Beldi Guido, Bisch-Knaden Sonja, Banz Vanessa, Mühlemann Kathrin, Candinas Daniel
Department of Visceral and Transplant Surgery, Bern, Switzerland.
Am J Surg. 2009 Aug;198(2):157-62. doi: 10.1016/j.amjsurg.2008.09.023. Epub 2009 Mar 12.
The aim of this study was to identify intraoperative risk factors for surgical site infections (SSIs), which are accessible to interventions. We evaluated the effect of extensive intraoperative antiseptic measures and the impact of the behavior of members of the surgical team on SSIs.
Standard versus extensive antiseptic measures were randomly assigned in 1,032 surgical patients. The adherence to principles of asepsis by members of the surgical team was assessed prospectively.
The rate of SSI was 14% with standard antiseptic measures and 15% with extensive measures (P = .581). Multivariate analysis identified following independent risk factors: lapses in discipline (odds ratio [OR] 2.02, confidence interval [CI] 1.05-3.88), intestinal anastomosis (OR 6.74, CI 3.42-13.30), duration of operation more than 3 hours (OR 3.34, CI 1.82-6.14), and body mass index >30 kg/m2 (OR 1.98, CI 1.22-3.20).
Extensive measures of antisepsis did not reduce the incidence of SSI. A lapse to adhere to principles of asepsis was identified as an independent risk factor for the development of SSI (ClinicalTrials.gov number, NCT00555815).
本研究旨在确定手术部位感染（SSI）的术中危险因素，这些因素可通过干预措施加以控制。我们评估了广泛的术中抗菌措施的效果以及手术团队成员行为对SSI的影响。
对1032例手术患者随机分配标准抗菌措施与广泛抗菌措施。前瞻性评估手术团队成员对无菌原则的遵守情况。
标准抗菌措施组的SSI发生率为14%，广泛抗菌措施组为15%（P = 0.581）。多变量分析确定了以下独立危险因素：纪律松懈（比值比[OR] 2.02，置信区间[CI] 1.05 - 3.88）、肠吻合术（OR 6.74，CI 3.42 - 13.30）、手术时间超过3小时（OR 3.34，CI 1.82 - 6.14）以及体重指数>30 kg/m²（OR 1.98，CI 1.22 - 3.20）。
广泛的抗菌措施并未降低SSI的发生率。遵守无菌原则的失误被确定为SSI发生的独立危险因素（ClinicalTrials.gov编号，NCT00555815）。
