Prevalence of nosocomial infections in a university hospital (Dakar, Senegal)

Nosocomial infections constitute today a great public health problem that is still ignored or poorly mastered in our health institutions. METHOD: A prevalence study initiated by the CLIN (committee for the prevention of nosocomial infections) was recently conducted at the Fann teaching hospital. A questionnaire was prepared and submitted to all patients that were hospitalized on the day of the study; the questionnaire allowed gathering a lot of information on exposure factors and clinical and microbiological arguments in favor of nosocomial infections. RESULTS: One hundred and seventy-five patients (59.9% of all available beds) participated in the study. Nosocomial infections were found mostly among people between 20 and 44 years of age and predominantly in women. Fifty-eight percent of those cases were found in the neurology unit. The infections were mostly urinary (40%) and pulmonary (25%). The germs responsible were multiresistant bacteria: Enterobacter cloacae secreting broad-spectrum betalactamase, methicillinresistant Staphylococcus aureus, and Pseudomonas aeruginosa. The infected patients were usually under antibiotic treatment (80%) with various protocols, mainly monotherapy. The antibiotics used were betalactams, fluoroquinolones, and nitroimidazoles.     

Epidemiology and prevention of surgical site infections after cardiac surgery

Deep sternal wound infection is the major infectious complication in patients undergoing cardiac surgery, associated with a high morbidity and mortality rate, and a longer hospital stay. The most common causative pathogen involved is Staphylococcus spp. The management of post sternotomy mediastinitis associates surgical revision and antimicrobial therapy with bactericidal activity in blood, soft tissues, and the sternum. The pre-, per-, and postoperative prevention strategies associate controlling the patient's risk factors (diabetes, obesity, respiratory insufficiency), preparing the patient's skin (body hair, preoperative showering, operating site antiseptic treatment), antimicrobial prophylaxis, environmental control of the operating room and medical devices, indications and adequacy of surgical techniques. Recently published scientific data prove the significant impact of decolonization in patients carrying nasal Staphylococcus aureus, on surgical site infection rate, after cardiac surgery.     

乳腺癌手术预防应用抗菌药物对降低手术部位感染的作用

目的 明确预防应用抗菌药物对乳腺癌手术后手术部位感染发病率的影响.方法 通过检索Medline、Embase和Cochrane图书馆数据库,筛选2011年12月之的公开发表的文献,无语言限制;选择标准为乳腺癌患者接受围手术期抗菌药物的随机对照试验、研究结局为手术部位感染;数据收集和分析由作者审查检索的所有研究的标题和摘要,然后评估研究质量,并从符合纳入标准的研究中提取数据.结果 共纳入了8项研究,所有研究干预组均为抗菌药物,对照组为安慰剂或空白对照,而且均为高质量随机对照研究;研究结果表明,乳腺癌手术患者围手术期预防应用抗菌药物可显著降低手术部位感染率(RR=0.71,95％CI:0.55～0.92);经过Begg's检验(z=0.12,P-0.90)和Egger's检验(t=0.16,P=0.88),该研究不存在明显的发表偏倚.结论 预防应用抗菌药物可降低乳腺癌手术后手术部位感染发病率,但需权衡考虑感染引起的潜在风险如伤口愈合或延迟质量和用药引起的不良后果如成本、药物反应或增加细菌耐药性等.     

重症医学科医院感染的病原菌监测与分析

目的 通过监测,统计重症医学科医院感染主要病原菌的分布,为临床治疗和有效做好感染控制措施提供依据.方法 统计2010年4月-2011年4月重症医学科医院感染病例,对送检标本中分离到的主要病原菌进行调查分析与统计.结果 从医院感染病例中共分离出病原菌527株,前5位分别为金黄色葡萄球菌、肺炎克雷伯菌、白色假丝酵母菌、嗜麦芽寡养单胞菌及铜绿色假单胞菌,分别占16.69％、11.39％、10.63％、7.21％及7.02％;病原菌与感染部位分布中,下呼吸道分离出437株,占82.92％,其次为泌尿道分离出32株,占6.07％.结论 加强危重患者管理,进行科学监测,对预防和控制医院感染的发生有积极作用.     

