现场干预在外科手术部位感染目标性监测中的作用

目的探讨现场干预对外科手术部位感染(SSI)目标性监测的作用,降低SSI发生率。方法采用干预性研究方法,对6种手术患者的手术部位感染及相关因素进行了目标性监测,对危险因素进行现场干预。结果共监测手术患者519例,SSI发生率为1.9%;手术部位感染与年龄、保温措施、ASA评分、住院天数、是否引流有关(P<0.05);其中保温措施、外科引流与手术部位感染有显著关系(P<0.01);经过现场干预,直肠、结肠手术及胆囊、胆管手术的手术部位感染率分别下降至7.1%及6.3%,单纯胆囊切除术下降至1.6%;甲状腺切除术及大隐静脉高位结扎术患者预防性抗菌药物使用率从100.0%降至<30.0%。结论术中低体温、引流、住院天数等是手术部位感染的高危因素,目标性监测中现场干预是控制这些高危因素的强有力措施。

Effect of on-site intervention on targeted monitoring of surgical site infections

OBJECTIVE To explore the risk factors of surgical site infections(SSI) and provide basis for reducing the SSI.METHODS A prospective study and interventional methods were performed on surgical site in patients undergoing six surgeries in the hospital.Both single and multiple regression logistic analysis were executed with SPSS on the 10 factors including,on-site intervention in the risk factors.RESULTS Among 519 patients undergoing surgeries,the incidence rate of SSI was 1.9%;the insulation measure and the surgical drainage had the most significant correlation with the SSI(P<0.01);after the on-site intervention,the incidence rates of the SSI caused by colorectal surgery and gallbladder bile duct surgery decreased to 7.1% and 6.3%,respectively,the simple cholecystectomy decreased to 1.6%;the utilization rate of the prophylactic antibiotics of the patients undergoing thyroidectomy or high ligation of the great saphenous vein decreased from 100.0% to below 30.0%.CONCLUSION The intraoperative low temperature,drainage,hospital stay are the high-risk factors for SSI,and the on-site intervention in the target monitoring is an powerful way to control the high-risk factors.