外科手术部位感染危险因素分析及对策

摘要 目的 分析手术部位感染危险因素,制定感染控制策略。方法 通过回顾性调查方法,对某医院普外科2014年1月1日至2015年12月31日实施手术的所有患者手术部位感染情况进行调查,并对手术部位感染进行单因素分析。 结果 两年间共实施手术1 276例,发生手术部位感染13例,感染率为1.02%,年龄、住院天数、手术切口清洁程度、术前预防性使用抗菌药物、有无糖尿病均为手术部位感染的相关危险因素。结论 加强(≥60岁）患者的身体免疫力、缩短患者住院时间和合理术前预防性使用抗菌药物（0.5~2 h）可有效降低手术部位感染的风险。     

某医院外科手术部位感染目标性监测与分析

摘要 目的 探讨外科手术部位感染的发病率及危险因素。方法 对2016年1月-12月外科手术部位感染的状况进行目标性监测,采用病例对照研究方法进行危险因素分析。结果 监测1 076名外科手术患者,发生手术部位感染42例,手术部位感染率为3.90%,感染病原菌以革兰阴性杆菌为主。logistic回归分析结果显示,外科手术部位感染危险因素为年龄>60岁、手术持续时间3 h以上、术前抗菌药物联合使用及2级、4级ASA评分。结论 应根据外科手术部位感染的相关危险因素进行综合管理。     

手术部位感染的预防及控制

手术部位感染(surgical site infection,SSI)指无植入物手术后30d内、有植入物(如人工心脏瓣膜、人造血管、机械心脏、人工关节等)手术后1年内发生的与手术相关感染,包括浅表切口感染、深部切口感染以及器官/组织间隙感染。现将手术部位感染危险因素、预防及控制对策总结如下。     

神经外科手术部位感染病例分析

[目的]了解医院神经外科在院手术部位感染现状及相关因素,为采取有效干预措施提供依据。[方法]选择某医院神经外科住院病人3 078例,其中发生手术部位感染49例,对其进行分析。[结果]该院神经外科在院手术部位感染发生率为1.32%,89.8%术后病人放置引流管,放置时间超过72h占18.4%,因感染延长住院天数中位数为10d,病原菌检出率为22.2%。[结论]加强手术相关医务人员的无菌意识、加强颅内引流管的护理、合理使用抗菌药物可降低医院神经外科手术部位感染发生率。     

外科手术部位感染因素调查及病原菌分析

摘要 目的 分析手术部位感染（SSI）的相关因素及病原菌分布。 方法 调查某院2015-2016年部分外科手术1 360例次,术前根据手术切口污染情况进行切口类型分类,术后密切观察手术部位伤口愈合情况,并对病原菌进行分析。 结果 共发生SSI 66例,感染率为4.9%;手术危险等级分类、手术切口分类调查中各组差异有统计学意义（P<0.05）,而不同年龄（<60岁和≥60岁）差异无统计学意义（P>0.05）;病原菌以凝固酶阴性葡萄球菌、大肠埃希菌和金黄色葡萄球菌为主。 结论 缩短手术时间,术前做好必要准备,有利于预防和减少SSI,术后应加强手术部位的观察,严格遵守换药流程和要求,避免手术部位SSI的发生。     

5例神经外科患者手术部位感染原因分析

目的：探讨引起短期多例神经外科患者手术部位感染的可能原因。方法：回顾2013年2月1日至3月15日所有神经外科手术患者资料,进行相关暴露因素分析,探讨可能引起手术部位感染的危险因素。结果：“第五手术间”OR=4．07（95％CI=0．52～36．65）,第五手术间环境微生物采样除麻醉剂袖带菌落总数超标以外均符合国家要求;各“手术主刀医生”“手术参与者”的手术部位感染专率较神经外科手术部位平均感染率均无差异（P〉0．05）;“二次手术”OR=18．00（95％CI=2．00～180．00）。结论：“二次手术”是此次短期多例神经外科患者手术部位感染的高危因素;对其干预措施可由此入手,进一步探讨。     

控制外科手术部位感染的护理进展

随着医院管理机制的逐渐完善,近年来,手术部位感染已有下降趋势,但仍时有发生.本文对外科手术部位感染的常见因素,以及控制外科手术部位感染的新举措进行综述,为临床护理提供参考.     

