Surgical-site infection following spinal fusion: a case-control study in a children's hospital.

OBJECTIVES: To determine the rates of surgical-site infections (SSIs) after spinal surgery and to identify the risk factors associated with infection. DESIGN: SSIs had been identified by active prospective surveillance. A case-control study to identify risk factors was performed retrospectively. SETTING: University-associated, tertiary-care pediatric hospital. PATIENTS: All patients who underwent spinal surgery between 1994 and 1998. Cases were all patients who developed an SSI after spinal surgery. Controls were patients who did not develop an SSI, matched with the cases for the presence or absence of myelodysplasia and for the surgery date closest to that of the case. RESULTS: There were 10 infections following 125 posterior spinal fusions, 4 infections after 50 combined anterior-posterior fusions, and none after 95 other operations. The infection rate was higher in patients with myelodysplasia (32 per 100 operations) than in other patients (3.4 per 100 operations; relative risk = 9.45; P < .001). Gram-negative organisms were more common in early infections and Staphylococcus aureus in later infections. Most infections occurred in fusion involving sacral vertebrae (odds ratio [OR] = 12.0; P = .019). Antibiotic prophylaxis was more frequently suboptimal in cases than in controls (OR = 5.5; P = .034). Five patients required removal of instrumentation and 4 others required surgical debridement. CONCLUSIONS: Patients with myelodysplasia are at a higher risk for SSIs after spinal fusion. Optimal antibiotic prophylaxis may reduce the risk of infection, especially in high-risk patients such as those with myelodysplasia or those undergoing fusion involving the sacral area.     

Prevalence of nosocomial infections after surgery in Greek hospitals: results of two nationwide surveys.

OBJECTIVE: To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals. DESIGN: Two point-prevalence studies. SETTING: Fourteen Greek hospitals. PATIENTS: Those in the hospitals during two prevalence surveys undergoing surgery during their stay. RESULTS: In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively. CONCLUSION: Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.     

Prevalence and predictors of surgical site infection in Tbilisi, Republic of Georgia

Surgical site infections (SSIs) are a serious problem worldwide. Little is known about the epidemiology of SSI in the former Soviet Union. In order to determine the prevalence and predictors of SSI in the Republic of Georgia, we undertook a multicentre observational study of SSIs in three urban hospitals in the capital, Tbilisi. Point prevalence studies (PPS) were performed every 3-5 weeks from September 2000 to January 2002 using the National Nosocomial Infections Surveillance (NNIS) System definitions. All patients who had undergone surgery and were present in participating departments at study hospitals on the day of PPS were included. Of 872 surgical procedures, 146 (16.7%) were complicated by SSI. The prevalence of SSI varied by procedure and risk category. On multivariate regression analysis, age, wound class, one hospital (B) and urological surgery were predictive of SSI. In a separate model, NNIS risk index was highly predictive of SSI. Antibiotic prophylaxis was rare (29.5% of operations), while postoperative antibiotic use was common. SSI is an important problem in the Republic of Georgia. Potential areas for intervention include antibiotic prophylaxis and shaving practices for skin preparation.     

Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study.

OBJECTIVE: To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections. DESIGN: Prospective cohort study, with telephone follow-up for 1 month after hospital discharge. SETTING: The general surgery service of a tertiary hospital in Spain. MAIN OUTCOME MEASURE: In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician. RESULTS: Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and post-discharge SSIs remained even after controlling for time from operation to diagnosis. CONCLUSIONS: Most predictors of in-hospital SSI were not predictors of postdischarge SSI.     

Incidence of and risk factors for surgical-site infections in a Peruvian hospital.

