手术部位感染目标性监测及干预效果评价  

Targeted monitoring on surgical site infection and effect of intervention

作　　者：张玉[1] 李正康[1] 李六亿[2] 贾会学[2] 陆群[3] 文建国[4] 杨怀[5] 刘运喜[6] 李卫光[7] 吴安华[8] 杨芸[9] 宗志勇[10] 胡必杰[11] 徐英春[12] 姜亦虹[13] 姜利 张秀月 何雪芬 谢金兰[17] 侯铁英[1] 

机构地区：[1]广东省人民医院,广东省医学科学院,广东广州510000 [2]北京大学第一医院,北京100034 [3]浙江大学医学院附属第二医院,浙江杭州310009 [4]郑州大学第一附属医院,河南郑州450052 [5]贵州省人民医院,贵州贵阳550002 [6]解放军总医院,北京100853 [7]山东省立医院,山东济南250021 [8]中南大学湘雅医院,湖南长沙410008 [9]山西医学科学院山西大医院,山西太原030001 [10]华西医院,四川成都610041 [11]复旦大学附属中山医院,上海200032 [12]北京协和医院,北京100032 [13]南京大学医学院附属鼓楼医院,江苏南京210008 [14]复兴医院,北京100000 [15]盛京医院,辽宁沈阳110004 [16]东阳市人民医院,浙江东阳322103 [17]苏北人民医院,江苏扬州225001

出　　处：《中国感染控制杂志》2015年第11期757-760,765,共5页Chinese Journal of Infection Control

基　　金：医院感染预防与控制能力建设项目(CHA-2012-XSPX-0629-1)

摘　　要：目的了解手术部位感染(SSI)发病情况和集束化干预措施的依从性,评价集束化干预措施对SSI的控制效果。方法选取2013年10月—2014年9月全国29所医院开展的3类手术(大肠手术、腹式子宫切除手术、股骨颈修复手术)作为目标监测对象,其中2013年10月—2014年3月为基线调查期;2014年4—9月为项目干预期。结果共监测6 166例次手术,SSI发病率为1.64%,其中大肠手术、腹式子宫切除术和股骨颈修复手术SSI发病率分别为4.47%、1.03%和0.21%,3类手术P75时间分别为3、2和2 h。干预措施依从性:干预期多数措施依从性较基线期均有不同程度的提高,提高幅度最大的是大肠手术"手术部位含氯己定消毒剂消毒"选项(依从性提高了29.09%),其次为股骨颈修复手术的"术前沐浴"(提高26.24%),大肠手术的"术前沐浴"(提高22.95%)和"手术当日备皮"(提高20.75%)。3类手术SSI发病率干预前后比较,差异均无统计学意义(均P>0.05)。结论不同手术类型SSI发病率不同,干预期部分集束化措施依从性较基线期显著提高,但其干预效果有待进一步研究。Objective To explore the incidence of surgical site infection （SSI）and compliance to bundled interven-tion measures,and evaluate the effect of bundled interventions on controlling SSI.Methods From October 2013 to September 2014,three types of surgeries （colorectal surgery,abdominal hysterectomy,and femoral neck repair sur-gery）in 29 hospitals in China were monitored,October 2013 to March 2014 was baseline investigated stage,April 2014 to September 2014 was intervention stage.Results A total of 6 166 episodes of surgeries were monitored,the incidence of SSI was 1 .64%,incidence of SSI following colorectal surgery,abdominal hysterectomy,and femoral neck repair surgery were 4.47%,1 .03%,and 0.21 % respectively.The P 75 time of three types of surgeries were 3,2,and 2 hours respectively.Compared with the baseline stage,the compliance to most intervention measures im-proved after intervention,the largest increase in the compliance to interventions was disinfection with chlorhexidine-containing disinfectant at surgical sites of colorectal surgery （increased by 29.09%）,followed by preoperative shower of femoral neck repair surgery （increased by 26.24%）,preoperative shower of colorectal surgery（increased by 22.95%）,and skin preparation on the day of operation （increased by 20.75%）.Incidences of SSI in three types of surgeries were not significantly different before and after intervention（all P 〉0.05）.Conclusion The incidences of SSI are different among different types of surgeries,the compliance to most bundled intervention measures has im-proved to some extent after intervention,but effectiveness of intervention measures needs to be further observed.

关 键 词：手术部位感染 集束化干预措施 干预研究 目标监测 依从性 

分 类 号：R181.32[医药卫生—流行病学]