Leaper David, Ousey Karen
Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
Curr Opin Infect Dis. 2015 Apr;28(2):158-63. doi: 10.1097/QCO.0000000000000144.
Surgical site infection (SSI) is a common healthcare-associated infection and complicates up to 10-20% of operations with considerable strain on healthcare resources. Apart from the widely adopted use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and perioperative glycaemic control to reduce SSIs, this review has considered new research and systematic reviews, and whether their findings should be included in guidelines.
The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and perioperative oxygen supplementation to reduce the risk of SSI is still in doubt. By contrast, the use of 2% chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic surgical dressings do show promise. Antimicrobial sutures in independent meta-analyses were found to reduce the risk of SSI after all classes of surgery (except dirty) whereas the use of wound guards, or diathermy skin incision (compared with scalpel incision), did not.
The incidence of SSI after surgery is not falling. Based on this review of published trials and evidence-based systematic reviews some advances might be included into these care bundles. More research is needed together with improved compliance with care bundles.
手术部位感染（SSI）是一种常见的医疗相关感染，高达10%-20%的手术会并发该感染，给医疗资源带来相当大的压力。除了广泛采用适当的毛发去除、抗生素预防、避免体温过低和围手术期血糖控制以减少手术部位感染外，本综述还考虑了新的研究和系统评价，以及它们的研究结果是否应纳入指南。
术前沐浴/淋浴、清洁手术的抗生素预防以及围手术期补充氧气以降低手术部位感染风险的疗效仍存在疑问。相比之下，使用2%氯己定酒精皮肤准备、术后负压伤口治疗和抗菌手术敷料确实显示出前景。在独立的荟萃分析中发现，抗菌缝线可降低所有类型手术（脏污手术除外）后手术部位感染的风险，而使用伤口防护装置或透热皮肤切口（与手术刀切口相比）则不能。
手术后手术部位感染的发生率并未下降。基于对已发表试验和循证系统评价的综述，一些进展可能会纳入这些护理套餐。需要更多的研究以及提高对护理套餐的依从性。
