集束化措施降低神经外科手术部位感染率的效果  

Effect of cluster measures on reducing incidence of surgical site infection in neurosurgery department patients

作　　者：谭细兰[1] 赖勇昌 钟晓祝[1,2] TAN Xi-lan;LAI Yong-chang;ZHONG Xiao-zhu(Zhujiang Hospital of Southern Medical University,Guangzhou,Guangdong 510282,China)

机构地区：[1]南方医科大学珠江医院感染管理科,广东广州510282 [2]南方医科大学深圳医院感染管理科,广东深圳518110

出　　处：《中华医院感染学杂志》2022年第18期2869-2872,共4页Chinese Journal of Nosocomiology

基　　金：广东省基础与应用基础研究基金资助项目(2019A1515111063)。

摘　　要：目的 研究集束化措施降低神经外科手术部位感染率的效果。方法 针对神经外科手术患者采取缩短术前住院时间、术前皮肤清洁、改变术前备皮方式、术前规范皮肤消毒、减少手术时间,对手术医生进行专项感控培训指导、培养神经外科专科护士等集束化措施,分析集束化措施实施前(2015年2月-2015年12月)与实施后(2017-2019年)神经外科术后手术部位感染率、术前住院时间、术后住院时间、总住院时间、神经外科专科护士参与情况。结果 采取集束化措施后,神经外科术后手术部位感染率从9.68%下降至4.80%(P<0.05);术前住院时间由6.32(3.04,9.77)d下降至5.66(3.08,8.01)d、总住院时间由22.53(15.51,33.82)d下降至17.59(13.34,25.25)d、参与手术例次≥8次护士占比从26.42%提高至55.28%、手术时长从240.00(109.80,330.00) min下降至220.00(130.00,320.00)min。脑脊液培养阳性率为27.71%,主要检出病原菌为表皮葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌。结论 采取降低术前住院时间,培养神经外科专科护士,提高参与手术例次≥8次护士占比的集束化措施可降低神经外科手术部位感染发生率。OBJECTIVE To observe the effect of cluster measures on reducing incidence of surgical site infection in neurosurgery department patients.METHODS A bundle of measures,including shortening preoperative length of hospital stay,preoperative skin cleaning,change of preoperative skin preparation method,standardization of preoperative skin disinfection and shortening operation duration,were taken for the neurosurgery department patients,the cluster measures such as special infection control guidance for surgeons and training of nurse specialists were taken.The incidence of postoperative surgical site infection,preoperative length of hospital stay,postoperative length of hospital stay,total length of hospital stay and participation of neurosurgery department nurse specialists were observed and compared before(from Feb 2015 to Dec 2015) and after(from 2017 to 2019) the cluster measures were taken.RESULTS After the cluster measures were taken,the incidence rate of postoperative surgical site infection was decreased from 9.68% to 4.80%(P<0.05);the preoperative length of hospital stay was decreased from 6.32(3.04,9.77)days to 5.66(3.08,8.01)days;the total length of hospital stay was decreased from 22.53(15.51,33.82) days to 17.59(13.34,25.25)days;the proportion of nurses who participated surgeries for no less than 8 case-times was increased from 26.42% to 55.28%;the operation duration declined from 240.00(109.80,330.00) min to 220.00(130.00,320.00)min.The positive rate of culture of cerebrospinal fluid was 27.71%.Staphylococcus epidermidis,Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were dominant among isolated pathogens.CONCLUSION The cluster measures,shortening the preoperative length of hospital stay,cultivating nurse specialists and raise the proportion of nurses participating surgeries for no less than 8 case-times,may reduce the incidence of surgical site infection in the neurosurgery department patients.

关 键 词：手术部位感染 神经外科 医院感染 术前皮肤准备 集束化措施 

分 类 号：R6193[医药卫生—外科学]