神经外科手术部位感染风险预警模型的建立与应用

目的 了解神经外科患者手术部位感染现状,分析其危险因素,构建手术部位感染风险预警模型,为筛查手术部位感染的高危人群提供技术支持。方法 采用回顾性和前瞻性调查相结合的方法,选择2018—2021年神经外科2 364例手术患者作为研究对象,将数据按6:4的比例随机分为建模组和验证组,通过单因素分析和二元Logistic回归构建预警模型,以ROC曲线下面积（AUC）评价模型的预测效果。结果 2364例神经外科手术患者,发生手术部位感染67例,感染率为2.83%。纳入风险预警模型的变量有低蛋白血症、幕下手术入路、术中放置植入物、术中留置引流管、使用激素、二次手术、术前联合使用抗菌药物等因素;预警模型ROC曲线下面积为AUC=0.938,灵敏度为93.94%,特异度为84.99%。结论 建立的预警模型判别能力较好,对控制手术部位感染、保障患者安全具有重要的现实意义。     

手术部位感染的危险因素及护理对策

手术部位感染（Surgical Site Infection,SSI）是指围手术期发生在切口或手术深部器官或腔隙的感染。SSI既包括了切口感染,也包括手术曾涉及到的器官和腔隙的感染。SSI是手术后最常见的并发症之一,居医院感染的第3位,占住院患者医院感染的14％～16％。SSI的发生不仅严重威胁着患者的健康及生命,而且给患者的家庭及社会带来了巨大的经济负担。本文结合手术室临床工作实际就手术部位感染的相关危险因素及护理对策综述如下。     

骨科手术部位感染的危险因素及防控策略探讨

综述了骨科手术部位感染的现状、危险因素和防控策略,认为更新某些可能存在的错误观点,灵活掌握手术部位感染的防控策略可减少手术部位感染的发生,减轻患者痛苦,提高手术质量。     

Surgical site infection surveillance after open gastrectomy and risk factors for surgical site infection

Surgical site infection (SSI) surveillance was examined in gastric cancer patients who had undergone an open gastrectomy between 1997 and 2003 at Keio University Hospital in Tokyo, Japan. National Nosocomial Infections Surveillance (NNIS) reports and several studies have discussed SSI risk factors, but only open gastrectomy was analyzed by regression analysis. The purpose of this study was to examine these issues by performing a regression analysis for the prediction of SSI. SSI was defined by the surgical patient component according to the NNIS system (1999) produced by the Centers for Disease Control and Prevention. Patients undergoing an open gastrectomy were followed up and monitored for SSIs. Risk factors for SSI, after all factors were considered, were studied using single and multivariate analysis. The study enrolled 984 patients who had undergoing an open gastrectomy. Using multivariate and logistic regression analysis, the duration of the operation was identified as the only risk factor for SSI at open gastrectomy. Although numerous potential risk factors in surgical patients were examined, the duration of the operation was the only significant risk factor for SSIs after open gastrectomy. Part of this study was presented at the 76^th conference of the Infectious Disease Society An erratum to this article is available at .     

腹部外科手术后真菌感染的易感因素与护理

目的探讨腹部外科手术后真菌感染的危险因素及护理干预措施。方法选择2000年1月至2010年12月,接受开腹手术治疗后发生真菌感染的62例患者,并随机选择术后未发生真菌感染的患者395例为对照组。回顾性分析并比较两组患者的临床资料和护理记录,总结真菌感染原因、临床特点及护理措施。结果62例患者共分离出65株菌株,其中白色念珠菌为主要致病菌,占55．4％。单因素分析及多元Logistic回归分析显示,真菌感染的危险因素主要有年龄、住院时间、广谱抗生素使用时间、皮质类固醇激素使用、白细胞计数偏低、侵袭性操作等。结论真菌感染是腹部外科手术后的重要并发症,对患者的康复和预后影响极大。严密观察病情,提高和增强机体的抵抗力,合理使用抗生素,减少侵入性操作和各类导管留置时间,加强基础护理,保持环境清洁,加强无菌观念等是防止腹部外科手术后真菌感染的有效护理措施。     

Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

BACKGROUNDHigh-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. Infection can negatively impact patient outcomes.AIMTo compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.METHODSAmong the 137 patients included, 67 developed a surgical site infection. Demographic, clinical, and surgical factors were compared between the two groups. A binary logistic regression analysis was used to determine the odds ratio (OR) and corresponding 95%CI for significant risk factors for postoperative infection.RESULTSThe distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows: Gram-positive, 58.2% (n = 39); Gram-negative, 38.8% (n = 26); and fungal, 2.9% (n = 2). The following factors were associated with postoperative infection (P < 0.05): a Ruedi–Allgower pilon fracture type III (OR = 2.034; 95%CI: 1.109–3.738); a type III surgical incision (OR = 1.840; 95%CI: 1.177–2.877); wound contamination (OR = 2.280; 95%CI: 1.378–3.772); and diabetes as a comorbidity (OR = 3.196; 95%CI: 1.209–8.450).CONCLUSIONInfection prevention for patients with a Ruedi–Allgower fracture type III, surgical incision type III, wound contamination, and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.     

成人心脏直视术后手术部位感染危险因素分析

目的 探讨成人心脏直视术后手术部位感染(SSI)发生的危险因素,为控制SSI的发生提供依据.方法 对本院心脏外科2001年1月至2009年12月间体外循环心脏直视术后发生SSI 54例成年患者临床资料进行分析,按1:3比例配对选取对照组.对2组患者的临床资料中SSI的潜在危险因素进行单因素和多因素条件Logistic回归分析.结果 单因素条件Logistic分析:左心室射血分数(LVEF)<50%(OR=2.134,95%CI:1.095～4.159,P=0.026),心功能NYHA≥Ⅲ级(OR=2.390,95%CI:1.218～4.690,P=0.011),糖尿病(OR=3.275,95%CI:1.391-7.708,P=0.007),慢性阻塞性肺疾病(COPD)(OR=5.408,95%CI:1.248～23.445,P=0.024),体外循环时间>90 min(OR=3.045,95%CI:1.540～6.024,P=0.001),手术时间>4 h(OR=3.281,95%CI:1.610～6.685,P=0.0131),血液制品用量>2 U(OR=1.929,95%CI:1.018～3.675,P=0.044),切口连续缝合(OR=2.344,95%CI:1.221～4.498,P=0.010),二次开胸止血(OR=6.625,95%CI:1.597～27.491,P=0.009),术后高血糖(OR=3.510,95%CI:1.596～7.718,P=0.002),重症监护病房入住>72 h(OR=3.281,95%CI:1.505～7.150,P=0.003)与SSI发生相关.多因素条件Lgistic回归分析显示:手术时间>4 h(OR=3.100,95%CI:1.470～6.537,P=0.003)、切口皮下层连续缝合(OR=2.340,95%CI:1.183～4.692,P=0.015)、术后高血糖(OR=3.272,95%CI:1.427～7.505,P=0.005)是SSI的独立危险因素.结论 手术时间>4 h、切口皮下连续缝合及术后高血糖是心脏直视术后SSI发生的危险因素.     

