ObjectiveTo investigate the risk factors for surgical site infection (SSI) in patients after colorectal surgery, in order to provide a basis for regulation and implementation of preventive measures against SSI. MethodsFrom February to December 2012, a targeted surveillance on surgical site infection of "colon resection" and "rectum resection" surgery patients in the Department of Gastrointestinal Surgery was carried out. We analyzed the monitoring data, and explored the occurrence of postoperative SSI. At the same time, by case-control study, both single and multiple regression logistic analyses were performed on the 12 variables such as hypertension, diabetes mellitus duration during operation, America Society of Anesthesiologists score, grade of incision and so on to analyze the risk factors for SSI. ResultsAmong the 535 patients who underwent colorectal resections, 44 had SSI with an infection rate of 8.22%. Multiple logistic regression analysis showed that the length of hospital stay[OR=1.070,95%CI(1.033,1.109), P<0.001]and emergency surgery[OR=6.320,95%CI(1.932,20.669),P=0.002] were independent risk factors for SSI after colorectal resections. ConclusionThere are many risk factors for SSI after colorectal surgery. Through the implementation of targeted surveillance, we can find the main risk factors, which provides a basis for the regulation and implementation of intervention measures against SSI.
目的 分析外科手术部位感染率过低的原因，掌握手术部位感染诊断标准，减少医院感染漏报，及时发现医院感染流行趋势，采取控制措施，防止医院感染暴发。 方法 选择开展较多、手术部位一旦发生感染对患者安全威胁性较大的手术：包括胆囊切除或（和）胆管手术，结肠、直肠切除术，阑尾切除术，疝手术，乳房切除术，剖宫产，子宫切除术及附件切除术，全髋关节置换术，食道贲门手术，腰椎间盘摘除术，监测时间为2011年1月1日－6月30日及2012年1月1日－6月30日，共监测1 180例手术，对手术部位感染率进行对比分析。 结果 2011年半年监测手术部位感染率1.99%，调整感染率4.74%；比国内报道低6～9倍；通过分析原因，对医院感染诊断标准再培训、加强病原微生物送检等，2012年半年监测手术部位感染率4.68%，调整感染率32.12%；与2011年比较差异有统计学意义（χ2=141.841，P=0.000）。 结论 手术部位感染率偏低的原因是医生漏报所致；采取整改措施后，提高了手术部位感染的识别能力，减少了漏报，对及时发现医院感染暴发具有重要意义。
ObjectiveTo systematically review the effect of perioperative supplemental oxygen administration on surgical site infection (SSI) in patients underwent abdominal surgery with general anesthesia. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2,2015), CBM, VIP, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about perioperative supplemental oxygen administration versus normal FiO2 in patients underwent abdominal surgery with general anesthesia from inception to March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 3 532 patients were included. The results of meta-analysis indicated that: the incidence of SSI in the perioperative supplemental oxygen administration group was lower than that in the control group (OR=0.68, 95%CI 0.47 to 0.99, P=0.04). There were no significiant differences between both groups in incidence of atelectasis, incidence of infection requiring reoperation and 30-day mortality after surgery (all P values >0.05). ConclusionPerioperative supplemental oxygen administration could further decrease the risk of SSI in patients underwent abdominal surgery with general anesthesia, and does not increase the risk of other adverse events. Due to the limitations of quality of included studies, more high quality studies are needed to verify the above conclusions.
每位外科医师均会遭遇到外科感染，这是手术技术自身所决定了的，外科手术必然破坏人体宿主抵抗力的第一道防线皮肤和粘膜屏障，使得细菌得以进入体内。从外科发展历史看，因外科感染而死亡是很常见的，特别是在19世纪末叶以前，当时截肢术死亡率在25%~90%之间，美国内战时期则为50%左右，这主要是外源性感染所致。但从现代外科学观点看，外科感染的内涵已发生了许多重要变化，如医院内获得性感染超过了患者原有的感染； 体内的内源性正常菌群感染多于外源性致病细菌感染； 外科手术后的手术部位感染（surgical site infection，SSI）多于需要外科处理的一般化脓性感染。其中SSI已成为值得关注的临床课题。
Objective To compare preventive effect between continuous dissecting suture and traditional interrupted suture, silver ion dressing and traditional dressing, on the incisional surgical site infection (SSI) after ostomy for colorectal surgery, and to explore the influencing factors of SSI. Methods ① Sixty patients underwent the firstly elective open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Mar. 2015 to Jan. 2016, were collected to equivalently divided into continuous dissecting suture group and traditional interrupted suture group randomly. ② Twenty-seven patients with emergency open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to Jun. 2015, as well as 33 patients with elective open ostomy for colorectal surgery, who were treated in the same 2 Departments from Jul. 2015 to May. 2016, were collected to equivalently divided into silver ion dressing group and traditional dressing group. ③ Clinical data of 184 patients with elective open ostomy for colorectal surgery who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to May. 2016 were collected to analyze the influencing factors of SSI after elective open ostomy for colorectal surgery. Results ① There was no significant difference in the incidence of SSI between continuous dissecting suture group (3.3%, 1/30) and traditional interrupted suture group (16.7%, 5/30), P=0.085. ② The incidence of SSI in silver ion dressing group (6.7%, 2/30) was significantly lower than that of traditional dressing group (30.0%, 9/30), P=0.020. ③ There were 28 patients (15.2%) of the 184 elective patients and 11 patients (40.7%) of the 27 emergency patients suffered from SSI after open ostomy for colorectal surgery, and the incidence of SSI in elective surgery group was lower than that of emergency surgery group (P=0.001). ④ Results of logistic regression model showed that, patients with body mass index (BMI) <25 kg/m2 had lower risk of SSI than patients with BMI≥25 kg/m2(OR=0.383, P=0.023), patients received permanent colostomy had higher risk of SSI than patients received protective ileostomy (OR=4.370, P=0.004), patients underwent Mile’s surgery had higher risk of SSI than patients received distal anastomosis (OR=4.406, P=0.005). Conclusions The ostomy is a high risk factor for incisional SSI after elective open ostomy for colorectal surgery, especially for the obesity patients and patients who receive colostomy. The using of silver ion dressing play an important role in preventing the incisional SSI.
ObjectiveTo analyze the relevant factors for surgical site infection. MethodsA total of 677 cases of surgery in one hospital from July 1 to December 31 in 2012 were surveyed (not including implant and cardiac intervention surgeries), which were divided into different groups according to the preoperative incision contamination level, and the postoperative healing of incisions were observed closely. After the patients were discharged, we investigated the situation of incisions by phone or periodic review, and forms were filled in on schedule. ResultsBy follow-up evaluation of the 677 cases, the incisions in 12 cases were infected and the infection rate was 1.77%. Polluted and infected (14.28%, 30.76%) incisions caused more infection than the clean and clean-polluted incisions (0.00%, 0.59%). The patients who stayed in hospital for 4 or more than 4 days before surgeries (infection rate was 4.55%) took more risk of infection than the patients whose preoperative time in hospital were 2-3 days (infection rate was 0.60%) and 1 or shorter than 1 day (0.68%). Perioperative use of antibiotics for longer than 72 hours will increase the risk of incision infection than those within 48 hours (7.69%, 0.00%; P=0.002). ConclusionSurgical site infection is related to the incision type. Shortening the preoperative in-hospital time will reduce the risk of infection. Long time use of antibiotics in perioperative period cannot prevent the postoperative infection effectively, but may increase the risk of infection.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.
Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.