莫匹罗星围手术期应用进展

手术部位存在大量人体寄殖菌群,手术时可能污染术野导致感染。因此,围术期使用抗菌药物,一是清洁手术时预防切口感染;二是污染手术时防止手术部位及全身性感染。     

《外科手术部位感染的预防指南（2017）》更新解读

预防外科手术部位感染(SSI)一直是外科技术的重要部分。2017年版《外科部位感染预防指南》进行了要点首次更新,主要针对手术中的14个核心领域,根据最全、最广泛、最新的循证医学证据,给出了证据级别和推荐等级,最终得出了42条指南建议,这其中包括广泛应用的手术皮肤准备、无菌手术贴膜及预防抗生素使用等。新指南较为全面地反映了SSI预防的最新与最权威的观点,不仅更新了临床操作规范,而且有助于临床一线医生有关手术感染的观念更新,故对新指南的重要观点作一解读。     

围手术期抗菌药物合理应用

围手术期使用抗菌药物的目的有二:预防手术部位感染(包括切口感染和手术部位的深部腔隙或器官感染)或治疗已经存在的感染。预防性用药抗生素对手术部位感染的预防作用不容置疑,但并非所有手术都需要用抗生素,如头颈部手术、不使用人工材料的疝修补术、一般体表手术都不必使用抗生素。一、预防性应用抗生素的适应证1.手术中污染不可避免的胃肠道、呼吸道、女性生殖道大手术。2.清洁大手术,一旦感染后果严重者,如开颅手术、心脏和大血管手术。3.使用人工材料的手术,如人工关节置换术、人工心脏瓣膜置换术、人工血管移植术等。4.患者有感染高危…     

应用抗菌药物防治外科感染的指导意见(草案)Ⅱ-预防手术部位感染

预防手术部位感染 感染是最常见的手术后并发症.正确预防性应用抗生素有助于减少外科手术部位感染(surgical site,SSI).     

合理应用抗生素预防疝和腹壁外科手术部位感染

一般而言，在无细菌感染的情况下以预防为目的地使用抗生素不是明智之举。但在外科领域，预防性使用抗生素却占有相当重要的地位，这主要是为了预防外科手术部位感染（surgicalsiteinfection,SSI）,包括外科手术后的伤口感染和手术部位的深部腔隙或器官感染，如胸腔感染、腹腔感染、脓肿形成等。此类感染约占全部医院感染的15%，占全部外科病人感染的40%，可见其重要性不容忽视。据Cruse统计，清洁切口的感染发生率＜2%，清洁污染切口为＜10%，污染切口约为20%，污秽切口约为40%。抗生素对术后感染的预防作用不容置疑，但并非所有手术都需…     

隔离盘技术在腔道手术中的应用

目的 预防腔道手术术中污染.方法 用1块小单包裹-治疗盘制成隔离盘,建立新的无茵区域.在259例腔道手术过程中,污染物品集中放置,污染操作在规定区域内进行.结果 99.23%患者伤口一期愈合,未发生因手术操作引起的感染病例.结论 隔离盘技术最大限度地减少了污染机会,是腔道手术中预防感染的有效措施.     

外科手术部位感染的目标性监测

目的:探讨影响手术部位感染的相关因素。方法:确定监测手术类别，填写统一表格。由医院感染专职人员对手术患者切口情况进行观察,并在出院后1个月进行电话回访，了解手术切口愈合情况。结果:共调查2 399例次手术患者，其中110例次手术部位发生感染，感染率为4.59％。不同手术类别相同危险指数的手术以结、直肠切除术和胆道手术的感染发生最高（10.16%，χ2=53.09,P=0.000）。同一类别手术，危险指数越高手术部位感染发生率越高（χ2=6.13， P=0.044）;候手术时间≥4 d组手术部位的感染率高于1～3d组（χ2=11.27，P=0.004）。 切口类型级别高者手术部位感染发生率也高，清洁及清洁-污染类型手术在出院后发生手术部位感染的几率高于其他切口类型手术;围手术期抗菌药物预防用药＞72 h组的手术部位感染率高于≤48 h组 （χ2=7.96， P=0.019）。结论:手术部位感染的发生与危险指数相关;缩短候手术时间能降低手术部位感染的发生;加强手术后追踪观察可了解感染发生的真实情况;围手术期长时间应用抗菌药物不仅不能有效预防术后感染反而还会增加感染的发生。     

