CAJ | 학술논문

目的：查明2013年5月中山市某医院剖宫产术后切口感染罹患率异常增高的原因，并提出控制措施。方法调查该医院2011年1月至2013年6月剖宫产术后切口感染病例资料，并访谈剖宫产手术流程；针对2013年5月切口感染病例，开展1∶2病例对照研究；采集感染切口分泌物和环境标本进行细菌培养检测，阳性菌株利用脉冲场凝胶电泳（PFGE）进行分子分型。结果2013年5月该医院有4例剖宫产术后切口感染患者，罹患率为10.3%（4/39）。手术至术后切口感染间隔2～3 d；入院至手术间隔2～9 h（M＝7.2 h），其时间短于未发生切口感染患者（M＝20.8 h）（Z＝5.50，P＝0.03）。其中2例分别于术前1.4、8.4 h做过B超检查，另2例有术前2 h持续胎心音监护史，4例患者手术区域皮肤均接触B超耦合剂，且未彻底清洁。切口感染患者术前10 h内进行B超检测或胎心音监护的比例高于切口未感染患者（χ2＝5.19，P＝0.01）。于1例患者切口分泌物、2份B超探头涂抹拭子及在使用和未开封的B超耦合剂（同批号）中均检测出洋葱伯克霍尔德菌（BC），PFGE分型显示5株菌的同源性为100%。结论患者剖宫产术前手术区域皮肤接触BC污染的B超耦合剂，且未彻底消毒，导致切口感染暴发。
목적：사명2013년5월중산시모의원부궁산술후절구감염리환솔이상증고적원인，병제출공제조시。방법조사해의원2011년1월지2013년6월부궁산술후절구감염병례자료，병방담부궁산수술류정；침대2013년5월절구감염병례，개전1∶2병례대조연구；채집감염절구분비물화배경표본진행세균배양검측，양성균주이용맥충장응효전영（PFGE）진행분자분형。결과2013년5월해의원유4례부궁산술후절구감염환자，리환솔위10.3%（4/39）。수술지술후절구감염간격2～3 d；입원지수술간격2～9 h（M＝7.2 h），기시간단우미발생절구감염환자（M＝20.8 h）（Z＝5.50，P＝0.03）。기중2례분별우술전1.4、8.4 h주과B초검사，령2례유술전2 h지속태심음감호사，4례환자수술구역피부균접촉B초우합제，차미철저청길。절구감염환자술전10 h내진행B초검측혹태심음감호적비례고우절구미감염환자（χ2＝5.19，P＝0.01）。우1례환자절구분비물、2빈B초탐두도말식자급재사용화미개봉적B초우합제（동비호）중균검측출양총백극곽이덕균（BC），PFGE분형현시5주균적동원성위100%。결론환자부궁산술전수술구역피부접촉BC오염적B초우합제，차미철저소독，도치절구감염폭발。
Objective In May 2013,an abnormal increase of surgical-site infection among post cesarean section patients was reported at one hospital in Zhongshan. An investigation was conducted to identify the risk factors and related control measures. Methods All the reported surgical-site infection records among post cesarean section patients were checked. A review of cesarean section schedules of health workers was also performed. An 1∶2 case-control study was conducted among surgical-site infection cases in May 2013. Microbiologic cultures were performed on 2 surgical site secretion samples and 12 samples from the environment. All the positive isolates were molecular typed by pulsed field gel electrophoresis(PFGE). Results In May 2013,4 post cesarean section patients who developed surgical-site infection symptom at one hospital in Zhongshan were reported,with an attack rate as 10.3%(4/39). The emergence time of symptom was 2-3 days after operation. All of the 4 cases underwent an emergency operation. The median time interval for cases from admission to operation was 7.2 hours(ranged from 2 to 9 hours),lower than that seen in the controls,with a median time of 20.8 hours (Z=5.50,P=0.03). Two of the 4 cases took type-B ultrasonic inspection 1.4 h and 8.4 h before the operation,and the other two cases took continuous fetal heart monitoring 2 hours before the operation. Skin of the operation area on the 4 cases had been exposed to ultrasonic couplant,without a thorough clean. The proportion of type-B ultrasonic inspection or continuous fetal heart monitoring was much higher in cases than in controls(χ2=5.19, P=0.01). Burkholderia cepacia (BC) isolates were discovered from:one surgical site secretion,2 type-B ultrasonic probe samples,one ultrasonic couplant in use and one ultrasonic couplant unopened. All the isolates were identified as 100%identical by PFGE. Conclusion The skin of operation area of cesarean section patients had been exposed to BC contaminated ultrasonic couplant without thorough cleaning,which seemed to be related to the outbreak of surgical-site infection,in our case.