Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Suite 1350, Chicago, IL 60611, USA.
Spine J. 2013 Sep;13(9):1017-29. doi: 10.1016/j.spinee.2013.03.051. Epub 2013 May 24.
Despite an increase in physician and public awareness and advances in infection control practices, surgical site infection (SSI) remains to be one of the most common complications after an operation. Surgical site infections have been shown to decrease health-related quality of life, double the risk of readmission, prolong the length of hospital stay, and increase hospital costs.
To critically evaluate the literature and identify modifiable factors to reduce the risk of SSI.
STUDY DESIGN/SETTING: Systematic review of the literature.
A critical review of the literature was performed using OVID, Pubmed, and the Cochrane database and focused on eight identifiable factors: preoperative screening and decolonization of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus protocols, antiseptic showers, antiseptic cloths, perioperative skin preparation, surgeon hand hygiene, antibiotic irrigation and/or use of vancomycin powder, closed suction drains, and antibiotic suture.
Screening protocols have shown that 18% to 25% of patients undergoing elective orthopedic surgery are nasal carriers of S. aureus and that carriers are more likely to have a nosocomial infection and SSI. The evidence suggests that an institutionalized prescreening program, followed by an appropriate eradication using mupirocin ointment and chlorhexidine soap/shower, will lower the rate of nosocomial S. aureus infections. Based on the current literature, definitive conclusions cannot be made on whether preoperative antiseptic showers effectively reduce the incidence of postoperative infection. The use of a chlorhexidine bathing cloth before surgery may decrease the risk of SSI. There is no definitive clinical evidence that one skin preparation solution effectively lowers the rate of postoperative infection compared with another. The use of dilute betadine irrigation or vancomycin powder in the wound before closure likely decreases the incidence of SSI.
There is strong evidence in the literature that optimizing specific preoperative, intraoperative, and postoperative variables can significantly lower the risk of developing an SSI.
尽管医生和公众的意识有所提高，感染控制实践也有所进步，但手术部位感染（SSI）仍然是手术后最常见的并发症之一。手术部位感染已被证明会降低与健康相关的生活质量，使再入院的风险增加一倍，延长住院时间，并增加医院成本。
批判性评估文献并确定可改变的因素以降低 SSI 的风险。
研究设计/设置：对文献进行系统评价。
使用 OVID、Pubmed 和 Cochrane 数据库对文献进行批判性评价，重点关注八个可识别的因素：术前筛选和耐甲氧西林金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌方案的去定植、抗菌淋浴、抗菌布、围手术期皮肤准备、外科医生手卫生、抗生素灌洗和/或万古霉素粉的使用、密闭引流和抗生素缝合。
筛选方案表明，接受择期骨科手术的患者中有 18%至 25%是金黄色葡萄球菌的鼻腔携带者，携带者更容易发生医院感染和 SSI。有证据表明，建立机构性的预筛选计划，然后使用莫匹罗星软膏和洗必泰肥皂/淋浴进行适当的根除，将降低医院获得性金黄色葡萄球菌感染的发生率。根据目前的文献，不能确定术前抗菌淋浴是否能有效降低术后感染的发生率。手术前使用洗必泰浴布可能会降低 SSI 的风险。没有明确的临床证据表明，与其他皮肤准备溶液相比，一种皮肤准备溶液能更有效地降低术后感染的发生率。在关闭伤口之前，使用稀释的洗必泰冲洗或万古霉素粉可能会降低 SSI 的发生率。
文献中有强有力的证据表明，优化特定的术前、术中和术后变量可以显著降低发生 SSI 的风险。
