Bengtsson S, Hambraeus A, Laurell G
J Hyg (Lond). 1979 Aug;83(1):41-57. doi: 10.1017/s002217240002581x.
A prospective study of 2983 operations in general and orthopaedic surgery during 3 years performed in four operating theatres in a modern operating suite was carried out in order to evaluate the importance of airborne infection. Weekly nose-and-throat samples were taken from the surgical staff and pre-operative samples were taken from the nose, throat, skin and perineum of the patients. The air contamination was followed by using settle plates, which showed low mean counts of total bacteria of between 9 and 15 c.f.u./m(2)/min, with mean counts of Staph. aureus of between 0.03 and 0.06 c.f.u./m(2)/min. No correlation was found between the total number of bacteria and the incidence of post-operative infections or between the amount of Staph. aureus in the air and post-operative Staph. aureus infections. It was concluded that further increases in ventilation could, at best, only marginally affect the incidence of post-operative infection.The post-operative wound-infection rate was 9.0%. In various types of surgery, the infection rates varied from 5.3% in clean operations to 47.6% in dirty surgery. About one third of the infections were classified as moderate or severe.Adverse patient factors, such as immunodeficiency, steroid treatment, intensive care, etc., increased the rate to 15.0%; in ;normal' patients it was 3.8%.Among the bacteria isolated, gram-negative bacilli (31% of wounds), often together with other bacteria, and Staph. aureus (28%) predominated, but in 25% no specimens were taken.Of 76 post-operative Staph. aureus infections, 32 were caused by the patients' own strains, and of the remaining 44 infections, 22, or 8% of all infections, could be traced to strains present in the air and/or the respiratory tracts of staff during the operation.The length of pre-operative hospital stay had no influence on the carrier rate of Staph. aureus in patients. The incidence of post-operative wound infection was significantly higher in patients carrying Staph. aureus and was even higher if these bacteria were found on the skin.Patients with wound infections stayed, on an average, 15 days longer than patients without infections. In serious infections the increase in duration of stay was > 20 days. Although infections were commoner in older patients, the average additional hospital stay of infected patients did not increase with age. If the post-operative infections studied in a concurrent retrospective study are taken into account more than 12 000 bed-days were due to post-surgical wound infections in the period studied or, in other words, some 12 beds (corresponding to 5.5% of the total) were always occupied by infected patients.
为评估空气传播感染的重要性，对一家现代化手术室的四个手术间在3年内进行的2983例普通外科和骨科手术进行了前瞻性研究。每周采集手术人员的鼻咽喉样本，术前采集患者的鼻、咽喉、皮肤和会阴样本。使用沉降平板监测空气污染情况，结果显示总细菌平均计数较低，为9至15 c.f.u./m²/分钟，金黄色葡萄球菌平均计数为0.03至0.06 c.f.u./m²/分钟。未发现细菌总数与术后感染发生率之间、空气中金黄色葡萄球菌数量与术后金黄色葡萄球菌感染之间存在相关性。得出的结论是，进一步增加通风最多只能对术后感染发生率产生微小影响。术后伤口感染率为9.0%。在各类手术中，感染率从清洁手术的5.3%到污染手术的47.6%不等。约三分之一的感染被归类为中度或重度。免疫缺陷、类固醇治疗和重症监护等不良患者因素使感染率升至15.0%；“正常”患者的感染率为3.8%。在分离出的细菌中，革兰氏阴性杆菌（占伤口的31%，常与其他细菌一起）和金黄色葡萄球菌（占28%）占主导，但25%的病例未采集到标本。在76例术后金黄色葡萄球菌感染中，32例由患者自身菌株引起，其余44例感染中，22例（占所有感染的8%）可追溯到手术期间空气中和/或工作人员呼吸道中的菌株。术前住院时间对患者金黄色葡萄球菌携带率没有影响。携带金黄色葡萄球菌的患者术后伤口感染发生率显著更高，如果在皮肤上发现这些细菌，感染率更高。伤口感染患者的住院时间平均比未感染患者长15天。在严重感染中，住院时间增加超过20天。尽管老年患者感染更为常见，但感染患者的平均额外住院时间并未随年龄增加。如果考虑同期回顾性研究中所研究的术后感染，在所研究期间，超过12000个床位日归因于术后伤口感染，换句话说，约12张床位（占总数的5.5%）总是被感染患者占用。
