骨科无菌手术切口感染的危险因素分析及防治对策

目的 分析骨科无菌手术切口感染的危险因素,探讨防治骨科无菌手术切口感染的对策.方法 回顾性分析医院2008年3月-2009年9月收治的行骨科无菌手术患者631例,按照切口感染与否,将患者分为感染组与非感染组,比较两组患者的一般资料、医疗差异,分析骨科无菌手术切口感染的危险因素,根据危险因素探讨防治切口感染的措施.结果 经比较切口感染组和未感染组患者的一般资料及医疗差异,年龄、肥胖、手术时间、抗菌药物使用例次、合并糖尿病、不问内置物、病房环境、责任护士年资、术后住院时间等因素,组间比较差异有统计学意义(P＜0.05);感染病原菌分布,以金黄色葡萄球菌感染率最高,占48.8％,其次为凝固酶阴性葡萄球菌,占26.8％.结论 临床在对患者行骨科无菌手术时,应综合考虑患者因素、医院感染控制规范管理、环境因素等,尽量降低骨科无菌手术切口的感染率.     

难愈性创面感染耐甲氧西林金黄色葡萄球菌危险因素

目的探讨难愈性创面感染耐甲氧西林金黄色葡萄球菌（MRSA）的危险因素,为临床防控提供依据。方法对2006年1月-2013年12月某院烧伤外科难愈性创面分离出金黄色葡萄球菌患者的临床资料进行分析,根据细菌是否为甲氧西林耐药菌和是否来源于难愈性创面分为4组,分析难愈性创面感染MRSA的危险因素及其持续存在的危险因素。结果共112例次创面分泌物标本培养出金黄色葡萄球菌,难愈性创面MRSA组与难愈性创面甲氧西林敏感金黄色葡萄球菌（MSSA）组患者在住院时间、近期使用侵入性操作和近期使用抗菌药物治疗3个方面比较,差异具有统计学意义（均P＜0.05）;非条件logistic回归分析显示,住院时间＞30 d(OR 95% CI：1.14~30.69)和近期有侵入性操作(OR 95% CI：1.41~17.84)是难愈性创面MRSA感染的独立危险因素。难愈性创面MRSA组与非难愈性创面MRSA组患者在既往MRSA感染史、创面深度、近期手术治疗和近期使用抗菌药物治疗4个方面比较,差异具有统计学意义（均P＜0.05）;非条件logistic回归分析结果显示,近期使用抗菌药物治疗(OR 95% CI：2.080~26.800）是难愈性创面MRSA感染持续存在的独立危险因素。结论缩短创面感染患者住院时间、减少侵入性操作和合理使用抗菌药物有助于防控难愈性创面患者感染MRSA。     

The use of the wound scoring method 'ASEPSIS' in postoperative wound surveillance

For the purposes of wound surveillance programmes and clinical trials, a wound scoring method, ASEPSIS, makes assessment of wound sepsis more objective and reproducible by allotting points both for the appearance of the wound in the first week and for the clinical consequences of infection. ASEPSIS was compared with other definitions of wound infection in 1029 surgical patients and its suitability for surveillance and detection of risk factors were examined. Satisfactory healing was recorded in 867 patients, disturbance of healing in 74 and minor, moderate and severe wound infection in 41, 24 and 23 patients respectively. An ASEPSIS score over 20 points was more sensitive and as specific as the presence of pus as an indicator of changes in management resulting from infection. Multiple regression analysis of ASEPSIS scores indicated that operation type, ward, degree of contamination, age, body mass index, and preoperative stay in hospital were significant risk factors. In matching 52 infected patients with uninfected controls, any wound score over 10 points was associated with a significant delay in discharge from hospital (median 3 days, P less than 0.0005).     

