中国实用外科杂志

中国实用外科杂志

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手术部位感染与手卫生相关性研究

刘    颂1，王    萌1，丁    杰1，王革非2，吴秀文2，任建安2，管文贤1   

  1. 1 南京大学医学院附属鼓楼医院普通外科，江苏南京 210008；2 南京大学医学院临床学院南京军区南京总医院普通外科研究所， 江苏南京 210002
  • 出版日期:2017-06-01 发布日期:2017-05-31

  • Online:2017-06-01 Published:2017-05-31

摘要：

目的    探讨外科手术部位感染的发生率、常见致病菌谱及其耐药性，并分析手术部位感染发生率与手卫生产品消耗量之间的统计学相关性。方法    回顾性分析2015年南京鼓楼医院与南京军区南京总医院诊治的外科手术病人资料，遴选出发生手术部位感染的研究人群，分析并总结其手术部位感染相关资料，并针对各科室手术部位感染发生率与该科室手卫生产品消耗量进行相关性分析及多元回归分析。结果    在30 678例外科手术中，共307例发生手术部位感染，总体发生率为1.00%；不同科室的手术部位感染发生率存在较大差异，以普通外科最高（2.14%）、神经外科最低（0.14%）；手术部位感染常见致病菌包括大肠埃希菌（35.8%）、金黄色葡萄球菌（13.20%）、粪肠球菌（7.84%）、铜绿假单胞菌（5.89%）、肺炎克雷伯菌（4.90%）等。相应病原菌的耐药率存在较大差异。外科各科室的手术部位感染发生率与三种手卫生产品消耗量均呈显著负相关（r=-0.83～-0.88、P=0.0031～0.0083）；多元回归分析进一步显示：免洗手消毒液使用量显著影响手术部位感染发生率（P=0.023）。结论    手卫生是影响手术部位感染发生率的关键因素，推动医务人员手卫生依从性或有助于减少手术部位感染。了解手术部位感染临床特征有助于制定个体化、区域性手术部位感染防治策略。

关键词: 手术部位感染, 手卫生, 医院获得性感染, 病原学

Abstract:

Surgical site infection and hand-hygiene compliance        LIU Song*, WANG Meng, DING Jie, et al. *Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
Corresponding author：REN Jian-an，E-mail：Jiananr@gmail.com；GUAN Wen-xian，E-mail：guan_wenxian@sina.com
Abstract    Objective    To investigate the incidence of surgical site infection，summarize the microbial profiles and corresponding antimicrobial resistance, and analyze the correlation between the incidence of surgical site infection and the consumption of hand-hygiene products. Methods    The clinical data of all patients that received surgical procedures in 2015 in Nanjing Drum Tower Hospital and the General Hospital of Nanjing Military Command were collected retrospectively. The characteristics of surgical site infection were analyzed. Spearman correlation and multiple linear regression models were performed for correlation analysis. Results    A total of 30 678 surgical procedures were performed in 2015. Among them，307 cases of surgical site infection were identified with an overall incidence of 1.00%. General Surgery and Neurosurgery exhibited the highest and lowest incidence of surgical site infection， with 2.14% and 0.14% respectively. E. coli （35.8%），S. aureus （13.2%），E. faecalis （7.84%），P. aeruginosa （5.89%） and K. pneumoniae （4.90%） were the most common pathogens of surgical site infection. Antimicrobial resistance profiles varied between different types of pathogens. A significant negative correlation was identified between consumption of hand-hygiene products and incidence of surgical site infection （r=-0.83~-0.88，P=0.0031~0.0083）. Furthermore， the consumption of hand sanitizer could significantly impact the incidence of surgical site infection among surgical patients （P=0.023）. Conclusion    Hand hygiene is involved in the occurrence of surgical site infection. Promoting hand-hygiene compliance could probably decrease the incidence of surgical site infection. The characteristics of surgical site infection in current study could assist to tailor regional antimicrobial strategy in China.

Key words: surgical site infection, hand hygiene, nosocomial infection, microbial profiles