根因分析法对抑制颅脑外科院内感染的价值研究

目的 探讨根因分析法（RCA）对颅脑外科手术显微器械病原菌分布的影响及预防院内感染的价值。方法 回顾性分析自2017年4月-2018年4月间行神经外科手术治疗患者270例病例资料，抽选2018年6月-2019年6月间行270例患者为观察组。比较各组一般资料，采用根因分析法评估后院内感染发生率、手术器械清洗消毒质量、不合格显微器械病原菌分布和手术室空气质量改善情况。结果 两组研究对象性别、年龄、手术类型等差异无统计学意义（P>0.05），实施RCA前神经外科颅脑感染发生率高于实施后，差异有统计学意义（x2=14.128，P<0.001）。实施RCA后手术显微器械清洗目测法、试剂法合格率高于实施前，差异有统计学意义（x2=6.383，P=0.011；x2=5.741，P<0.05）。 细菌培养结果显示，RCA实施前检出革兰氏阴性菌（G-）17株，革兰氏阳性菌（G+）35株、真菌2株，实施后检出革兰氏阴性菌（G-）8株，革兰氏阳性菌（G+）5株，但未检出真菌，差异无统计学意义（x2=4.237，P=0.120），RCA评估指导制定相关措施后，实施后术前、手术10min、术毕时空气菌落数低于实施前，差异有统计学意义（F=9.650，P<0.001；F=14.882，P<0.001；F=36.214，P<0.001）。结论 根因分析法能够提高手术器械清洗消毒合格率和室内空气清洁度，有效预防颅脑手术感染率。

Value of root cause analysis in suppressing nosocomial infections in craniocerebral surgery

To investigate the influence of root cause analysis ( ＲCA) on the distribution of pathogens inmicrosurgical instruments and the value of preventing nosocomial infections. Methods The data of 270 patients who underwentneurosurgery from 2017 /4 to 2018 /4 were retrospectively analyzed. 270 patients who underwent neurosurgery from 2018 /6 to2019 /6 were selected as the observation group. The general data of each group were compared. Ｒoot cause analysis was used toevaluate the incidence of infection in backyard，cleaning and disinfection quality of surgical instruments，distribution ofpathogenic bacteria of unqualified microscopic instruments and improvement of air quality in operating room. ＲesultsThere wasno significant difference in gender，age and type of surgery between the two groups ( P ＞ 0. 05 ) . The incidence ofcraniocerebral infection in neurosurgery before ＲCA was higher than that after ＲCA ( χ2 = 14. 128，P ＜ 0. 001) . The qualifiedrate of cleaning and visual inspection method and reagent method for surgical microscopic instruments after ＲCA was higher thanthat before ＲCA ( χ2 = 6. 383，P = 0. 011; χ2 = 5. 741，P ＜ 0. 05) . The results of bacterial culture showed that 17 Gram －negative bacteria ( G － ) and 35 Gram － positive bacteria ( G + ) and 2 fungi were detected before ＲCA was implemented. AfterＲCA was implemented，8 Gram － negative bacteria ( G － ) and 5 Gram － positive bacteria ( G + ) were detected，but no fungiwere detected. The difference was not statistically significant ( χ2 = 4. 237，P = 0. 120 ) . After ＲCA evaluation guided theformulation of relevant measures，the number of air colonies before and 10min after the operation and at the end of the operationwas lower than that before the implementation，and the difference was statistically significant ( F = 9. 650，P ＜ 0. 001; F =14. 882，P ＜ 0. 001; F = 36. 214，P ＜ 0. 001) . Conclusion The root cause analysis method can improve the cleaning anddisinfection rate of surgical instruments and indoor air cleanliness，and effectively prevent the infection rate of brain surgery.