颅脑外科气管切开患者医院感染危险因素分析

目的探讨颅脑外科99例气管切开患者医院感染危险因素. 方法对某院2003年颅脑外科99例气管切开患者进行了前瞻性和回顾性调查,并对病原学标本进行了细菌培养和药敏试验. 结果 99例患者中发生医院感染65例次,医院感染例次率为65.66%,以下呼吸道感染为主,其次为手术伤口感染;致病菌中以革兰阴性杆菌为主共82株,真菌14株,这些菌对常用抗菌药物都有不同程度的耐药性,且多重耐药呈上升趋势;气管切开患者医院感染与侵入性操作、不合理使用抗菌药物等密切相关. 结论颅脑损伤气管切开术后感染率高是多因素作用的结果,合理应用抗菌药物、加强无菌技术操作、提高宿主自身免疫力,可降低医院感染发病率.     

Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20–3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48–4.54).The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds ratio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23–4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.Corresponding Author     

颅内肿瘤患者术后医院感染的临床分析

目的了解颅内肿瘤患者术后医院感染的临床特点、危险因素及预防治疗措施。方法对2006年1月-2009年12月神经外科收治的306例颅内肿瘤患者术后进行回顾性调查分析。结果 306例颅内肿瘤患者术后发生医院感染22例,感染率7.19%;感染部位以颅内感染为主,占46.15%,其次为切口感染,占23.08%;病原菌以革兰阴性菌为主,铜绿假单胞菌占23.81%。结论颅内肿瘤患者术后医院感染发生率明显高于其他科室,手术时间长、侵入性操作、术中植入物使用、抗菌药物的应用等是医院感染的危险因素。     

Risk factors for surgical wound infection among the elderly.

One hundred fifty-seven elderly patients with surgical wound infection were matched on wound classification and date of surgery to non-infected control patients. Factors examined for their association with wound infection included medical history, functional status, behaviour (e.g. smoking), factors predisposing to infection (e.g. results of CBC and urinalysis) and operative factors such as preparation, duration and type of operation. Conditional logistic regression analysis identified factors already known to be risk factors for wound infection at all ages (e.g. type and duration of operation), as well as factors unique to the elderly (e.g. age greater than 70 years and limited mobility).     

粒细胞缺乏患者入住无菌病房医院感染危险因素分析及护理对策

目的探讨粒细胞缺乏患者入住无菌病房行保护性隔离期间发生医院感染的环节、相关因素及护理对策方法采用前瞻性和回顾性调查的方法,对2010年1月～2011年7月我院血液科入住无菌病房的106例粒细胞缺乏患者入住无茵病房期间发生的医院感染的相关危险因素进行统计分析结果106例入住无菌病房的粒细胞缺乏患者发生院内感染77例次,医院感染发病率为72.6%,其中主要以呼吸道感染为主,占41.6%,入住无菌病房期间:患者自身免疫力低下、不同患者交叉感染、自我防护知识欠缺、未严格遵守无菌病房操作规范、医护人员手卫生不达标等是粒细胞缺乏患者院内感染的高危因素。结论粒细胞缺乏入住无菌病房的患者相关宣教效果及其遵医行为的养成、医护人员严格执行无菌操作、执行手卫生等在预防粒细胞缺乏患者入住无菌病房期间发生院内感染有重要作用。     

急性化脓性阑尾炎术后切口感染的相关危险因素分析

目的探讨急性化脓性阑尾炎术后切口感染的危险因素,为切口感染的预防提供参考。方法对298例行阑尾切除治疗的急性化脓性阑尾炎患者的临床资料进行回顾性分析,对切口感染的相关危险因素进行Logistic回归分析,筛选切口感染的相关危险因素。结果急性化脓性阑尾炎患者术后发生切口感染率为7.05%。单因素分析结果显示,年龄、BMI、合并基础疾病、手术时间、手术方式与切口感染有关,而切口感染与性别和切口长度无明显相关性(P0.05);多因素Logistic回归法分析表明,手术方式、BMI、手术时间是切口感染的危险因素。结论开腹手术、BMI≥24kg/m2、手术时间≥1 h发生切口感染的风险性大,对以上三个危险因素加以重点评估和合理控制,可以降低切口感染的发生。     

