Vilar-Compte Diana, Roldán-Marín Rodrigo, Robles-Vidal Carlos, Volkow Patricia
Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico.
Infect Control Hosp Epidemiol. 2006 Aug;27(8):829-34. doi: 10.1086/506395. Epub 2006 Jul 20.
To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer.
Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000.
The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Student's t test).
Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.
描述一项干预计划在一家癌症转诊教学医院乳腺肿瘤科室降低手术部位感染（SSI）率的效果。
研究医院乳腺肿瘤科室引入的预防措施如下：从2000年7月起，伤口护理采用无菌技术；从2001年起，使用封闭式抗反流硅胶引流系统，围手术期使用抗菌药物预防，向外科医生提供反馈，并对门诊伤口护理诊所进行改造。我们对2001年2月1日至12月31日期间所有接受乳房切除术的患者进行了监测，并计算了SSI率。对已知与SSI相关的危险因素进行了病例对照分析。结果与2000年的数据进行了比较。
该研究纳入了关于385例手术的数据。在这385例手术中，有52例（13.7%）发生了SSI，这一发生率比2000年的感染率（33.1%）低58.6%。与SSI相关的危险因素包括同步进行化疗和放疗（比值比[OR]，3.6[95%置信区间{CI}，1.9 - 7.1]）、在夜班期间进行手术（OR，1.9[95%CI，1.1 - 3.6]）以及在术后晚期插入第二根引流管（OR，2.8[95%CI，1.4 - 5.7]）。门诊伤口护理诊所术后就诊的平均次数（±标准差）从2000年的11.6±7.1次降至2001年的9.2±4.4次（P<0.001，学生t检验）。引流系统的平均使用天数从19.0天降至16.0天（P = 0.001，学生t检验）。
持续伤口监测，以及向外科医生提供反馈、使用封闭式抗反流引流系统和伤口及引流管护理的标准化操作，使感染率较高的乳腺外科科室的SSI率降低了58.6%。