冠状动脉旁路移植术后手术部位感染的配对研究

目的 分析冠状动脉旁路移植术(CABG)后手术部位感染(SSI)患者和非感染患者的抗菌药物预防使用情况和部分临床指标,为合理使用抗菌药物提供依据.方法 对北京市9所医院2008-2010年的CABG手术进行前瞻性目标性监测,将发生SSI的62例患者作为SSI组,未发生感染的124例患者作为对照组,分析两组患者围术期抗菌药物使用、术后早期血像和体温等临床指标.结果SSI组和对照组患者抗菌药物使用率均为100.0％,联合预防用药率分别为81.42％和79.29％,预防用药时间分别为(11.18±1.12)d和(10.95±0.98)d,两组差异无统计学意义;SSI组和对照组术后24～48 h白细胞绝对值分别为(18.2±0.48)、(17.9±0.92) k/μl,术后72 h患者体温分别为(37.8±0.86)、(38.0±0.24)℃,两组差异无统计学意义.结论 预防SSI不应单纯依赖长时间、联合使用抗菌药物,术后早期血像升高、体温升高在鉴别SSI上指示作用不明显,不应片面参考血像和体温作为延长使用抗菌药物预防SSI的绝对指征,应结合其他指标进行综合判断.     

Automating the monitoring of surgical site infections using variable life-adjusted display charts

We describe a software tool specifically developed to support the monitoring and reporting of the occurrence of surgical site infections (SSI) in hospitals. The tool uses data collected routinely by a London teaching hospital as part of its infection surveillance system, which includes post-discharge follow-up. Based on these data, the tool is used to generate graphs showing cumulative infections over time and variable life-adjusted display (VLAD) charts that account for the expected specialty average infection risk. The user can select, along with other options, the definition of infection used in the preparation of the graphs. Using an illustrative example of SSI monitoring in orthopaedic surgery, we demonstrate the tool and its intended use to trigger further scrutiny rather than draw firm conclusions. We show that the tool has the ability to generate departmental debate, which should ultimately lead to the increased safety of surgical patients. We recommend adopting the tool and VLAD charts wherever surgical site surveillance is continuous.     

普通外科患者术后手术部位感染的易感因素分析及对策

目的 研究普通外科患者术后手术部位感染的易感因素,探讨防止手术部位感染的方法.方法 将医院普通外科于2010年1月-2011年1月收治行手术治疗的462例患者作为研究对象,按照手术部位感染与否,分为手术部位感染组和正常组,对两组患者的一般资料、诊治资料进行分析,总结普通外科患者术后手术部位感染的易感因素,并探讨针对性预防手术部位感染的对策.结果 462例患者中发生术后手术部位感染43例,手术部位感染发生率为9.3％;感染组和正常组年龄＞60岁分别占51.2％、22.2％;肥胖分别占74.4％、27.4％;合并糖尿病分别占74.4％、16.7％;急诊手术分别占67.4％、16％;污染类手术分别占60.4％、21.2％;手术时间分别为(5.3±2.1)、(3.0±2.7)h;术后住院时间分别为(12.4±3.6)、(8.2±4.1)d,频繁过量应用抗菌药物等,均是术后手术部位感染的易感因素,组间比较差异均有统计学意义(P＜0.05).结论 临床在对普通外科患者进行手术治疗时,应综合考虑患者因素、治疗因素,采取针对性的防感染措施,以降低患者术后手术部位的感染发生率.     

剖宫产手术部位感染临床特点分析

目的 探讨剖宫产手术部位感染(SSI)临床特点及预防措施.方法 回顾性分析剖宫产2450例产妇的临床资料;观察病原菌分布、SSI发生情况及相关因素、临床结果.结果 2450例剖宫产产妇合并SSI共80例,占3.26％;检出病原菌52株,革兰阴性杆菌40株,革兰阳性球菌12株,SSI组年龄大、检查和治疗次数多、体质量指数高、术前身体状况分级低、试产时间长、瘢痕子宫比例高、手术时间长,是SSI的危险因素,SSI经过治疗均痊愈,住院时间(7.12±2.56)d,长于非SSI组的(5.22±2.13)d,差异有统计学意义(P＜0.05).结论 剖宫产术发生SSI发生率较高,虽然愈合良好,但延长住院时间,应采用合理方法预防SSI,做好产前检查保健工作、提高手术水平、合理使用抗菌药物.     

