Fernández Arjona M, Herruzo Cabrera R, Vera Cortés M, del Ray Calero J
Departamento de Medicina Preventiva, Universidad Autónoma de Madrid, Hospital La Paz.
Rev Sanid Hig Publica (Madr). 1993 Nov-Dec;67(6):497-506.
We have carried out a prospective study among 2,047 patients, operated in the Department of Traumatology of "La Paz" Hospital during two years in order to know the time trend of nosocomial infection.
All the operated patients have been included in the Study. Several variables have been collected (age, kind of surgery, infection, day of infection onset). Information was collected from the patient's clinical history and evolution and processed with the Sigma programme.
The total percentage of infection was 10.06%; it was 7.63% in clean surgery and 26.79% in dirty surgery. Wound was the most frequent location of infection, followed in order of frequency by urine, respiratory system and sepsis. Since the patient is operated, there are two periods when infection increase significantly; those are between the 7-10 and 25-30 post operation days. This tendency is typical of wound and urine infections; but in septicaemia, infection appears about the third post operation day in dirty surgery and about the 14th day in clean surgery. When studying the moment of patients's infection in clean surgery, a quick increase of wound infection is obtained in the second week, going from 33% (the 7th day) to 78% (the 14th day); next the curve slope diminishes down to 100% (the 61st day). In dirty surgery, the initial increase of wound infection is greater (54% on infections appear the 7th day) and next it slows (64% of infections appear the 14th day and 100% are present the 45th day).
It is necessary to reduce the infection rate in clean surgery mainly by improving surgical prophylaxis. The risk of infection appears earlier in dirty surgery than in clean surgery; for this reason, we shall insist upon its treatment (not prophylaxis) at the moment of the operation. Surveillance of infection signs must be intensified at maximum during the first post-operation week for dirty surgery and in the second week for clean surgery.
我们对在“拉巴斯”医院创伤科接受手术的2047例患者进行了一项为期两年的前瞻性研究，以了解医院感染的时间趋势。
所有接受手术的患者均纳入研究。收集了几个变量（年龄、手术类型、感染情况、感染发病日期）。信息从患者的临床病史和病情演变中收集，并使用西格玛程序进行处理。
感染总发生率为10.06%；清洁手术中为7.63%，污染手术中为26.79%。伤口是最常见的感染部位，其次依次为尿液、呼吸系统和败血症。自患者接受手术以来，有两个时期感染率显著上升；分别是术后7至10天和25至30天。这种趋势在伤口和尿液感染中较为典型；但在败血症中，污染手术中感染大约出现在术后第3天，清洁手术中大约出现在第14天。在研究清洁手术患者的感染时间时，伤口感染在第二周迅速增加，从第7天的33%升至第14天的78%；随后曲线斜率减小至第61天的100%。在污染手术中，伤口感染的初始增幅更大（第7天出现感染的占54%），随后减缓（第14天出现感染的占64%，第45天全部出现感染）。
有必要主要通过改进手术预防措施来降低清洁手术中的感染率。污染手术中感染风险出现的时间比清洁手术早；因此，我们应在手术时强调对其进行治疗（而非预防）。对于污染手术，术后第一周必须最大程度加强对感染迹象的监测，对于清洁手术，则在第二周加强监测。
