人工关节置换术感染预防与持续改进分析

目的预防性管理措施改进对人工关节转换术术后感染的影响。方法收集山东省烟台市烟台山医院收治的309例施行人工关节置换术的患者，按改进前后时间将患者分为改进前组（94例）和改进后组（215例）。对2组患者术中空气、主刀人员的手、手术护士的手进行细菌采集，观察改进前与改进后的细菌生长情况。结果改进后组空气培养有细菌生长率与改进前组比较，差异有统计学意义[59．5％（128／215）比73．4％（69／94）]（P〈0．05）。空气培养中的细菌有微球菌、棒状杆菌、溶血葡萄球菌、奈瑟菌、柘草芽孢杆菌、黏质沙雷菌。改进后组主刀人员、护士手培养的有细菌菌生长率与改进前组比较，差异有统计学意义[1．9％（4／215）比6．4％（6／94）]（P〈0．05）。空气、主刀人员、护士手细菌培养中的细菌有微球菌、棒状杆菌、溶血葡萄球菌、奈瑟菌、枯草芽胞杆菌、黏质沙雷菌、表皮葡萄球菌、鲍曼不动杆菌。结论加强手术室感染管理，层流设备定期检测消毒，对人工关节置换术后感染的预防起重要作用。

Analysis of infection prevention and continuous improvement of artificial joint replacement surgery

Objective To analyze the causes of reducing postoperative infection after joint replacement and to observe the prophylactic mangement measures. Methods Totally 309 patients with total joint replacements of Yantaishan hospital of Yantai city were selected and divided into improving before group （94 cases） and impro- ving group （215 cases）. The speciments for bacterial culture were taken from the hands of the operation surgeon, the scrub nurse and the air flow in the operation room for all cases. The growth of bacteria after improvement was observed. Results There were significant differences on bacteria growth rate of air aulture in improving group compared with improve before group [ 59.5 % （ 128/215 ） vs 73.4 % （69/94） 1 （ P 〈 0.05 ）. There were significant differences on bacteria growth rate of hand of surgeon and nurse in improving group compared with improving before group [ 1.9% （4/215） vs 6.4% （ 6/94 ） ] （ P 〈 0.05 ）. There were Micrococcus, Corynebacterium, Staphylococcus haemolyticus, Neisseria, Brevibacterium bacteria, Serratia marcescens, Staphylococcus epidermidis and Baumanii from bacterial culture of hands of the operation surgeon, scrub nurse and the air flow. Conclusion Improvement of the management in the operation room and checking the laminar air flow device regularly are important for the infection prevention after total joint replacement.