世界卫生组织手术部位感染预防指南介绍

世界卫生组织“病人安全”项目于2012年开始启动全球性手术部位感染（SSI）预防指南的制定工作,并将于2016年正式出版。该指南在以下几方面进行了更新：（1）术前沐浴以降低SSI发生率仅是临床规范,并无循证医学证据支持,不推荐术前使用洗必泰擦拭巾。（2）推荐手术部位消毒使用含碘伏或氯己定的酒精类消毒液。（3）推荐在切皮前120 min内预防性应用抗生素,但同时须考虑抗生素半衰期。（4）推荐全麻气管插管的结直肠手术成年病人术中和术后2～6 h吸入80%浓度的氧气。（5）不建议术中施行目标导向性液体治疗或限制性液体治疗以降低SSI发生率。（6）建议对清洁-污染切口和污染切口的腹部手术使用伤口保护套减少SSI发生。     

骨科手术中手套穿孔情况的调查

目的了解骨科手术中手套穿孔情况,以增强手术人员的自我保护意识,预防医患感染。方法对560例骨科手术中使用的4820只手套于术后采用超量注水挤压实验法检测手套穿孔情况。结果骨科手术中手套穿孔468只（9.71%）;术中主刀医生的手套穿孔率显著高于其他手术人员（均P〈0.0125）;左手示指为穿孔高发部位。结论骨科手术中手套穿孔发生率较高,为预防医患双方交叉感染,术中手套一旦破损,应及时更换;高危手术可戴双层手套,以减少患者血液及其他体液的污染,保障手术人员的自身健康,减少职业危害。     

应用抗菌药物防治外科感染的指导意见(草案)Ⅱ

预防手术部位感染感染是最常见的手术后并发症。正确预防性应用抗生素有助于减少外科手术部位感染 (surgicalsiteinfection ,SSI)。一、手术部位感染的定义及诊断标准SSI是指围手术期 (个别情况在围手术期以后 )发生在切口或手术深部器官或腔隙的感染 (如切口感染、脑脓肿、腹膜炎 )。SSI约占全部医院感染的 1 5 % ,占外科患者医院感染的35 %～ 40 %。SSI的概念比创口感染要宽 ,因为它包含了手术曾经涉及到的器官和腔隙的感染 ;又比“手术后感染”的概念要窄而且具体 ,因为它不包括那些与手术没有直接关系的感染 ,如肺炎、尿路感染等。…     

Prävention der postoperativen Wundinfektionen

The number of hospitals participating in the German national nosocomial infection surveillance system (KISS) has been increasing during the last 14 years. A total of 616 surgical departments from 495 hospitals have provided data on a voluntary basis between 2006 and 2010, among them 172 departments with data on hip prosthesis following arthrosis, 117 departments with hip prostheses following fractures and 107 with knee prostheses. It was possible to demonstrate that feedback, careful interpretation of data and introduction of appropriate interventions lead to a significant reduction of surgical site infections. Significant risk factors for surgical site infections were male gender with an odds ratio (OR) of 1.15, age (OR=1.03), wound contamination class (OR=4.28), ASA (American Society of Anesthesiologists) score (OR=2.18) and summer season (OR=1.30). The most frequent pathogens of surgical site infection were S.aureus (35.5%) followed by coagulase negative staphylococci (12.9%) and enterococci (12.8%).     