阑尾切除术手术部位感染危险因素研究

目的探讨阑尾切除术手术部位感染的危险因素,为制定感染控制措施提供依据。方法对某院2010年8月-2011年12月施行阑尾切除术的512例患者资料进行调查。结果512例患者发生手术部位感染42例,感染率8.20%,均为表浅手术切口感染。单因素分析结果显示,患者年龄、皮下组织厚度、是否患糖尿病、麻醉类型、手术持续时间、手术季节、手术切口类型、阑尾病理类型等与手术部位感染相关（均P＜0.05）。多因素Logistic回归分析结果显示,手术切口类型(OR 95%CI: 2.75～67.45)、皮下组织厚度(OR 95%CI: 4.54～45.81)、是否患糖尿病(OR 95%CI: 5.13～29.91)、麻醉类型(OR 95%CI: 1.79～53.28)、手术持续时间(OR 95%CI: 8.10～78.63)及阑尾病理类型(OR 95%CI:5.51～54.74)是患者手术部位感染的危险因素（均P＜0.05）。结论应针对手术部位感染危险因素重点防控,预防阑尾切除术后手术部位感染的发生。     

Risk control of surgical site infection after cardiothoracic surgery

The purpose of this prospective study was to investigate whether a risk control programme based on risk assessment, new treatment modalities and the presence of a surveillance programme reduces the incidence of surgical site infections (SSI). Between January 2001 and December 2003, 167 patients were treated for a total of 183 SSIs. Data were collected on pre-operative risk factors, intra-operative data and postoperative recovery, including complications, infecting organisms, SSI treatment techniques and length of hospital stay. In this series, the total incidence of SSI was 5.6%. The mean age of affected patients was 65.1 years with a range of 20–87 years. Mean intensive care and hospital stay for SSI was 3.6 days and 18.8 days, respectively. Total mortality was 4.8%. Many risk factors were encountered, some of which were associated with a high morbidity. The majority of SSIs were treated by topical negative pressure therapy (N=81), which gave few side-effects and good clinical results. After starting the surveillance programme, a steady decline in prevalence was observed from 8.9% to 3.9%. This series adds to the evidence that SSI after cardiothoracic surgery is a major but mainly preventable cause of morbidity and mortality. Risk factor assessment, application of novel treatment modalities and an adequate surveillance system all increased patient safety.     

肝胆外科手术部位感染目标性监测分析

目的探讨肝胆外科手术部位感染(SSI)特点和高危因素,为肝胆外科患者SSI的预防和治疗提供理论参考。方法采用前瞻性监测方法对2013年3月-2014年2月收治的547例肝胆外科手术患者进行有针对性的监测,观察并记录患者SSI情况,及时进行电话随访,统计分析感染率、感染程度、手术时间等相应指标,采用SPSS19.0软件对数据进行统计分析。结果 547例肝胆外科手术患者21例发生SSI,发生率为3.84%,急诊手术SSI发生率为12.82%,择期手术SSI发生率为3.15%,急诊与择期手术感染率差异有统计学意义(P<0.01);Ⅰ类切口55例无SSI发生,Ⅱ类切口486例发生SSI 20例,发生率4.12%,Ⅲ类切口6例,SSI发生1例,发生率16.67%,肝胆外科手术部位感染以Ⅱ类切口为主;手术时间≤2.5h的患者共410例,切口感染者8例,感染率1.95%;手术时间>2.5h的患者共137例,切口感染者13例,感染率9.49%,差异有统计学意义(P<0.01)。结论肝胆外科SSI与切口类型、手术时间、手术危险指数等多种因素有关,为减少感染的发生,应采取有针对性的预防控制措施。     

胃结肠手术部位感染相关危险因素研究

目的探讨胃结肠手术部位感染(SSI)的危险因素,为SSI的预防控制措施提供依据。方法采用目标性监测的方法,研究胃结肠手术后SSI的发生,采用SPSS 10.0软件对其相关危险因素,如术前住院日、血糖、外周血血浆白蛋白、术前发热、手术持续时间、手术方式、ASA评分、内镜使用、失血量、术后引流管放置天数、入住ICU等25个变量进行单因素和多元logistic回归分析。结果 502例胃结肠手术后SSI发生率为6.17%,其中住院期间感染24例,感染率为77.4%,出院后随访感染7例,感染率为22.6%;多元logistic回归分析显示,血糖异常(P=0.002)、手术持续时间长(P=0.000)、内镜使用(P=0.032)是SSI发生的主要危险因素。结论胃结肠SSI是多因素综合作用引起的,开展目标性监测加强对临床干预可促使医疗质量持续改进,降低SSI发生率。     

