骨科手术切口感染的目标性监测与预防

目的：对骨科住院手术患者进行切口感染的目标性监测，为预防和控制手术切口感染提供依据。方法对2012年10-12月在某院骨科住院手术患者的切口情况及其影响因素进行目标性监测，对监测资料进行统计分析。结果共监测7252例骨科住院手术患者，发生手术切口感染223例，切口感染率为3．08％，感染247例次，感染例次率为3．41％。共检出病原菌247株，其中革兰阴性杆菌166株，占67．21％；革兰阳性球菌79株，占31．98％；真菌2株，占0．81％。检出的首位病原菌为金黄色葡萄球菌，68株占27．53％，其次是铜绿假单胞菌，63株占25．51％，第3位是鲍曼不动杆菌，32株占12．96％。年龄＜16岁或＞60岁、急诊手术、Ⅲ类手术切口、手术时间＞2 h、合并糖尿病、血红蛋白含量＜110 g/L、术前存在其他感染、围手术期未合理使用抗菌药物等是骨科患者发生手术切口感染的危险因素（P＜0．05）。结论应重视并针对骨科手术切口感染的危险因素进行持续工作改进，以控制和降低骨科手术后切口感染的发生。

Targeted surveillance and preventive measures of orthopedic surgical incision infection

Objective A targeted surveillance was conducted to the orthopedic patients surgical incision infection , in order to provide evidence for preventing and controlling of surgical incision infection . Methods To investigate the incision and its influencing factors of orthopedic surgery patients , we conducted the targeted surveillance from October to December 2012 , and then , analyzed the monitored data .Results Totals of 7 252 orthopedic surgery patients were monitored , including 223 patients occurred incision infection , with an incision infection rate of 3.08%; 247 patients had secondary infection , with an infection rate of 3.41%. 247 pathogens were detected , within which 166 gram-negative bacilli , accounting for 67 .21%; 79 Gram-positive cocci, accounting for 31.98%;2 fungi, accounting for 0.81%.The most detection of the pathogen was Staphylococcus aureus , accounting for 68 cases （ 27 .53%） , followed by Pseudomonas aeruginosa , accounting for 63 cases （25.51%）, the third place was Acinetobacter baumannii , accounting for 32 cases （12.96%）. The risk factors of surgical site infection included age 〈16 or 〉60 years old, emergency surgery , type Ⅲincision, operation time 〉2 h, diabetes, hemoglobin 〈110 g/L, existed infections before surgery , without rational use of antimicrobial drugs during perioperative period （ P 〈0 .05 ） .Conclusions We should pay attention to the risk factors of infection and continue to improving surveillance work , in order to control and reduce the incision infection of orthopedic surgical patients .