小儿外科伤口感染原因调查分析

目的 调查分析小儿外科手术伤口感染的原因,探讨小儿外科手术伤口感染的防治措施.方法 对医院小儿外科2009年2月-2010年2月进行外科手术治疗的1567例患儿中发生外科手术伤口感染的78例治疗护理资料进行整理.结果 年幼、体轻患儿较易发生伤口感染,其中＞3岁患儿发生伤口感染率为4.2％,＜3岁患儿发生伤口感染率为6.9％;体轻、正常体重、超重患儿伤口感染率分别为6.1％、4.8％、4.8％;年资＞5年的较＜5年手术者对患儿伤口感染发生率分别为:5.5％、8.5％,差异有统计学意义;年资＞3年较＜3年责任护士的患儿伤口感染率分别为3.1％、8.3％,差异有统计学意义;手术切口类别不同,患儿发生伤口感染的概率亦不同,Ⅲ类切口手术后感染率为7.7％,Ⅱ类切口为5.3％,Ⅰ类切口为2.2％;单独病房患儿发生伤口感染的概率明显低于双人病房及多人病房患儿,分别为6.2％、3.3％、2.0％.结论 加强医疗护理人员的无菌操作意识,做好患儿围术期的各项准备工作,术后做好患儿伤口护理、营养支持、病房环境管理等,是降低小儿外科伤口感染的有效措施.     

Significant reduction of endemic MRSA acquisition and infection in cardiothoracic patients by means of an enhanced targeted infection control programme

Due to increasing methicillin-resistant Staphylococcus aureus (MRSA) infection in cardiothoracic patients at St Thomas' Hospital, an enhanced infection control programme was introduced in September 2000. It was based on UK national guidelines on the control of MRSA and targeted additional identified risk factors for surgical site infection (SSI). It included recognition of the problem by senior staff and their taking responsibility for it; intensive support, education and advice from the infection control team; improved ward and theatre hygiene; pre-admission, admission and weekly MRSA screening; isolation and clearance treatment; nursing care pathways for MRSA colonized patients; and teicoplanin plus gentamicin surgical prophylaxis. The effectiveness of the programme was assessed by retrospective analysis of computerized patient data for the 16 months before and after the introduction of the programme. There was no significant change in the number of operations or the proportion of patients admitted with MRSA, although nine patients were cleared of carriage before admission. However, there were significant falls in the proportion of patients acquiring MRSA on the ward [38/1036 to 14/921, P=0.003, RR 2.4 (95%CI 1.32-4.42)] and in the rate of bloodstream MRSA infections [12/1075 to 2/956, P=0.014, RR 5.34 (95%CI 1.20-23.78)]. Sternal and leg wound infections both halved (from 28/1075 to 13/956 and 16/1075 to 7/956, respectively) but this did not reach statistical significance. These results demonstrate that an enhanced, targeted infection control programme based on the UK national guidelines, SSI prevention guidelines and local risk assessment can reduce the incidence of nosocomial MRSA acquisition and invasive infection in cardiothoracic patients in the face of continuing endemic risk.     

引起剖宫产术切口感染危险因素的临床研究

目的探讨引起剖宫产术切口感染的危险因素及预防。方法选择2004年1月至2008年1月笔者所存医院所有剖官产产妇为观察对象,将发生切口感染的产妇作为观察组,未发生切口感染的产妇作为对照组,比较两组产妇在体重指数、术前白细胞总数、阴道检查或人工破膜等阴道操作史、高频电刀应用、手术时间等方面上的差异,并进行统计学分析处理。结果4年间进行剖宫产1820例,发生切口感染80例,发生率4．40％。与切口感染有关的因素为：体重指数高、白细胞总数高、存在阴道操作史、应用高频电刀、手术时间长。结论剖宫产切口感染的发生率较高,与多种因素有关．应针对影响因素采取相应措施来预防和减少切口感染发生。     

Nosocomial infections in a children's hospital in Argentina: impact of a unique infection control intervention program.