The Influence of Iodine-Impregnated Incision Drapes on the Bacterial Contamination of Scalpel Blades in Joint Arthroplasty

BackgroundProsthetic joint infections (PJI) are a disastrous and feared complication in arthroplasty. Over the past decades, surgeons have tried to lower infection rates through all sorts of improvements. At present, it is impossible to reduce the risk to zero. As the contamination of surgical instruments and the surgical field has been identified as a remaining gap prone for infection, scalpel blades among others have become a focal point of several studies. This study is the first to compare the effect of adhesive incision drapes on contamination rates of scalpel blades in primary arthroplasty of the hip and knee.MethodsA total of 344 microbiologic blade culture results from 2 study groups with and without drape usage and 1 group with known PJI were analyzed and compared to histopathologic and microbiologic tissue results.ResultsIn 78% of all positive cultures, the bacteria were part of the local skin flora. The contamination rate for the skin blades with a drape was 3.81% vs 12.19% without drape usage. A significant difference was determined between positive skin blade culture results incision drape usage (P = .031). The different pathogens likely responsible for the PJI correlated with the deep blade cultures (P ≤ .01). The overall contamination rate of surgical blades (1.37%) is comparatively low to the results obtained from other surgical equipment in literature. None of those blade-positive patients developed a surgical site infection during 12-month follow-up.ConclusionIodine-impregnated incision drapes are able to reduce surgical skin blade contamination. Further studies may be needed to assess the relationship between blade contamination and surgical site infections.     

The Surgical Looking Glass: A Readily Available Safeguard Against Eye Splash Injury/Contamination During Infiltration of Anesthesia for Cysts and Other "Porous" Lesions of the Skin

BACKGROUND: "Breaks" in barrier precautions are a definite abrogating influence on the effectiveness of "universal precautions." Dermatologists and dermatologic surgeons are exposed to significant infectious agents on a daily basis, especially due to the high number of minor surgical procedures performed. Backsplash, spray, and eye splash of bodily fluids during these procedures place the surgeon at a high risk of contamination/infection via the conjunctival membranes. The surgical looking glass is a simple utility based on inexpensive equipment already in place in the physician's office which protects the eyes and face during infiltrative anesthesia or incision of cysts and other lesions. OBJECTIVE: To offer a simple and inexpensive utility to assist with protection from and reduction of contamination/infection of the ocular mucous membranes during surgical procedures. METHODS: Utilizing one or two readily available microscope slides overlying the injection site during local infiltrative anesthesia, backsplash or spray can be contained. RESULTS: This utility is effective in containment of backsplash or spray of anesthesia or bodily fluids during even minor surgical procedures. CONCLUSION: The surgical looking glass can enhance safety and promote "universal precautions" during even minor surgical procedures or infiltration of anesthesia into more porous areas or lesions for the practicing dermatologist or dermatologic surgeon. The pragmatic, practical, and inexpensive nature of the surgical looking glass invites its use on a daily basis by the practicing dermatologist.     

Occlusive wrap dressing reduces infection rate in saphenous vein harvest site

BACKGROUND: Infection in the saphenous vein harvest site is a common problem. We developed an occlusive circumferential wrap dressing technique that reduces skin edge tension, eliminates dead space, and prevents external contamination. We compared the surgical site infection rate using the wrap dressing technique with that of standard longitudinal dressings. METHODS. One hundred fifty-two consecutive patients were randomly assigned to receive either standard dressings or the wrap dressing. Data were collected in the hospital and then 4 to 6 weeks postoperatively. Superficial and deep wound infections were defined by the standard criteria from the Centers for Disease Control and Prevention. RESULTS: The infection rate in the wrap group was 14% compared with 35%, for the standard group (p = 0.006). Multivariate analysis showed that wrap technique was the only significant predictor (negative) of infection (odds ratio, 0.19; p = 0.001). CONCLUSIONS: In saphenous vein harvest wounds, the occlusive wrap dressing technique has the potential to reduce the rate of infection by 50%. This simple and inexpensive technique is also readily applicable to the radial artery harvest site in the arm and may provide similar benefit.     

