Kelly A J, Bailey R, Davies E G, Pearcy R, Winson I G
Department of Orthopaedic Surgery, Southmead Hospital, Westbury on Trym, Bristol, UK.
J R Coll Surg Edinb. 1996 Apr;41(2):129-31.
The incidence of early post-operative wound infection was studied prospectively in 1053 patients undergoing elective orthopaedic procedures over a 3-month period. The study was repeated in 1131 patients a year later, 6 months after the hospital had moved to new premises. A clinical definition of wound infection identified disturbingly high sepsis rates. A total of 44% of all infections occurred after discharge from hospital. Despite the large sample, there was no significant difference in the rate of early wound infection between the two periods (7.85 and 6.82%). There was no significant difference in infection rates between theatres with and without laminar air flow. In the majority (35 out of 53) of minor infections, bacteriological confirmation was not available because no microbiological specimens were received. Conversely, there were five negative swabs out of 16 wounds defined clinically as major infections. We conclude that, where the rate of bacteriological confirmation of wound infection is low, the use of a clinical definition gives higher audited sepsis rates. Large audit samples are required to demonstrate differences as a result of a changed practice.
前瞻性研究了1053例接受择期骨科手术的患者在3个月期间术后早期伤口感染的发生率。一年后，在医院迁至新址6个月后，对1131例患者重复了该研究。伤口感染的临床定义显示败血症发生率高得惊人。所有感染中有44%发生在出院后。尽管样本量很大，但两个时期的早期伤口感染率没有显著差异（分别为7.85%和6.82%）。有层流和没有层流的手术室之间的感染率没有显著差异。在大多数轻微感染（53例中的35例）中，由于未收到微生物标本，无法进行细菌学确认。相反，在临床上定义为严重感染的16个伤口中，有5个拭子检测结果为阴性。我们得出结论，在伤口感染细菌学确认率较低的情况下，使用临床定义会使经审核的败血症发生率更高。需要大量的审核样本才能证明因实践改变而产生的差异。
