多模态策略在骨科患者手术部位感染控制和预防中的应用——波兰医院的一项 10 年回顾性观察研究。
Multimodal strategy in surgical site infections control and prevention in orthopaedic patients - a 10-year retrospective observational study at a Polish hospital.
机构信息
1State Higher Vocational School in Tarnów, Szpital Wojewódzki im. Św. Łukasza, Tarnów, Poland.
2Department of Microbiology, Polish Society of Hospital Infections, Jagiellonian University, 18 Czysta St., 31-121 Kraków, Poland.
出版信息
Antimicrob Resist Infect Control. 2020 Jan 23;9(1):20. doi: 10.1186/s13756-020-0680-6. eCollection 2020.
INTRODUCTION
Surgical site infections (SSIs) are among the most common healthcare-associated infections. They are associated with longer post-operative hospital stays, additional surgical procedures, risk of treatment in intensive care units and higher mortality.
MATERIAL AND METHODS
SSIs were detected in patients hospitalized in a 40-bed orthopaedics ward in 2009-2018. The total number of study patients was 15,678. The results were divided into two 5-year periods before and after the introduction of the SSI prevention plan. The study was conducted as part of a national Healthcare-Associated Infections Surveillance Programme, following the methodology recommended by the HAI-Net, European Centre for Disease Prevention and Control Program (ECDC).
RESULTS
One hundred sixty eight SSIs were detected in total, including 163 deep SSIs (SSI-D). The total SSI incidence rate was 1.1%, but in hip prosthesis: 1.2%, in knee prosthesis: 1.3%, for open reduction of fracture (FX): 1.3%, for close reduction of fracture (CR): 1.5, and 0.8% for other procedures. 64% of SSI-D cases required rehospitalisation. A significantly reduction in incidence was found only after fracture reductions: FX and CR, respectively 2.1% vs. 0.7% (OR 3.1 95%CI 1.4-6.6, < 0.01) and 2.1 vs. 0.8% (OR 2.4 95%CI 1.0-5.9, < 0.05). SSI-Ds were usually caused by Gram-positive cocci, specially , 74 (45.7%); Enterobacteriaceae bacillis accounted for 14.1% and Gram-negative non-fermenting rods for 8.5%.
CONCLUSIONS
The implemented SSI prevention plan demonstrated a significant decrease from 2.1 to 0.7% in SSI-D incidence only in fracture reductions, without changes in epidemiology SSI incidence rates in other procedures. Depending on the epidemiological situation in the ward, it is worthwhile to surveillance of SSIs associated to different types of orthopaedic surgery to assess the risks of SSI and take preventive measures.
介绍
手术部位感染（SSI）是最常见的与医疗保健相关的感染之一。它们与术后住院时间延长、额外的手术程序、入住重症监护病房的风险以及更高的死亡率有关。
材料和方法
2009 年至 2018 年，在一家拥有 40 张床位的骨科病房住院的患者中检测到 SSI。研究患者总数为 15678 人。结果分为引入 SSI 预防计划前后的两个 5 年期间。该研究是作为国家医疗保健相关感染监测计划的一部分进行的，遵循 HAI-Net、欧洲疾病预防控制中心方案（ECDC）推荐的方法。
结果
总共检测到 168 例 SSI，包括 163 例深部 SSI（SSI-D）。总 SSI 发生率为 1.1%，但髋关节假体为 1.2%，膝关节假体为 1.3%，骨折切开复位（FX）为 1.3%，骨折闭合复位（CR）为 1.5%，其他手术为 0.8%。64%的 SSI-D 病例需要再次住院。仅在骨折复位后才发现发病率显著下降：FX 和 CR 分别为 2.1%和 0.7%（OR 3.1 95%CI 1.4-6.6， < 0.01）和 2.1%和 0.8%（OR 2.4 95%CI 1.0-5.9， < 0.05）。SSI-D 通常由革兰氏阳性球菌引起，特别是 74 株（45.7%）；肠杆菌科杆菌占 14.1%，革兰氏阴性非发酵杆菌占 8.5%。
结论
实施的 SSI 预防计划表明，仅在骨折复位中，SSI-D 的发病率从 2.1%降至 0.7%，而其他手术程序的 SSI 发病率无变化。根据病房的流行病学情况，值得对不同类型的骨科手术相关 SSI 进行监测，以评估 SSI 的风险并采取预防措施。
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