不同皮肤准备方法术后切口感染的研究及预防
불동피부준비방법술후절구감염적연구급예방
Prospective study on the effect of different methods of preoperative skin prepara-tion on surgical site infection and the implications for infection prevention
  • 万方数据
    中国感染与化疗杂志 중국감염여화료잡지
    CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
    2014年 2期 121-126 ,共6页

    刘德秀%王正芸%李家瑜

    류덕수%왕정예%리가유

    手术切口感染%皮肤准备%析因设计 手術切口感染%皮膚準備%析因設計
    수술절구감염%피부준비%석인설계
    surgical site infection%skin preparation%factorial design
    目的：比较术前不同皮肤准备方法和术后切口感染情况的关系，探讨科学、有效、简便的手术后感染预防措施。方法对可能影响术后切口感染的因素剃毛 A、清洁方式 B 和备皮时间 C 3个因素进行析因设计，共获8种搭配；分析总感染率及A、B、C 各组单独感染率。结果本次调查住院手术患者共1802例，发生手术感染146例，总感染率8．1％。其中，Ⅰ类手术978例，发生感染80例（8．2％），Ⅱ类手术824例，发生感染66例（8．0％）；两种手术类型感染率比较差异无统计学意义（P ＞0．05）；146例感染者中114例进行伤口分泌物、引流液病原微生物检查，送检率78．1％，共获得阳性病原菌65株，其中构成比前3位的是金葡菌（22．5％）、铜绿假单胞菌（15．3％）和大肠埃希菌（13．9％）；不同手术部位中发生感染最多的是胃肠道手术，42例（10．3％），其次为骨科手术，37例（10．1％）。各组感染率差异有统计学意义（χ2＝24．540，P ＝0．01），A1B1C1组（术前1 d 备皮，不剃毛，清水清洁）和 A2B1C1组（术前1 d 备皮，剃毛，清水清洁）感染率分别为12．4％和13．6％，高于其他组（P ＜0．05）；A1水平（即不剃毛组）术后切口感染率8．5％，A2水平（剃毛组）术后切口感染率7．7％，两组差异无统计学意义（P ＞0．05）；B1水平（清水清洁）术后感染率10．5％，B2水平（肥皂水清洁）术后感染率5．6％，两者差异有统计学意义（P ＜0．05）；C1水平（术前1 d）感染率为9．8％，C2水平（术前2 h）感染率为6．4％，两者差异有统计学意义（P ＜0．05）。对各组菌落总数进行方差分析，F＝34．436，P ＝0．000，各组之间差异有统计学意义（P ＜0．01）；各组经析因设计方差分析结果显示，B（清洁方式）、C（术前准备时间）单因素分析差异有统计学意义（P ＜0．01），A 因素（剃毛与否）单因素分析差异无统计学意义（P ＞0．05）；B 与 C、A 与 C 之间存在交互作用（P ＜0．01），A 与 B 之间无交互作用（P ＞0．05）；A、B、C 之间存在二级交互作用（P ＜0．01）。结论手术前皮肤准备对于术后切口感染预防具有重要意义。在进行术前备皮时，应优先考虑皮肤清洁，大量肥皂水或消毒水冲洗，彻底杀灭皮肤表面暂居致病菌；同时缩短备皮准备时间，减少细菌在皮肤表面的繁殖，预防切口感染；在保证术野清洁的前提下，尽量减少皮肤损伤，可以考虑剪毛或使用脱毛剂脱毛等方式，无须剃毛。
    목적：비교술전불동피부준비방법화술후절구감염정황적관계，탐토과학、유효、간편적수술후감염예방조시。방법대가능영향술후절구감염적인소체모 A、청길방식 B 화비피시간 C 3개인소진행석인설계，공획8충탑배；분석총감염솔급A、B、C 각조단독감염솔。결과본차조사주원수술환자공1802례，발생수술감염146례，총감염솔8．1％。기중，Ⅰ류수술978례，발생감염80례（8．2％），Ⅱ류수술824례，발생감염66례（8．0％）；량충수술류형감염솔비교차이무통계학의의（P ＞0．05）；146례감염자중114례진행상구분비물、인류액병원미생물검사，송검솔78．1％，공획득양성병원균65주，기중구성비전3위적시금포균（22．5％）、동록가단포균（15．3％）화대장애희균（13．9％）；불동수술부위중발생감염최다적시위장도수술，42례（10．3％），기차위골과수술，37례（10．1％）。각조감염솔차이유통계학의의（χ2＝24．540，P ＝0．01），A1B1C1조（술전1 d 비피，불체모，청수청길）화 A2B1C1조（술전1 d 비피，체모，청수청길）감염솔분별위12．4％화13．6％，고우기타조（P ＜0．05）；A1수평（즉불체모조）술후절구감염솔8．5％，A2수평（체모조）술후절구감염솔7．7％，량조차이무통계학의의（P ＞0．05）；B1수평（청수청길）술후감염솔10．5％，B2수평（비조수청길）술후감염솔5．6％，량자차이유통계학의의（P ＜0．05）；C1수평（술전1 d）감염솔위9．8％，C2수평（술전2 h）감염솔위6．4％，량자차이유통계학의의（P ＜0．05）。대각조균락총수진행방차분석，F＝34．436，P ＝0．000，각조지간차이유통계학의의（P ＜0．01）；각조경석인설계방차분석결과현시，B（청길방식）、C（술전준비시간）단인소분석차이유통계학의의（P ＜0．01），A 인소（체모여부）단인소분석차이무통계학의의（P ＞0．05）；B 여 C、A 여 C 지간존재교호작용（P ＜0．01），A 여 B 지간무교호작용（P ＞0．05）；A、B、C 지간존재이급교호작용（P ＜0．01）。결론수술전피부준비대우술후절구감염예방구유중요의의。재진행술전비피시，응우선고필피부청길，대량비조수혹소독수충세，철저살멸피부표면잠거치병균；동시축단비피준비시간，감소세균재피부표면적번식，예방절구감염；재보증술야청길적전제하，진량감소피부손상，가이고필전모혹사용탈모제탈모등방식，무수체모。
