PDCA循环对手术室空气质量及术后感染的影响

Effects of PDCA circulation on air quality and postoperative infection in operating room

目的探讨戴明环(PDCA)循环对手术室空气消毒质量及术后感染的影响, 为手术室医院感染的预防及控制提供参考。方法选取2016年6月至2017年6月在河南省人民医院手术室行手术治疗的920例患者, 将患者根据手术室实施PDCA时间顺序分为对照组(2016年6~12月, 486例)与观察组(2017年1~6月, 434例)。对照组根据常规医院感染及手术室相关制度执行感染控制管理措施, 观察组给予PDCA循环管理, 检测每台手术术前10 min、术中30 min、术毕时的手术室内空气质量, 观察术后医院感染发生情况。结果两组术前手术室空气细菌菌落数比较差异无统计学意义(P>0.05), 术中30 min、术毕时观察组手术室空气细菌菌落数分别为(20.55±3.34)cfu/m3、(27.46±5.39)cfu/m3, 明显低于对照组的(24.56±4.26)cfu/m3、(36.55±6.57)cfu/m3, 差异均有统计学意义(均P<0.05);观察组术后10例发生医院感染, 对照组39例发生医院感染, 差异有统计学意义(P<0.05);观察组呼吸道感染、泌尿道感染、切口感染率分别为1.15%、0.69%、0.46%, 对照组分别为3.09%、2.47%、2.06%, 观察组感染率低于对照组, 差异有统计学意义(P<0.05);观察组医院感染患者培养出病原菌13株, 其中革兰阴性菌5株、革兰阳性菌8株, 对照组医院感染患者培养出病原菌45株, 其中革兰阴性菌37株、革兰阳性菌8株, 病原菌分布比较差异无统计学意义(P>0.05)。结论 PDCA循环管理方法有助于提高手术室空气质量, 降低术后医院感染的发生率。

Objective To explore the effect of PDCA cycle on air disinfection quality and postoperative infection in operating room,and to provide reference for the prevention and control of nosocomial infection in operating room.Methods A total of 920 patients who undement surgery in the operating room of Henan Provincial People^s Hospital from June 2016 to June 2017 were selected and divided into the control group(from June to December 2016,486 cases)and the observation group(from January to June 2017,434 cases)according to the time sequence of PDCA implementation in the operating room.The control group was administered infection control management measures according to routine nosocomial infection and operating room related systems,while the observation group was administered PDCA cycle management.The air quality in the operating room was detected 10 minutes before,30 minutes during and after each operation,and the incidence of postoperative nosocomial infection was obsened.Results There was no significant difference in the number of preoperative air bacterial colonies between the two groups(P>0.05).The number of air bacterial colonies in the operating room of the observation group was(20.55±3.34)cfu/m^(3) and(27.46±5.39)cfu/m^(3) at 30 minutes and at the end of the operation,which were significantly lower than that in the control group(24.56±4.26)cfu/m^(3) and(36.55±6.57)cfu/m^(3).And the differences were statistically significant(P<0.05).Nosocomial infection occurred in 10 cases in the observation group and 39 cases in the control group,and the difference was statistically significant(P<0.05).The infection rates of respiratory tract infection,urinan tract infection and incision were 1.15%,0.69%and 0.46%in the observation group,and 3.09%,2.47%and 2.06%in the control group,respectively.The infection rates in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).13 strains of pathogenic bacteria were cultured from patients with nosocomial infection in the observation group,including 5 strains of gram-negative bacteria and 8 strains of gram-positive bacteria,while 45 strains of pathogenic bacteria were cultured from patients with nosocomial infection in the control group,including 37 strains of gram-negative bacteria and 8 strains of gram-positive bacteria.There was no statistical significance in the distribution of pathogenic bacteria(P>0.05).Conclusions PDCA circulation management method is helpful to improve the air quality of operating room and reduce the incidence of postoperative nosocomial infection.