降低脊柱手术患者术后感染率的多学科诊疗模式探讨

Exploration of multi-disciplinary diagnosis and treatment in reducing postoperative infection rate in patients with spinal surgery

目的探讨多学科诊疗(MDT)模式在降低脊柱手术患者术后感染率中的应用效果。方法通过成立MDT小组对脊柱手术团队进行感染控制干预,归纳总结2016年1—9月725例脊柱手术患者术后感染的31例病例的危险因素,提出可控因素;选取2016年10月—2017年6月746例作为干预后对照、效果追踪。结果 MDT感染管理模式使脊柱患者手术后院内感染发生率由干预前的4.3%下降至干预后的2.1%;干预前后手术部位感染率分别为1.8%和0.4%;切口菌种分布比较,手术切口感染以革兰氏阳性菌为主,其中表皮葡萄球菌干预前后占比分别为1.7%、0.3%;干预后未见金黄色葡萄球菌。结论 MDT协作感染管理模式,可有效提高脊柱手术团队感控措施的依从性,可降低脊柱手术患者切口感染率。

Objective To explore effect of multi-disciplinary diagnosis and treatment（ MDT） in reducing postoperative infection rate in patients undergoing spinal surgery. Methods The infection control intervention of spinal surgery team was carried out by setting up MDT group. The risk factors of infection in 31 cases with postoperative infection in 725 patients undergoing spinal surgery from January to September 2016 were analyzed,and the controllable risk factors were proposed.Meanwhile,746 cases from October 2016 to June 2017 were selected as control group,and results were followed up. Results The incidence of nosocomial infection decreased from 4. 3% before intervention to 2. 1% after intervention by MDT,the infection rates of surgical site before and after intervention was 1. 8% and 0. 4%,respectively. Gram-positive bacteria were the main infection in surgical incision. The proportion of Staphylococcus epidermidis before and after intervention was 1. 7% and0. 3%,respectively. No Staphylococcus aureus was found after intervention. Conclusion MDT can effectively improve the compliance of infection control in spinal surgery team and reduce incision infection rate in patients undergoing spinal surgery.