Incidence of Surgical Site Infection in the Foot and Ankle with Early Exposure and Showering of Surgical Sites: A Prospective Observation

The incidence of postoperative surgical site infection (SSI) reported in the published data for foot and ankle surgery has been 1.0% to 5.3%. A variety of interventions have been used before, during, and after surgery to decrease the patient's risk of acquiring an infection at the surgical site. Foot and ankle surgeons often keep the incision site dry and covered until the sutures and pins have been removed, with the goal of preventing a SSI, despite the lack of available published evidence to support this practice. We undertook a prospective observation of 110 elective surgical patients to determine the rate of SSI when early surgical site exposure and showering were allowed. The risk factors for infection were recorded, and a series of logistic regression analyses was performed to determine the associations between the infection rate and early showering. The patients were evaluated at each postoperative appointment for signs of infection. For the present study, mild infection was defined as the subjective presence of erythema and/or swelling beyond that typically expected in the early postoperative period. These cases of presumed or mild SSI were managed with oral antibiotics until they had resolved. Major infection was defined as any infection altering the course of recovery or requiring admission or additional surgery. The overall infection rate was 4.5%, with all infections considered mild. Logistic regression analysis showed that none of the recorded risk factors significantly predicted infection. The results of the present study suggest that early daily showering of a surgical site after foot and ankle surgery will not be significantly associated with an increased risk of infection.     

Guidelines for perioperative antibiotic use in digestive tract surgery

Guidelines for the use of antibiotics in postoperative infections after digestive tract surgery have been under discussion in Japan since the mid-1980s, when the number of infections with methicillin-resistant Staphylococcus aureus began to increase. It is important to make a distinction between prophylactic and therapeutic antibacterial administration in the perioperative period. Prophylactic antibacterial administration to prevent postoperative infection is necessary to prevent surgical site infection and remote infection from invading the surgical site. Because the type of bacterial contamination of the surgical site differs with the organ undergoing surgery, the type of antibiotic selected also differs. Antibiotic administration to prevent postoperative infection after surgery requiring a short time to perform may be started preoperatively. In patients undergoing prolonged surgery, antibiotics are administered every 3 hours. If an antibacterial agent is administered for 3-4 days, there is a risk of the development of resistance and therefore administration should not exceed 3-4 days, including the day of surgery. However, during surgery in which bacterial contamination is already evident, the therapeutic use of antibiotics should be initiated at diagnosis. For example, toxinemia is common in many cases of colon rupture and the administration of powerful antibiotics is necessary to save patients' lives.     

The efficacy of multifaceted versus single anesthesia work area infection control measures and the importance of surgical site infection follow-up duration

BackgroundEarlier a randomized trial showed efficacy of a multifaceted intervention approach for reducing surgical site infection: hand hygiene, vascular care, environmental cleaning, patient decolonization (nasal povidone iodine, chlorhexidine wipes), with feedback on pathogen transmission. The follow-up prospective observational study showed effectiveness when applied to all operating rooms of an inpatient surgical suite. In practice, many organizations will at baseline not be using conditions equivalent to the control groups but instead functionally have had ongoing a single intervention for infection control (e.g., encouraging better hand hygiene). Organizations also differ in how well and long they survey every surgical patient for postoperative surgical site infection. Thus, estimation of the expected net cost savings from implementing multifaceted intervention depends on the relative efficacy of multifaceted approach versus single intervention approaches and on the incidence of surgical site infection, the latter depending itself on the monitoring period for infection development.MethodsThe retrospective cohort analysis included 4865 patients from two single intervention and two multifaceted studies, each of the four studies with matched control groups. We used Poisson regression with robust variance to estimate the relative risk reduction in surgical site infections for the multifaceted approach versus single interventions and, with 30-day follow-up versus ≥60-day follow-up for infection.ResultsThe multifaceted approach was associated with an estimated 68% reduction in postoperative surgical site infections relative to single interventions (risk ratio 0.32, 97.5% confidence interval 0.15–0.70, P = 0.001). There were approximately 2.61-fold more surgical site infections detected with follow-up for at least 60 days of medical records relative to 30 days of records reviewed (97.5% CI 1.62 to 4.21, P < 0.001).ConclusionsAn evidence-based, multifaceted approach to anesthesia work area infection control can generate substantial reductions in surgical site infections. A follow-up period of at least 60-days is indicated for infection detection.     

