手术部位感染目标性监测及干预效果评价

目的了解手术部位感染(SSI)发病情况和集束化干预措施的依从性,评价集束化干预措施对SSI的控制效果。方法选取2013年10月—2014年9月全国29所医院开展的3类手术(大肠手术、腹式子宫切除手术、股骨颈修复手术)作为目标监测对象,其中2013年10月—2014年3月为基线调查期;2014年4—9月为项目干预期。结果共监测6 166例次手术,SSI发病率为1.64%,其中大肠手术、腹式子宫切除术和股骨颈修复手术SSI发病率分别为4.47%、1.03%和0.21%,3类手术P75时间分别为3、2和2 h。干预措施依从性:干预期多数措施依从性较基线期均有不同程度的提高,提高幅度最大的是大肠手术"手术部位含氯己定消毒剂消毒"选项(依从性提高了29.09%),其次为股骨颈修复手术的"术前沐浴"(提高26.24%),大肠手术的"术前沐浴"(提高22.95%)和"手术当日备皮"(提高20.75%)。3类手术SSI发病率干预前后比较,差异均无统计学意义(均P0.05)。结论不同手术类型SSI发病率不同,干预期部分集束化措施依从性较基线期显著提高,但其干预效果有待进一步研究。

Targeted monitoring on surgical site infection and effect of intervention

ObjectiveTo explore the incidence of surgical site infection (SSI) and compliance to bundled intervention measures, and evaluate the effect of bundled interventions on controlling SSI.MethodsFrom October 2013 to September 2014, three types of surgeries (colorectal surgery, abdominal hysterectomy, and femoral neck repair surgery) in 29 hospitals in China were monitored, October 2013 to March 2014 was baseline investigated stage, April 2014 to September 2014 was intervention stage. ResultsA total of 6 166 episodes of surgeries were monitored, the incidence of SSI was 1.64%, incidence of SSI following colorectal surgery, abdominal hysterectomy, and femoral neck repair surgery were 4.47%, 1.03%, and 0.21% respectively. The P75 time of three types of surgeries were 3, 2, and 2 hours respectively.Compared with the baseline stage， the compliance to most intervention measures improved after intervention, the largest increase in the compliance to interventions was disinfection with chlorhexidine containing disinfectant at surgical sites of colorectal surgery (increased by 29.09%), followed by preoperative shower of femoral neck repair surgery (increased by 26.24%), preoperative shower of colorectal surgery(increased by 22.95%), and skin preparation on the day of operation (increased by 20.75%). Incidences of SSI in three types of surgeries were not significantly different before and after intervention(all P＞0.05).ConclusionThe incidences of SSI are different among different types of surgeries，the compliance to most bundled intervention measures has improved to some extent after intervention, but effectiveness of intervention measures needs to be further observed.