Taye Mulat
Department of Surgery, Tikur Anbessa Hospital, Addis Ababa, Ethiopia.
Ethiop Med J. 2005 Jul;43(3):167-74.
A prospective study of surgical wound infection has been conducted on 1754 surgical patients operated from January 1, 1999 to Dec 31, 1999 in Tikur Anbessa hospital. Demographic data and information on potential risk factors and the occurrence of wound infection in the first 30 days post operatively were collected using pretested data collection form. Among the patients 1162 (66.2%) were males and 592 (33.8%) were females. The age ranged from one day to 95 years with a mean of 30 (+/- 19) years. Seven hundred twenty eight (41.5%) wounds were classified as clean, 674 (38.4%) as clean-contaminated, 241 (13.7%) as contaminated and 111 (6.3%) as dirty and infected wounds. The overall wound infection rate was 14.8%. The infection rate for clean, clean-contaminated, contaminated and dirty and infected wounds were 8.0%, 14.8%, 22.0% and 44.2% respectively. The overall wound infection rates vary between 5.4% and 27.9% among consultant surgeons and it was 17.3% for residents. After adjusting for variation in patients condition and wound class, the infection rate of two surgeons was significantly higher, with odds ratio (OR) of 2.3 and 2.9. Shaving in the ward and use of drains were associated with a statistically significantly higher infection rate after adjusting for all factors considered in the study, with OR of 1.9 & 2.3 respectively. Preoperative antibiotics were found to be highly protective after multiple stepwise regressions with OR of 0.33. Post operative hospital stay and mortality were significantly higher in patients who had wound infection after adjusting for potentially confounding variables. It is concluded that the infection rate are much higher than the acceptable standard and this underscores the need for establishing hospital infection control system. Minimizing the use of drains, avoiding preoperative shaving, judicious use of preoperative antibiotics and meticulous surgical technique should be part of the immediate strategy to reduce wound infection rate.
1999年1月1日至1999年12月31日期间，在提库尔·安贝萨医院对1754例接受手术的患者进行了一项关于手术伤口感染的前瞻性研究。使用预先测试过的数据收集表收集人口统计学数据、潜在风险因素信息以及术后前30天伤口感染的发生情况。患者中，1162例（66.2%）为男性，592例（33.8%）为女性。年龄范围为1天至95岁，平均年龄为30（±19）岁。728例（41.5%）伤口被分类为清洁伤口，674例（38.4%）为清洁-污染伤口，241例（13.7%）为污染伤口，111例（6.3%）为脏污且感染伤口。总体伤口感染率为14.8%。清洁伤口、清洁-污染伤口、污染伤口以及脏污且感染伤口的感染率分别为8.0%、14.8%、22.0%和44.2%。顾问外科医生的总体伤口感染率在5.4%至27.9%之间，住院医生的感染率为17.3%。在对患者病情和伤口类别差异进行调整后，两位外科医生所负责患者的感染率显著更高，比值比（OR）分别为2.3和2.9。在对研究中考虑的所有因素进行调整后，病房内备皮和使用引流管与统计学上显著更高的感染率相关，OR分别为1.9和2.3。经过多次逐步回归分析发现，术前使用抗生素具有高度保护作用，OR为0.33。在对潜在混杂变量进行调整后，发生伤口感染的患者术后住院时间和死亡率显著更高。得出的结论是，感染率远高于可接受标准，这突出了建立医院感染控制系统的必要性。尽量减少引流管的使用、避免术前备皮、合理使用术前抗生素以及采用精细的手术技术应成为降低伤口感染率近期策略的一部分。
