骨科关节镜手术手术部位感染聚集的流行病学调查

Epidemiological investigation on clustered surgical site infection after arthroscopic surgery

目的对骨科关节镜手术后手术部位感染(SSI)聚集进行流行病学调查,为医院感染防控提供依据。方法对某三级医院骨科2020年9—10月关节镜术后3例SSI开展流行病学调查,循证后干预,并对防控效果进行评价。结果骨科病区短期出现3例关节镜术后SSI病例,切口分泌物培养均为铜绿假单胞菌,且药敏谱表型一致。暂停关节镜手术,分别对相关医务人员卫生手、病房环境、手术器械等进行多批次采样,最后模拟手术操作的方式在关节镜鞘卡管腔冲洗液标本中分离出铜绿假单胞菌,且与患者切口分泌物中分离的铜绿假单胞菌药敏结果一致。根据流行病学调查结果进行干预,将鞘卡低温等离子灭菌改成高温高压灭菌,再次模拟手术操作的方式采集管腔冲洗液标本培养,未再培养出铜绿假单胞菌。恢复手术后1个月,未再发现SSI病例,证实防控措施有效。结论关节镜鞘卡管腔内可能形成生物膜,清洗时难以去除。低温等离子灭菌无法穿透生物膜,导致关节镜手术SSI聚集事件,而热力学灭菌方式可高效灭活生物膜内的病原菌。

Objective To conduct an epidemiological investigation of clustered surgical site infection(SSI)after arthroscopic surgery in orthopedic ward,and provide evidence for the prevention and control of healthcare-associated infection(HAI).Methods Epidemiological investigation was carried out on 3 cases of SSI after arthroscopic surgery in the orthopedics department of a tertiary hospital from September to October 2020.Evidence-based intervention was performed.Prevention and control effect was evaluated.Results There were 3 cases of SSI after arthroscopic surgery in the orthopedic ward in a short time.Pseudomonas aeruginosa(P.aeruginosa)was isolated from incision secretion culture,and drug sensitivity spectrum phenotypes of isolated strains were identical.Arthroscopic surgery was suspended.Multiple sampling was conducted on hands of the relevant medical staff,ward environment,and surgical instruments.P.aeruginosa was isolated from flushing fluid specimen of arthroscopic trocar by simulating surgical operation,and corresponding drug sensitivity results were consistent with P.aeruginosa isolated from the patient’s incision secretion.Intervention was carried out according to epidemiological investigation results.Low temperature plasma sterilization on trocar was changed into high temperature and pressure sterilization.Specimens of lumen flushing fluid were collected and cultured by simulating the arthroscopic surgery again,and no P.aeruginosa was detected.One month after the resumption of arthroscopic surgery,no SSI case was found,thus confirmed the effectiveness of the prevention and control measures.Conclusion Biofilm may form in the lumen of the arthroscopic trocar,which is difficult to remove during cleaning.Low temperature plasma sterilization can not penetrate the biofilm,resulting in clustered SSI event of arthroscopic operation.Thermodynamic sterilization method can effectively sterilize the pathogenic bacteria in biofilm.