OBJECTIVE: To determine the incidence of and risk factors for surgical-site infections (SSIs) after abdominal surgery. DESIGN: A cohort study was conducted from January to June 1998. CDC criteria for SSI and the NNIS System risk index were used. SETTING: A tertiary-care hospital in Peru. PATIENTS: Adult patients undergoing abdominal surgery who consented were enrolled and observed until 30 days after surgery. Patients who had undergone surgery at another hospital or who died or were transferred to another hospital within 24 hours after surgery were excluded. RESULTS: Four hundred sixty-eight patients were enrolled. Their mean age was 37.2 years. One hundred twenty-five patients developed SSIs, 18% of which were identified after discharge. The overall incidence rate (IR) was 26.7%. The IR was 13.9% for clean, 15.9% for clean-contaminated, 13.5% for contaminated, and 47.2% for dirty interventions. The IR was 3.6% for NNIS System risk index 0 and 60% for index 3. Risk factors for SSI on logistic regression analysis were dirty or infected wound (RR, 3.8; CI95, 1.7-8.4), drain use longer than 9 days (RR, 6.0; CI95, 2.5-12.5), and length of surgery greater than the 75th percentile (RR, 2.1; CI95, 1.0-4.4). Patients with SSI had a longer hospital stay than did non-infected patients (14.0 vs 6.1 days; p < .001). CONCLUSIONS: SSI is a major problem in this hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.     

Postoperative wound infection: Relation to different types of operation and wound contamination categories in orthopaedic surgery

During one year, 1,407 operations were performed on inpatients in an orthopaedic department. The presence or absence of postoperative wound infection was recorded during the hospital stay, at discharge and at follow up. Wound infections were linked to operations of different contamination categories and to the different types of operation performed. Better information about the risk for postoperative wound infection and the need for antibiotic prophylaxis was provided by considering the different operation types.     

Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective.

OBJECTIVE: To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program. DESIGN: Prospective surveillance study. SETTING: A surgical ward at a university teaching hospital in Italy. PATIENTS: A total of 264 surgical patients were included in the study. RESULTS: The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (+/-SD) for patients who acquired a postdischarge SSI was 4.9+/-3.7 days, and SSI was diagnosed a mean duration (+/-SD) of 11.5+/-4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher. CONCLUSIONS: Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.     

Risk factors for surgical-site infections following cesarean section.

OBJECTIVE: To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections. DESIGN: Prospective cohort study. SETTING: High-risk obstetrics and neonatal tertiary-care center in upstate New York. PATIENTS: Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998. METHODS: Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by readmission to the hospital or by a postdischarge survey. RESULTS: Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95, 1.01-1.03; P=.04). Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (P=02), whether or not active labor or ruptured membranes were present. CONCLUSION: Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.     

Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study.

OBJECTIVE: Femoral neck fracture is the most frequent orthopedic emergency among elderly persons. Despite a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in this population, no multicenter study of antibiotic prophylaxis practices and the rate and microbiological characteristics of surgical site infection (SSI) has been performed in France. DESIGN: Retrospective, multicenter cohort study. SETTING: Twenty-two university and community hospitals in France. PATIENTS: Each center provided data on 25 consecutive patients who underwent surgery for femoral neck fracture during the first quarter of 2005. Demographic, clinical, and follow-up characteristics were recorded, and most patients had a follow-up office visit or were involved in a telephone survey 1 year after surgery. RESULTS: These 22 centers provided data on 541 patients, 396 (73%) of whom were followed up 1 year after surgery. Of 504 (93%) patients for whom antibiotic prophylaxis was recorded, 433 (86%) received a cephalosporin. Twenty-two patients had an SSI, for a rate of 5.6% (95% confidence interval, 3.7-8.0). SSI was reported for 15 (6.9%) of patients who had a prosthesis placed and for 7 (3.9%) who underwent osteosynthesis (P=.27). SSI was diagnosed a median of 30 days after surgery (interquartile range, 21-41 days); 7 (32%) of these SSIs were superficial infections, and 15 (68%) were deep or organ-space infections. MRSA caused 7 SSIs (32%), Pseudomonas aeruginosa caused 5 (23%), other staphylococci caused 4 (18%), and other bacteria caused 2 (9%); the etiologic pathogen was unknown in 4 cases (18%). Reoperation was performed for 14 patients with deep or organ-space SSI, including 6 of 7 patients with MRSA SSI. The mortality rate 1 year after surgery was 20% overall but 50% among patients with SSI. In univariate analysis, only the National Nosocomial Infections Surveillance System risk index score was significantly associated with SSI (P=.006). CONCLUSIONS: SSI after surgery for femoral neck fracture is severe, and MRSA is the most frequently encountered etiologic pathogen. A large, multicenter prospective trial is necessary to determine whether the use of antibiotic prophylaxis effective against MRSA would decrease the SSI rate in this population.     

