Mater Dei Hospital, Msida, Malta.
J Hosp Infect. 2011 Apr;77(4):348-51. doi: 10.1016/j.jhin.2010.12.005. Epub 2011 Feb 18.
Surgical site infections (SSIs) are challenging problems leading to significant postoperative morbidity and mortality and may reflect the level of adherence to infection control policies. We used a structured observational method to collect data about infection control practices among surgeons, anaesthetists, nurses, cardiopulmonary bypass technicians and orderlies practising in the cardiac operating theatre during open heart surgery at Mater Dei Hospital. To prevent bias, we did not disclose the actual procedures observed to the surgical team members, but participants knew they were being observed for infection control practices. We measured the 30-day SSI rate by post-discharge telephonic surveillance among surviving open heart surgery patients who had consented to the survey. We observed practices during 30 randomly chosen operations and found higher levels of inadequate practices related to environmental disinfection, hand hygiene, operating room traffic and surgical attire of non-scrubbed personnel (anaesthesiologists and cardiopulmonary bypass technicians). In all, 140 of 155 patients who underwent open heart surgery were followed up, achieving a response rate of 91.5%. Superficial and deep SSI rates were 16.4% and 4.3% respectively, including both sternal and harvest site infections. We found poor compliance with infection control practices by non-scrubbed personnel involved in cardiac surgery and observed a high surgical site infection rate, the majority being leg wound infections following saphenous vein harvesting.
手术部位感染（SSI）是一个严峻的问题，会导致术后发病率和死亡率显著增加，可能反映了感染控制政策的执行水平。我们采用结构化观察法，收集了在圣母医院心脏手术室进行心脏直视手术期间，外科医生、麻醉师、护士、心肺转流技术员和勤杂工在感染控制实践方面的数据。为了避免偏差，我们在向手术团队成员披露实际观察到的程序，但参与者知道他们正在接受感染控制实践的观察。我们通过对同意参与调查的存活心脏直视手术患者进行出院后电话随访，来测量 30 天 SSI 发生率。我们观察了 30 次随机手术中的操作实践，发现与环境消毒、手卫生、手术室人员流动和未进行手术刷手的非手术人员（麻醉师和心肺转流技术员）的手术着装相关的不充分实践水平更高。在总共 155 例接受心脏直视手术的患者中，有 140 例得到了随访，随访率为 91.5%。浅表和深部 SSI 发生率分别为 16.4%和 4.3%，包括胸骨和采集部位感染。我们发现非手术人员在心脏手术中感染控制实践的依从性较差，并且观察到手术部位感染率较高，大多数是大隐静脉采集后腿部伤口感染。
