patients with orthopedic surgery and perioperative intervention

目的探讨骨外科患者术后医院感染因素及围手术期干预措施,为临床预防及治疗提供有效手段。方法选取2014年9月-2016年7月医院骨外科收治的患者600例,所有患者填写统一制定的感染回顾调查表,详细记录性别、年龄、合并基础疾病等,实验室检查结果,全面评估患者医院感染情况,详细记录感染部位、感染时长等情况,对患者进行相关病原菌检查,对结果进行相关分析,制定基本因素的评估分界点,分析医院感染可能的危险因素。结果 600例骨外科住院患者术后发生医院感染68例,感染率为11.33%,其中交通事故患者发生医院感染18例占26.48%,股骨粉碎性骨折患者发生医院感染22例占32.35%;68例感染患者中呼吸道感染35例占51.47%,切口感染12例占17.65%,胃肠道感染19例占27.94%;将68例感染患者样本进行病原菌检测,共检出革兰阳性菌36株52.17%,革兰阴性菌32株占46.38%,真菌1株占1.45%;患者高龄、合并糖尿病、手术切口类型为II型、手术时机为急诊期医院感染率高,差异有统计学意义(P<0.05);患者年龄,合并糖尿病,切口类型及手术时机均是医院感染发生的独立危险因素。结论骨外科术后住院患者中股骨粉碎性骨折、跌倒骨折、交通事故是医院感染发生率较高群体,其中呼吸道感染为多发医院感染类型,医院感染的发生与患者高龄、合并糖尿病、手术切口II类、急诊手术呈正相关。

OBJECTIVE To explore the factors of postoperative nosocomial infection and perioperative intervention in patients with orthopedic surgery,so as to provide effective measures for clinical prevention and treatment.METHODS A total of 600 patients in department of orthopedics were enrolled in this study from Sep.2014 to Jul.2016.All patients were enrolled in a unified questionnaire for the review of infection.The gender,age,and underlying disease were recorded.The nosocomiat infection was comprehensively evaluated according to the results of the laboratory examination.The infection sites,duration of infection,etc.were detailed recorded.The pathogenic bacteria were examined,the results were analyzed,the basic factors were developed to determine the demarcation point,and the risk factors of nosocomial infection were analyzed.RESULTS Totally 68 cases of postoperative nosocomial infection occurred in 600 patients in department of orthopedics,with the infection rate of 11.33%.There were 18 cases of nosocomial infections in traffic accident patients and 22 cases of femoral incontinence in patients with comminuted fracture,accounting for 26.48% and 32.35%,respectively.Among 68 cases of patients with nosocomial infections,there were 35 cases of respiratory tract infections,19 cases of incision infections,and 19 cases of gastrointestinal infections,accounting for 51.47%,17.65%,and 27.94%,respectively.Pathogenicbac teria were detected in 68 cases of infected patients,there were 36 strains of gram-positive bacteria,32 strains of gram-negative bacteria,and 1 strain of fungus,accounting for 52.17%,46.38%,and 1.45%,respectively.The patients with older age,with diabetes,type Ⅱ surgical incision,and with emergency surgical time had high postoperative nosocomial infection rate,and the difference was statistically significant（P〈0.05）.The age,with diabetes mellitus,incision type and timing of surgery were independent risk factors for nosocomial infection.CONCLUsION Orthopedic patients with orthotopic femoral comminuted fracture,fall fracture and traffic accident have high incidence of nosocomial infection after orthopedic surgery.The respiratory tract infection is the main type of multiple sensation,and the occurrence of nosocomial infection is positively correlated with age,with diabetes mellitus,type Ⅱ surgical incision,and emergency surgery.