层流手术室急诊开颅手术中使用的无影灯无菌灯柄的细菌污染研究

Study on bacterial contamination of sterile lamp handle of shadowless lamp used for emergency craniotomy inlaminar flow operating room

目的通过明确层流手术室急诊开颅手术使用的无影灯无菌灯柄不同时间的细菌污染状况及影响因素,为实施针对性的干预措施提供依据。方法选取行急诊开颅手术使用的无影灯无菌灯柄197个作为研究对象,对不同时间点无菌灯柄的细菌污染状况及影响因素进行分析。结果急诊开颅手术使用的197个无影灯无菌灯柄,手术超过180 min开始检出细菌,手术结束时共有37个(18.78%)灯柄被细菌污染。Logistic回归分析结果显示,手术时间≥360 min、术中灯柄有明显血迹及合并开放性伤口是无菌灯柄检测出细菌的危险因素(OR>1,P<0.05),而在术前完成层流系统自净与头皮准备是避免无菌灯柄检测出细菌的保护性因素(OR<1,P<0.05)。结论层流手术室急诊开颅手术使用的无影灯无菌灯柄有较高的细菌污染率,与手术时间、血液污染情况、合并开放性伤口、术前头皮准备及层流系统自净情况密切相关,当手术时间超过180 min时,建议尽早更换灯柄。

Objective The bacterial contamination status and influencing factors of the sterile lamp handle of shadowless lamp used for emergency craniotomy in laminar flow operating room at different time were clarified to provide the basis for the implementation of targeted intervention measures.Methods A total of 197 sterile lamp handles of shadowless lamp used for emergency craniotomy were selected as research subjects to analyze the bacterial contamination status and influencing factors of sterile lamp handles at different time points.Results Among the 197 sterile lamp handles of shadowless lamp used for emergency craniotomy,bacteria could be detected at the opration time of more than 180 minutes,and a total of 37(18.78%)lamp handles were contaminated by bacteria at the end of the surgery.The results of Logistic regression analysis showed that operation time≥360 minutes,obvious blood stains on the lamp handle during operation,and combined open wound were the risk factors for the detection of bacteria in sterile lamp handle(OR>1,P<0.05),while completing self-cleaning of laminar flow system and scalp preparation before surgery were the protective factors to avoid bacteria detection in sterile lamp handles(OR<1,P<0.05).Conclusion The sterile lamp handle of shadowless lamp used for emergency craniotomy in laminar flow operating room has a high bacterial contamination rate,which is closely related to operation time,blood contamination status of lamp handle,combined open wound,preoperative scalp preparation,and self-cleaning status of laminar flow system.When the operation time exceeds 180 minutes,it is recommended to replace the lamp handle as soon as possible.