非层流手术室患者切口感染发生状况、 影响因素及感染病原菌分析

Analysis on Incisional Infection Rate,Influencing Factors and Pathogenic Bacteria of Patients in Non-laminar Flow Operating Room

目的探讨非层流手术室患者切口感染发生状况、影响因素及感染病原菌,为患者切口感染的防治提供参考。方法选取2016年1月~2018年6月于我院非层流手术室内行手术的患者500例,采集疑似切口感染的患者切口局部分泌物进行细菌培养,观察有无切口感染,同时对患者可能影响切口感染发生的因素进行调查,分析结果。结果41例发生切口感染,感染率为8.20%,其中30例浅部切口感染、11例深部切口感染,感染率分别为6.00%、2.20%;手术部位对切口感染无影响(P>0.05),手术时间≥2h时感染率为12.32%,高于<2h时的5.19%,接台手术感染率为8.64%,高于首台手术时的6.78%,术中参观人数≥5人感染率为14.71%,高于<5人时的3.72%(P<0.05);多因素Logistic回归分析结果显示,手术时间≥2h、接台手术、术中参观人数≥5人是患者发生切口感染的独立影响因素(P<0.05);34例切口感染患者局部分泌物中分离出病原菌,阳性率为82.93%,培养出病原菌36株,其中革兰阴性菌20株、革兰阳性菌16株,分别为55.56%、44.44%,感染主要病原菌为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌。结论非层流手术室患者切口感染发生率相对较高,大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌是引起切口感染的主要病原菌;手术时间、接台手术、术中参观人数是患者切口感染的独立影响因素,应针对以上因素进行干预以降低切口感染的发生。

Objective To explore the incisional infection rate,influencing factors,analyze pathogenic bacteria of patients in non-laminar flow operating room and provide the prevention and treatment of incision infection in patients.Methods For 500 cases of patients undergoing surgery in non-laminar flow operating room in January 2016 to June 2018,collected the incisional secretions of patients with suspected incisional infection for bacterial culture,observed the incidence of incision infection,at the same time,investigated the factors that may affect incisional infection of patients and analyzed the results.Results Incision infection occurred in 41 cases patients,the infection rate of 8.20%,there were 30 cases(6.00%)of superficial incision infection and 11 cases(2.20%)of deep incision infection.Surgical site was not associated with incisional infection(P>0.05),the infection rate was 12.32% of the operation time≥2h were more than 5.19% of the operation time<2h,the infection rate was 9.69% of continuous operations were more than 3.39% of first operation,the infection rate was 14.71% of the number of participants≥5 people were more than 3.72% of the number of participants<5 people,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis,surgical duration greater≥2h,continuous operations,and the number of participants≥5 people were independent factors influencing incisional infection in patients(P<0.05).34 patients with incision infection were positive for pathogens of local secretions,the positive rate was 82.93% and 36 strains of pathogenic bacteria were cultured,there were 20 gram-negative(55.56%)and 16 gram-positive strains(44.44%),the main pathogens of infection were escherichia coli,staphylococcus aureus and pseudomonas aeruginosa.Conclusion The incisional infection rate was relatively higher of patients in non-laminar flow operating room.Escherichia coli,staphylococcus aureus and pseudomonas aeruginosa are the main pathogens causing incision infection.Surgical duration,continuous operations,and the number of participants were independent factors influencing incisional infection in patients.So it should be targeted for intervention to reduce the incidence of incision infection.