OBJECTIVE: To assess the efficacy of parental education and use of parents as nursing assistants on reducing nosocomial infections. DESIGN: Prospective study. METHODS: Active surveillance for nosocomial infections was performed on two wards. On ward A, parents were educated about infection control practices and assisted nursing staff with routine tasks, so that nursing personnel could focus their efforts on procedures with higher risk of infection. Parental assistance was not sought on ward B, the comparison ward. RESULTS: From October 1990 through September 1991, 1,081 patients were admitted to wards A (470) or B (611). The over-all nosocomial infection rate was 7.1 per 100 admissions; the nosocomial infection rate was significantly higher on ward B than ward A (63/611 vs 14/470; P<.001). Multivariate analysis identified risk factors for nosocomial infection on the two wards as age <2 years (P=.01), malnutrition (P=.005), duration of hospitalization (P<.001), ward B hospitalization (P=.003), and ward cleanliness score (P=.009); the distribution of patients with these factors was similar on the two wards. CONCLUSIONS: Our data suggest that parental infection control education and recruitment to relieve nursing staff of routine low-risk procedures are economical and easily implemented measures to reduce nosocomial infections in hospitals with limited personnel resources in the developing world.     

铜绿假单胞菌在重症监护病房流行及控制措施

目的对一起铜绿假单胞菌(PAE)在重症监护病房(ICU)流行做回顾性调查,探讨病区内交叉感染的危险因素和控制措施。方法对2005年2-11月所有入住ICU的患者病历资料进行回顾性分析。结果在调查的10个月内,ICU共收治患者46例,均做过细菌培养,其中24例患者共培养出PAE 108株,分离时间集中在2005年5-8月,共83株(76.9%),按标本来源,痰液52株、气管吸出物26株、创面17株、其他标本13株;药敏结果提示此次PAE流行株对常用抗菌药物,包括亚胺培南、美罗培南等碳青酶烯类药物在内均有很高的耐药率;流行病学调查表明侵入性医疗操作、抗菌药物使用、病区环境和预防措施不落实是造成此次流行的主要原因。结论改善医疗环境条件、增强医务人员无菌观念、合理使用抗菌药物、加强微生物学监测是预防和控制病区内PAE流行的主要措施。     

Costs of an outbreak of wound infections in an orthopaedic ward.

An outbreak of serious wound infections occurring in an orthopaedic ward is reported. The outbreak involved 10 patients, all of whom had undergone clean, orthopaedic operative procedures. The outbreak was eventually terminated by discarding five damaged and contaminated mattresses. The costs incurred during this outbreak were calculated using a retrospective comparative study. The infected patients had an average increased hospital stay of 17 days and average increased costs of 2220 pounds. The outbreak demonstrated the high costs of hospital-acquired infection and the need for further investment in infection control programmes.     

剖宫产术后切口愈合不良危险因素调查

[目的]分析剖宫产术后切口愈合不良的危险因素,总结护理措施,以提高剖宫产患者切口愈合的质量。[方法]采用病例对照的研究方法,对某院110例行剖宫产术后伤口愈合不良患者的临床资料进行回顾性分析,与同时期剖宫产术后愈合良好组在有关不良危险因素方面进行比较分析,提出合理的护理措施。[结果]110例剖宫产患者伤口轻度愈合不良者72例(65.45%),中度25例(22.73%),重度13例(11.82%);与对照组比较发现,影响切口愈合的危险因素为:BMI高、基础疾病、术前未预防应用抗生素、无菌操作不严格、手术时间长。[结论]多种危险因素影响切口的愈合。提高认识,正确指导孕期保健,做好产前检查、围术期给予药物进行预防、控制病房内细菌的数量,积极采取应对护理措施,以提高切口愈合质量。     

老年患者医院感染危险因素分析

目的 了解干部病房老年患者医院感染发生情况,探讨其危险因素及控制方法 .方法 采用回顾性方法 对1194例≥60岁的患者进行回顾性调查.结果 干部病房老年患者医院感染率为10.30%,感染部位以下呼吸道为主占54.47%,其次为胃肠道与泌尿道,分别占17.89%、14.63%;菌群分布以铜绿假单胞菌、肺炎克雷伯菌、白色假丝酵母菌占前3位;感染发生与年龄、住院时间、基础疾病、使用广谱抗菌药物及侵入性操作等因素相关.结论 老年患者医院感染发生率高,应积极治疗原发病,控制相关危险因素,有效减少医院感染的发生.     