Impact of surgeon-specific feedback on surgical site infection rates in Thailand

Data on surgeon-specific feedback on surgical site infection (SSI) rates are not currently available in Thailand. The authors conducted a before and after study among patients undergoing surgery in seven Thai hospitals to examine whether a feedback system to surgeons could reduce SSI rates. After a six-month surveillance period, surgeons were provided with their own SSI rates and standardized infection ratios (SIRs). The criteria of the National Nosocomial Infection Surveillance (NNIS) system were used to determine SSI rates, and the SSI rates were compared with the NNIS report in terms of the SIR. To compare the SIR before and after intervention, the SIR ratio was calculated and logistic regression analysis was used to estimate the relative impact of surgeon-specific feedback, adjusting for patient sex, patient age, degree of wound contamination, American Society of Anesthesiologists' score, duration of operation, type of operation, use and duration of antibiotic prophylaxis, and length of pre-operative stay. After confidential feedback to surgeons for six months, SSI rates and the SIR remained unchanged. The SSI rate in the pre-intervention period was 1.7 infections/100 operations and the corresponding SIR was 0.8 [95% confidence intervals (CI)=0.6-0.9]. In the post-intervention period, the SSI rate was 1.8 infections/100 operations, with a corresponding SIR of 0.8 (95%CI=0.7-0.9). The SIR ratio was 1.0. The relative risk of SSI after surgeon-specific feedback suggested that this intervention had no effect (adjusted relative risk=1.02, 95%CI=0.77-1.35). Feedback to surgeons on their SSI rates did not reduce the rates of such infections in Thailand.     

Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery.

OBJECTIVE: To determine the relative importance of different risk factors for the development of surgical-site infections (SSIs) in orthopedic surgery with prosthetic implants. DESIGN: In a cohort of 272 patients, the following possible risk factors were studied: age, gender, method of hair removal, duration of operation, surgeon, underlying illness, and nasal carriage of Staphylococcus aureus. Infections were recorded following the Centers for Disease Control criteria. The relation between risk factors and SSI was tested in univariate and multiple logistic regression analysis. SETTING: Community hospital in Breda, The Netherlands. RESULTS: 18 (6.6%) of 272 patients experienced SSI: 11 superficial and 7 deep SSI. These infections led in three cases to removal of the prosthesis and caused 286 extra days in hospital. The main causative pathogen was S aureus. In multiple logistic regression analysis, the following factors were independent risk factors for the development of SSI: high-level nasal carriage of S aureus (P=.04), male gender (P=.005), and surgeon 1 (P=.006). The only independent risk factor for SSI with S aureus was high-level nasal carriage of S aureus (P=.002). CONCLUSION: High-level nasal carriage of S aureus was the most important and only significant independent risk factor for developing SSI with S aureus.     

剖宫产手术部位感染目标性监测效果分析

目的了解剖宫产手术部位感染(SSI)发病情况,分析其危险因素,实施干预措施,评价干预后效果。方法监测2013年1—12月某院产科行剖宫产的所有产妇,调查分两个阶段进行:评估阶段(2013年1—6月);干预阶段(2013年7—12月)。采用目标性监测和临床干预相结合的方法,针对干预前发现的危险因素采取干预措施,比较干预前后SSI情况及住院时间、住院费用。结果共监测行剖宫产患者1 593例,发生SSI 31例,发病率1.95%。其中评估阶段SSI发病率3.40%;干预阶段SSI发病率0.95%;干预前后SSI发病率比较,差异有统计学意义(χ~2=12.02,P0.01)。评估阶段单因素分析表明,手术时间≥1 h、身体质量指数≥26 kg/m~2、术中出血量≥300 mL、有基础疾病、有胎膜早破、未预防性使用抗菌药物是剖宫产患者SSI的危险因素(均P0.05)。评估阶段648例患者手术后预防性使用抗菌药物时间以48 h为主(395例,占60.96%);干预阶段945例患者手术后预防性使用抗菌药物时间以24 h为主(776例,占82.12%);干预前后两阶段手术后预防性使用抗菌药物不同时间分布比较,差异有统计学意义(χ2=673.26,P0.01)。31例SSI患者平均住院日为(13.83±3.26)d,非SSI患者为(7.06±1.66)d,差异有统计学意义(t=7.86,P0.01);SSI患者平均住院费用为(9 044.77±2 649.19)元,非SSI患者为(6 254.73±638.52)元,差异有统计学意义(t=4.344,P0.01)。结论针对剖宫产手术后SSI的危险因素采取干预措施,可有效降低剖宫产SSI发病率。     

Excess length of stay attributable to surgical site infection following hip replacement: a nested case-control study.

OBJECTIVE: We estimated the impact of hip replacement-associated surgical site infection (SSI) on morbidity and length of stay. METHODS: This was a pairwise matched (1 : 1) case-control study nested in a cohort. All patients who underwent hip replacement from January 1, 2000, to June 30, 2004, were prospectively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge, including any patients readmitted because of infection. RESULTS: Among the 1,260 hip replacements performed, 28 SSIs were detected, yielding a crude SSI rate of 2.2%. The median excess length of stay attributable to SSI was 32.5 days (P<.001), whereas the median prolonged postoperative stay due to SSI was 31 days (P<.001). Deep-wound SSI was the type that prolonged hospital stay the most (up to 49 days). Of the patients who developed an SSI, 4 required revision surgery, for an SSI-related morbidity rate of 14.3%. CONCLUSION: SSI prolongs hospital stay; however, although hospital stay is a rough indicator of the cost of this complication, to accurately estimate the costs of SSI, we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors.     

心脏起搏术后感染及其危险因素的研究

对某医院接受医院心脏起搏术治疗的２６６例重症缓慢性心律失常患者，进行起搏术后感染及其危险因素的调查，起搏术后感染６９例，感染率为２５．９４％，其中导管切口感染２５例，感染率９．４０％，皮囊切口感染２２例，感染率８．２７％。对调查的１５个因素进行单因素分析，术前住院天数、本次住院接受手术次数、消毒措施、暴露于ＣＣＵ、机器产地、植入方式、术中切口抗生素冲洗、术后预防用抗生素、易感因素与术后感染的发生有显著的联系。通过逐步回归分析，筛选出了４个与起搏术后感染有显著联系的因素：预防用抗生素、消毒措施、暴露于ＣＣＵ、植入方式。其中预防用抗生素种类多、暴露于ＣＣＵ均增加术后感染的危险性；而消毒措施、植入方式与术后感染呈负相关。     

Pattern of Pathogens and Their Sensitivity Isolated from Surgical Site Infections at the Aga Khan University Hospital,Nairobi, Kenya

Background

In low income countries, surgical site infections (SSIs) are costly and impose a heavy and potentially preventable burden on both patients and healthcare providers. This study aimed to determine the occurrence of SSI, pathogens associated with SSI, the antibiogram of the causative pathogens and specific risk factors associated with SSI at the hospital.

Methods

Two hundred and sixty-eight respondents admitted for general surgical procedures (other than neurological and cardiothoracic surgeries) at the Aga Khan University Hospital were eligible to take part in the study. Post-surgery patients were observed for symptoms of infection. Follow ups were done through the consulting clinics, breast clinic and casualty dressing clinic by a team of surgeons. In cases of infection, pus swabs were collected for culture.

Results

SSI incidence rate was 7.0%, pathogens isolated from SSI included gram negative enteric bacilli and S. aureus which was the most prevalent bacterial isolate. Only one isolate of MRSA was found and all staphylococci were susceptible to Vancomycin. Preoperative stay ≥ 2 days and wound class were the risk factors associated with SSI.

Conclusion

The SSI incidence rates (7.0%) observed in this study were relatively lower than the ones documented in other studies in Kenya. S. aureus is the most prevalent pathogen associated with SSI. Similar to findings from other studies done in the region; prolonged hospital stay and dirty wounds were the risks associated with postsurgical sepsis at the hospital.     

骨科手术部位感染率及危险因素的回顾性调查 FREE

目的 了解某院骨科手术部位感染状况及危险因素,为预防控制手术部位感染的发生提供参考依据。方法 回顾性调查3 326例骨科手术患者病历资料。结果 3 326例骨科手术患者中,116例发生手术部位感染,感染率3.49％。其中截肢术术后感染率最高,达30.39％（31/102）。骨科患者的手术部位感染与年龄、基础疾病、术前住院时间、手术部位、手术时间、侵入性操作、肾上腺糖皮质激素的使用等因素密切相关。结论 应重视并针对骨科手术部位感染的危险因素,持续改进工作质量,以有效降低和防止骨科手术部位感染的发生。     

Prospective surveillance for surgical site infection in St. Petersburg, Russian Federation.

OBJECTIVE: To assess the risk-adjusted incidence and predictors of surgical site infections (SSIs). DESIGN: Prospective, multicenter, observational cohort study. SETTING: Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation. PATIENTS: All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, "ASA classification") of at least 3. Surgery for 45% of the patients was emergent. RESULTS: In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation. CONCLUSIONS: The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation.     

The prevalence survey of nosocomial infections: a very informative tool in a big hospital setting

In November 2001 a one-day prevalence survey of nosocomial infections (NI) was conducted in surgical and intensive care units at two hospitals in Rome. The main goal was to quantify the occurrence of NI and of some patient-care practices, such as antibiotic use. The following NI were studied: pneumonia, bloodstream infections, urinary tract infections, surgical site infections (SSI), central line-related local infections. A total of 517 patients were included. The prevalence of the above mentioned NI was 6.6%. SSI were the most frequent NI (50%), with a prevalence of 6.5% in patients who underwent surgery; the SSI prevalence was 4.7% in clean surgical procedures (SP) and 5.6% in clean-contaminated SP. In 29 NI, 33 micro-organisms were isolated; the most frequent (24.3%) was Staphylococcus aureus, which was methicillin-resistant (MRSA) in 75% of the strains. On the day of the study, 41.8% of the patients were treated with antimicrobials, mainly aminopenicillins and third generation cephalosporins. In 31.8% of cases antibiotics were given for surgical prophylaxis; patients received prophylactic antibiotics more than 2 hours prior the initial incision in almost 40% of clean SP and 60% of clean-contaminated SP. In our hospitals prevalence survey was a very useful tool to identify the following priorities: SSI prospective surveillance in clean and clean-contaminated SP, control of MRSA selection and transmission, guidelines for antimicrobial prophylaxis in surgery.     

肝胆手术手术部位感染相关危险因素研究

目的探讨肝胆手术手术部位感染(surgical site infection,SSI)的危险因素,为制定SSI的控制措施提供依据。方法采用目标性监测的方法,研究肝胆手术SSI的发生情况,并对其相关危险因素:术前住院日、有无糖尿病、外周血血浆清蛋白、手术持续时间、手术方式、ASA评分、切口方向、切口长度、术中失血量、术后引流管留置天数及有无术后并发症等24个变量进行单因素和多因素Logistic回归分析。结果肝胆手术SSI发生率为11.74%(35/298),其中住院期问感染24例(68.57%),出院后随访发现感染11例(31.43%)。Logistic回归分析结果显示,术后出现脂肪液化和切口裂开等并发症、手术持续时间及术后引流天数是SSI的独立危险因素。结论肝胆手术SSI的发生是多因素共同作用的结果,必须采取综合性的预防措施才能有效地降低SSI的发生率。     

胸腰椎骨折患者手术部位感染的危险因素

目的分析胸腰椎骨折患者手术部位感染危险因素,为制定预防控制措施提供依据。方法采用信息监测系统、现场查看及电话回访相结合的方法监测2010年1月—2015年3月某院脊柱外科胸腰椎骨折手术患者,调查手术部位感染发生情况,对其危险因素进行单因素分析。结果共监测326例胸腰椎骨折手术患者,15例发生手术部位感染,感染发病率4.60%。年龄≥60岁、非层流手术室、预防使用抗菌药物非术前30 min内、术前住院日3 d、手术持续时间3 h、糖尿病、慢性呼吸道疾病患者的手术部位感染发病率较高(均P0.01)。结论患者年龄大、手术室净化级别低、未规范预防使用抗菌药物、手术时间长、术前住院时间长以及合并糖尿病、慢性呼吸道疾病均是胸腰椎骨折手术患者发生手术部位感染的高危因素,应采取有针对性的预防控制措施,降低感染发病率。