Linkage of microbiology reports and hospital discharge diagnoses for surveillance of surgical site infections

Surveillance of surgical site infections (SSIs) with feedback to surgical personnel is pivotal in decisions regarding infection control. Prospective surveillance is time and resource consuming, so we aimed to evaluate a method based on data collected routinely during care delivery. The study was carried out at three acute hospitals in North-eastern Italy, from 1 January 2001 to 31 December 2001. Hospital discharge diagnoses (selected codes from the International Classification of Diseases, 9th Revision--Clinical Modification) and electronic microbiology reports (positive cultures from surgical wounds and drainages) were linked to identify suspected SSIs. A random sample of tracked events was submitted to total chart review in order to confirm the presence of SSIs retrospectively according to Centers for Disease Control and Prevention definitions. Of 865 suspected SSIs, 64.5% were identified from the microbiological database, 27.1% from discharge codes, and 8.4% from both. Four hundred and three admissions were sampled for review; the overall positive predictive value was 72% (95%CI=69-76%). Since inpatient individual antibiotic exposure is not registered in Italy, the combined use of discharge codes and microbiology reports represents the most feasible automated method for surveillance of SSIs developing during hospital stay.     

口腔颌面部游离组织皮瓣手术部位感染的病原学诊断及治疗

目的观察口腔颌面部游离组织皮瓣手术患者手术部位感染(SSI)的病原学分析,以期提高临床诊治水平。方法选择2005年3月-2013年3月收治的152例口腔颌面部损伤需要接受游离组织皮瓣移植修复手术患者,观察患者SSI发生率,并统计发生SSI的相关因素以及病原学分析,数据均采用SPSS16.0软件进行统计分析和处理。结果 152例口腔颌面部游离组织皮瓣手术患者发生SSI 27例,发生率为17.76%;口腔颌面部游离组织皮瓣手术患者发生SSI的相关因素,与患者术前的白细胞计数以及术前抗菌药物使用时间有关,差异有统计学意义(P<0.05);SSI病原菌以革兰阴性菌为主占62.96%、革兰阳性菌为29.63%、真菌为7.41%。结论口腔颌面部游离组织皮瓣手术患者发生SSI的相关因素与术前白细胞计数以及抗菌药物使用时间有关,因此应加强患者术前预防性抗菌药物使用,加强术后的随访和干预措施,有效降低SSI的发生。     

肠道手术围术期低体温与手术部位感染关系研究

目的 探讨结肠及直肠手术患者围手术期低体温与手术部位感染(SSI)之间的关系,以降低SSI发生率.方法 选取2010年10月-2012年5月收治的190例结肠及直肠手术患者为研究对象,随机分为研究组和对照组各95例,研究组患者在常规护理基础上加以保温措施,对照组仅进行常规护理,比较两组低体温和SSI的发生率,总结两者的关系.结果 研究组患者低体温发生率为0,SSI发生率7.37％,对照组患者低体温发生率为98.95％,SSI发生率18.95％,研究组低体温和SSI发生率明显低于对照组,差异有统计学意义(P＜0.05),体温越高SSI发生率越低,切口恢复与体温高低成正比.结论 结肠及直肠手术患者SSI发生率与低体温有关,围手术期施以保温措施干预,可以减少低体温的发生,降低SSI的发生率.     

A comparison of two methods for identifying surgical site infections following orthopaedic surgery

Many infection control practitioners (ICPs) dedicate a significant amount of time and resources to surveillance of surgical site infections (SSIs). Alternative surveillance methods need to be explored to reflect the changes to the healthcare system and the increasing economic constraints placed on infection control units. This study was undertaken to compare two methods of identifying SSIs in orthopaedic surgery. Surveillance data collected routinely by ICPs was compared with data obtained from the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) coding in the medical record. Concordant results between the two methods were obtained. The use of ICD-9-CM coding, as stored in hospital patient administration system databases, has the ability to enhance routine surgical site surveillance programmes. These systems can be used as the basis for screening large data sets for SSIs and identifying where SSIs resulted in patient re-admission. A reduction in the duplication of data and time spent by the ICP on the collection of information for surveillance purposes can be achieved.