目标性监测在预防阑尾炎手术部位感染中的应用

目的:探讨目标性监测对预防阑尾炎手术部位医院感染的效果,为降低阑尾炎手术部位感染率,在围手术期制定感染控制干预措施提供依据。方法:比较我院2009年3月～2010年2月(实施目标性监测前,对照组)与2010年3月～2011年2月(实施目标性监测后,监测组)行开腹阑尾炎手术患者的手术部位感染情况。结果:监测组手术部位感染率低于对照组(P<0.05)。结论:采用目标性监测方法能有效降低医院感染率,减少患者的痛苦和医药资源浪费,提高医疗质量。     

Preventing surgical site infections

Over the past 50 years, increased interest in the discipline of surgical infection has resulted in advances in post-surgical infection control. Early investigations focused on the importance of anaerobic microflora to postoperative infection and paved the way for significant improvements in prophylactic and therapeutic antibiotic treatment of surgical patients. Later research centered on the identification of risk factors to better predict postoperative infection rates. This article reviews the evolution of postoperative infection control and highlights antibiotic prophylaxis in specific clinical situations.     

Surgical site infection after pediatric spinal deformity surgery

The incidence of surgical site infection (SSI) after spinal deformity surgery for adolescent idiopathic scoliosis ranges from 0.5–6.7%. The risk of infection following spinal fusion in patients with neuromuscular scoliosis is greater, with reported rates of 6.1–15.2% for cerebral palsy and 8–41.7% for myelodysplasia. SSIs result in increased patient morbidity, multiple operations, prolonged hospital stays, and significant financial costs. Recent literature has focused on elucidating the most common organisms involved in SSIs, as well as identifying modifiable risk factors and prevention strategies that may decrease the rates of infection. These include malnutrition, positive urine cultures, antibiotic prophylaxis, surgical site antisepsis, antibiotic-loaded allograft, local application of antibiotics, and irrigation solutions. Acute and delayed SSIs are managed differently. Removal of instrumentation is required for effective treatment of delayed SSIs. This review article examines the current literature on the prevention and management of SSIs after pediatric spinal deformity surgery.     

Risk factors for surgical site infection after major hepatobiliary and pancreatic surgery

Major hepatobiliary and pancreatic (HP) surgeries are complex procedures associated with a high incidence of surgical site infection (SSI) and are commonly performed in patients with cancer in Japan. This study was performed to investigate the risk factors for SSI, including incisional and organ/space SSI, in HP surgery. The following procedures were included in the study: hepatectomy with and without biliary tract resection, pancreatectomy [pancreaticoduodenectomy (PD), others], and open cholecystectomy. In total, 735 patients were analyzed. The incidence of SSI was 17.8% (incisional, 5.2%; organ/space, 15.5%; both 2.9%). The highest incidence of SSI was observed in patients who underwent hepatectomy with biliary tract resection (39.1%), followed by pancreatectomy (PD, 28.8%; others, 29.8%). Almost all SSIs after these three procedures were classified as organ/space (39.1%, 25.0%, and 27.7%, respectively), and these procedures were risk factors for not only total SSI but also organ/space SSI in the multivariate analysis. An American Society of Anesthesiologists physical status of ≥3 was a risk factor for incisional SSI. Preoperative biliary drainage, prolonged surgery, concomitant surgery, and massive intraoperative bleeding were associated with SSI. In conclusion, the main type of SSI was organ/space SSI after HP surgery, and different risk factors were identified between organ/space and incisional SSI. Procedure-related factors and preoperative biliary drainage were independent risk factors for SSI. To prevent SSI, the indication for preoperative biliary drainage should be carefully evaluated in patients undergoing HP surgery.     

Economic evaluation in critical care medicine

Scarce resources are a reality in all health care systems. There is a constant challenge to maximize health benefits within the resources available. This is particularly relevant when caring for critically ill patients, given the resource-intensive technologies and medicines used and the highly specialized professionals required. Moreover, given the high acuity of illness, decision makers and health care providers in critical care units must constantly assess the value derived from therapies and resources used. Economic evaluation is the comparative analysis of alternative health care interventions in their relative costs (resource use) and effectiveness (health effects). Economic evaluations have been increasingly published in critical care journals and read by clinicians. This article illustrates how the basic principles of health economics can be applied to health care decision making through the use of economic evaluation. We demonstrate how economic evaluation can link medical outcomes, quality of life, and costs in a common index, even for therapies for different medical conditions and with different health outcomes. This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown.