剖宫产术后切口感染监测分析

目的 调查剖宫产切口感染罹患率增高的关键因素,快速控制切口感染.方法 产科发生2例剖宫产切口感染后,立即做当日产科、外科罹患率与2周前15 d的回顾性调查及3个月的目标性监测,对剖宫产手术切口感染的相关因素特别是整个手术操作过程现场调查,分组进行干预对比.结果 2009年2月5日调查当日产科切口感染罹患率45.46%,11例手术中5例切口感染,1例检出金黄色葡萄球菌;外科术后98例,1例术后切口感染,罹患率1.03%;5例产科切口感染的手术医师均是妇科医师在急诊情况下行剖宫产术,在发现感染患者手术日期1月21日的前3 d妇科有1例切口金黄色葡萄球菌感染患者;1月21日-4月5日产科与外科同期的感染率比较差异有统计学意义(P<0.05);通过关注过程的目标性监测,采集手术相关的材料和手术环境生物检测113份,合格率100.00%,易感因素和用药与平时无差异;监测18例次手术医师术前外科手消毒时揉搓时间、力度和范围不够,均不合格,监测干预对比,干预组切口无感染,感染率比较差异有统计学意义(X~2-6.27,P<0.05).结论 剖官产术后切几感染,与手术医师术前外科手消毒密切相关,注重过程的目标监测及时有效.

Analysis of Incisional Infection of Hysterotomy

OBJECTIVE To investigate the critical factors of the increased incidence of incision infection of hysterotomy to control the infection rapidly. METHODS After two cases of incision infection of hysterotomy was reported, we investigated the infection rate of obstetric and surgical departments immediately on that day and the retrospective investigation before 15 days and 3-months of target monitoring was conducted. We investigate the relevant factors of ineisional infection of hysterotomy, especially the operation process. The cases were divided into three groups. RESULTS The rate of incisional infection of hysterotomy was 45.46% on Feb 5, 2009.5 cases of infection were found in 11 cases of hysterotomy and one was infected with Staphylococcus aureus. There was 1 cases of infection in 98 cases of surgical procedures and the rate of incisional infection was 1.03%. The patients with incisional infection were performed hysterotomy in case of emergency and there was a patient with S. aureus infection 3 days before operation. From from Jan 21 to April 5 the infection rates between obstetric and surgical showed significant difference (P<0.005). 113 samples of surgery-related material and surgical environment were detected out and pass rate was 100%. The risk factors and medication in two group had no difference. The rubbing time, and scope of hand washing were not up to standard. The incision of intervention group were not infected and the infection rates showed significant differrence between two groups (X~2 = 6.27 P<0.05).CONCLUSIONS Ineisional infection of hysterotomy is closely related to the preoperative " surgical hand disinfection" and the target monitoring is timely and effective.