构建预测永久性心脏起搏器植入患者术后囊袋感染风险的列线图模型

 目的 探讨永久性心脏起搏器植入患者术后囊袋感染的风险因素,依此构建个性化的风险预测模型。方法 采用回顾性队列研究方法分析2016年1月—2018年5月安徽省某三级甲等医院心血管内科收治的且接受永久性心脏起搏器植入术患者的临床资料及随访资料。依据患者术后1年囊袋感染的发生情况将受试对象分为感染组和未感染组。采用lasso回归和logistic回归分析永久性心脏起搏器植入术患者术后囊袋感染的独立风险因素。结果 共纳入322例永久性心脏起搏器植入术患者,术后起搏器囊袋感染的发病率为7.45%（24例）。lasso回归和多因素logistic回归模型分析结果显示,年龄、手术时长、手术次数、切口愈合不良是受试对象术后囊袋感染发生的独立风险因素（均P<0.05）。构建的列线图模型通过Bootstrp自抽样1 000次进行内部验证,内部验证后列线图模型的C统计量为0.869（95%CI：0.773~0.947）,提示列线图具有较好的区分度。校准曲线分析表明列线图模型的预测概率与患者实际发生情况的平均绝对误差为0.018,提示列线图具有较好的校准度。决策曲线分析法表明,当列线图模型的概率阈值为0.03~0.62时,患者的临床净收益率最高,提示列线图模型具有较好的临床适用性。结论 永久性心脏起搏器植入患者术后囊袋感染的发生情况受多种风险因素影响,列线图可整合术后囊袋感染的风险因素并用于个性化地预测患者术后囊袋感染风险,具有较高的临床应用价值。     

钦州市第二人民医院外科患者手术后切口感染危险因素的Logistic回归分析

[目的]对外科患者术后切口感染危险因素进行研究,为控制术后切口感染的发生提供科学依据。[方法]以钦州市第二人民医院2009年4399例外科手术患者为调查对象,参考文献及我院病案系统所收录的项目,调查包括年龄、性别、手术分级、手术持续时间、输血、手术部位、全麻、肿瘤、预防用药等项目,按医院感染诊断标准,将38例切口感染患者作为病例组,4361例切口未感染患者作为对照组。数据采用SPSS13.0统计软件进行分析,各变量现经单因素分析后,选择具有统计学差异的因素再进行非条件Logistic回归分析。[结果]钦州市第二人民医院外科切口感染的独立危险因素为手术分级、预防用药。[结论]通过控制外科切口感染独立危险因素,则很有可能降低外科切口感染率。     

Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus

Observational and microbiological data were collected from the patients and environment of a male general surgical ward over a period of 27 months from January 1998. Isolates of methicillin-resistant Staphylococcus aureus (MRSA) from patients and environment were typed by antibiogram, bacteriophage and pulsed field gel electrophoresis of chromosomal DNA. In September 1999, an intervention was put in place which included increasing the domestic cleaning time by 57 hours per week, with emphasis on removal of dust by vacuum cleaning, and allocation of responsibility for the routine cleaning of shared medical equipment.From January 1998 to September 1999, despite standard infection control measures (emphasis on hand hygiene, isolation of affected patients and staggered closure and cleaning of ward bays), 69 patients acquired a strain of E-MRSA16. This strain was also widespread in the ward environment. Typing confirmed that isolates from patients and environment were indistinguishable from one another and that the outbreak was due to a single strain. This strain was responsible for postoperative infection in approximately one third of the patients who acquired it. In the six months following the intervention, only three patients were colonized with the outbreak MRSA and monthly surveys failed to detect this strain in the environment. Thorough and continuous attention to ward hygiene and removal of dust was needed, to terminate a prolonged outbreak of MRSA infection on a general surgical ward, in addition to standard infection control measures. Control of hospital-acquired infection with MRSA requires a combination of measures, none of which are completely effective in isolation.