Effect of surgical adhesion reduction devices on the propagation of experimental intra-abdominal infection.

HYPOTHESIS: The use of certain surgical adhesion reduction devices where there is a risk of concomitant bacterial contamination potentiates intra-abdominal infection. DESIGN: Evaluation of adhesion reduction devices in an experimental model of intra-abdominal infection. SETTING: Experimental animal model. INTERVENTIONS: Adhesion reduction devices were administered at the time of bacterial challenge. MAIN OUTCOME MEASURES: Animal mortality rate, abscess formation, and bacterial counts in peritoneal fluid and blood cultures. RESULTS: The use of bioresorbable membrane adhesion reduction devices in the presence or absence of antibiotic therapy did not alter the disease process as compared with appropriate control groups. However, adhesion reduction gels prepared from sodium hyaluronate and carboxymethylcellulose chemically modified with carbodiimide or ferric ion complexed sodium hyaluronate increased the incidence of peritonitis in treated animals. Gel formulations containing diimide-modified carboxymethylcellulose did not have this effect. CONCLUSIONS: The use of certain adhesion reduction devices resulted in the propagation of intra-abdominal infection in an experimental rat model. This outcome was dependent on the composition of the device employed. The use of adhesion reduction devices should be tested in appropriate models of infection where there is the risk of concomitant bacterial contamination.     

Nosocomial infection and infection of the surgical site in a third level hospital (2002-2005)

IntroductionNosocomial infection rates constitute an indicator of welfare quality, permitting to adopt measures of prevention and control. It has been developed a surveillance plan of the nosocomial infection in hospitals, showing to be an efficient method to diminish its incident.ObjectiveTo know the indicators and characteristics of the nosocomial infection and of the infection of the site surgical particularly, in a urology service in a global form and by procedures.Matherial and MethodsProspective study by means of the epidemiological surveillance system from 2002 to 2005 in 4.618 patients hospitalised at least 24 hours, with a total of 3.096 surgical.ResultsThe overall incidence of nosocomial infection was 6,10%, 3.42% for urinary infection and 2,81% for the infection of the chirurgical site. For procedures, the incidence of the infection of the surgical site for cistectomy was 22,8%, 6,6% for surgery of kidney and ureter and 4,36% for open surgery of prostate.Eschericia Coli (43,6%) was the most frequently isolated organism, accounting for 43,6% of the causative organisms in the infection of the surgical site and 43,6% in the urinary infection. Pseudomonas aeruginosa is the next organism in frecuency with a 15% in both infections.ConclusionOur nosocomial infection rates are lower than the published standard values. The main infection rate of the surgical sites present in the most complex surgical techniques, whereas Escherichia Coli is the most frecuently isolated ethiological agent. The surveillance of the infection of the surgical site and related factors permit to incorporate improvements in the clinical-surgical practice which will be an indicator of reference in subsequent analysis.     

Impact of using triclosan-antibacterial sutures on incidence of surgical site infection

Background

Surgical site infection is a common complication of surgery. Its morbidities range from delayed healing to systemic sepsis. It has impact on the economy and health care resources.

Methods

This study was a prospective, randomized, double-blinded, controlled multicenter study aimed to compare triclosan-coated polyglactin 910 sutures with polyglactin 910 sutures for the reduction of surgical site infections. This article details the results from the Cairo University center. A total of 450 patients who had undergone different surgical procedures were enrolled; 230 were enrolled in the study group and 220 were enrolled in the control group.

Results

The study group and the control group were comparable regarding risk factors for surgical site infection. Surgical site infection incidence was 7% in the study group and 15% in the control group (P = .011). The mean extended stay as a result of infection was 3.71 days, with an average cost $91 US per day.

Conclusions

Use of the triclosan-coated polyglactin 910 antimicrobial suture lead to reduction of surgical site infection and has an impact on saving health care resources. The triclosan-coated polyglactin 910 antimicrobial suture could save $1,517,727 yearly in this single center.