    Objective To examine the correlation betwee different methods of preoperative skin preparation and post-operative surgical site infections and propose scientific,effective,and convenient measures for infection control.Methods The factorial design in this study considered three possible factors of post-operative surgical site infections,including factor A (shaving), factor B (way of cleaning),factor C (timing of skin preparation).There were 8 combinations in the design.The incidence of infection was analyzed for the total patients and each specificied group based on factors A,B,C.Results A total of 1 802 inpa-tients were included in this investigation.Infection was identified in 146 (8.1%)patients,including 80 (8.2%)of the 978 pa-tients undergoing type I operation,66 (8.0%)of the 824 patients receiving type II operation (P >0.05).Microbiological pathogens were identified for 65 patients.The top three pathogens were Staphylococcus aureus (22.5% ),Pseudomonas aeruginosa (15.3%)and Escherichia coli (13.9%).The surgical site infections were mainly seen in gastrointestinal tract surgery (42, 10.3%), followed by orthopedic operation (37,&nbsp;10.1%).The incidence of surgical site infections was significantly different between groups (χ2 = 24.540,P = 0.001).The incidence of infection in A1B1C1 (no shaving,cleaning with clear water,skin preparation one day before operation)and A2B1C1 (shaving,cleaning with clear water,skin preparation one day before operation)groups was 12.4% and 13.6% re-spectively,significantly higher than that in other groups (P < 0.05).The incidence of infection was 8.5% at A1 level (no shaving),and 7.7% at A2 level (shaving)(P >0.05).For factor B,the incidence of infection was 10.5% when cleaning with clear water (B1),and 5.6% when cleaning with soap (B2)(P <0.05).The incidence of infection was 9.8% at C1 level (skin preparation one day before operation)and 6.4% at C2 level (2 hour before operation)(P < 0.05).The total number of bacte-rial colonies was significantly different between groups by analysis of variance (F = 34.436,P <0.01).Factor B and C,but not A were independent risk factor of post-operative surgical site infection (P <0.01).There was interaction between factor B and C,A and C (P <0.01),but not A and B (P >0.05).Secondary interaction was also found for A and B and C (P <0.01).Conclusions Preoperative skin preparation plays an important role in prevention of surgical site infection.The skin cleaning with soap or disinfectant before operation is the most important measure for infection prevention,which is helpful to kill or remove the colonizing bacteria.Shorter interval between skin preparation and operation is conducive to the reduction of bacterial multiplication,which is also beneficial for prevention of infection.If the operating field is adequate,skin injury should be minimized by cutting hairs or using hair removal agent,and shaving is not necessary.
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