Jiang Xue, Ma Jianjun, Hou Fang, Li Juan, Li Ruigang, Lang Hongjuan
Tangdu Hospital , The Fourth Military Medical University, Department of Neurosurgery, Xi'an, China.
Turk Neurosurg. 2016;26(2):234-9. doi: 10.5137/1019-5149.JTN.12738-14.0.
To estimate the effect of a multimodal prevention program on controlling surgical site infection (SSI) risk among neurosurgical patients.
This prospective study was conducted among adult patients who have undergone neurosurgical procedures in a tertiary-care university-affiliated hospital during January 2008 to December 2013 since the implementation of an infection control program. SSI cases among inpatients were identified by daily active searches, whereas post-discharge surveillance was performed for outpatients through telephone contact 30-35 days after surgery, according to the definition proposed by the Center for Disease Control. The variation of SSI rate during the study period was analyzed by Cochran-Armitage trend test.
Overall, a total of 3042 patients were enrolled and 112 SSI cases were identified during the studied period. SSI more likely occurred in patients with older age (t=5.16, p < 0.01), undergoing emergency operations (x2=50.5, p < 0.01), having higher American Society of Anesthesiologists (ASA) scores (x2=7.2, p=0.01) and clean contaminated wound or above (x2=53.8, p < 0.01). The annual incidence rate of SSI was 6.21%, 5.01%, 3.89%, 3.06%, 2.38% and 2.28%, respectively, showing a significant decreasing trend (z=3.96, p < 0.01).
The results provide evidence of a significant decreasing trend in the SSI rate following the infection prevention program, demonstrating the role of multimodal approach in controlling SSI.
评估多模式预防方案对控制神经外科患者手术部位感染（SSI）风险的效果。
本前瞻性研究在一所大学附属三级医院自2008年1月至2013年12月实施感染控制方案后接受神经外科手术的成年患者中进行。住院患者中的SSI病例通过每日主动排查确定，而门诊患者在术后30 - 35天通过电话联系进行出院后监测，依据疾病控制中心提出的定义进行。研究期间SSI发生率的变化通过 Cochr an - Armitage趋势检验进行分析。
总体而言，共纳入3042例患者，研究期间确定了112例SSI病例。SSI更易发生在年龄较大（t = 5.16，p < 0.01）、接受急诊手术（x² = 50.5，p < 0.01）、美国麻醉医师协会（ASA）评分较高（x² = 7.2，p = 0.01）以及清洁 - 污染伤口或更高级别伤口（x² = 53.8，p < 0.01）的患者中。SSI的年发病率分别为6.21%、5.01%、3.89%、3.06%、2.38%和2.28%，呈显著下降趋势（z = 3.96，p < 0.01）。
结果提供了证据表明感染预防方案实施后SSI发生率呈显著下降趋势，证明了多模式方法在控制SSI中的作用。
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