手术部位感染回顾性调查及危险因素分析

摘要

目的 调查分析医院手术部位感染的流行病学特征,研究主要相关危险因素,以提出干预措施加强防控.方法 回顾性调查2009年1月-2011年9月间25 228份外科手术患者出院病历,对其医院感染分布、影响因素及病原菌构成进行分析,对可能的危险因素进行Logistic回归分析.结果 25 228例外科手术患者发生手术部位感染539例,554例次,手术部位感染率为2.14%,例次感染率为2.20%.将单因素分析有统计学差异的10个因素纳入Logistic回归分析模型,筛选出8个手术部位感染的危险因素,依OR值大小依次为:手术性质(OR 95% CI:1.29～18.43)、切口类型(OR 95% CI:1.19～9.28)、是否患糖尿病(OR 95% CI:1.25～7.23)、手术时间(OR 95% CI:1.14～6.69)、年龄(OR 95% CI:1.13～3.99)、术中出血量(OR 95% CI:1.25～2.78)、住院时间(OR 95% CI:1.38～2.39)、术前有无感染灶 (OR 95% CI:1.21～1.50).手术部位感染率居前3位的科室为:肝胆外科(6.53%)、心胸外科(4.87%)和泌尿外科(3.91%);共检出病原菌506株,以铜绿假单胞菌较多(22.33%),其次为鲍曼不动杆菌(14.62%)和粪肠球菌(11.07%).结论 手术部位感染的发生与多种因素有关,应强调加强切口感染的监测,重视各环节质量控制.%Objective To evaluate the epidemiological characteristics and related risk factors for surgical site infection (SSI) , so as to propose intervention measures. Methods Medical records of 25 228 surgery patients who were discharged between January 2009 and September 2011 were surveyed retrospectively, distribution of healthcare-associated infection(HAI), influencing factors and distribution of pathogens were analyzed, and possible risk factors were conducted Logistic analysis. Results Among 25 228 surgery patients, 539 developed 554 times of SSI, SSI rate was 2. 14%, case infection rate was 2. 20%. Logistic analysis showed the risk factors for SSI infection were as follows: classification of operation(OR 95% CI, 1. 29 - 18. 43) , incision type (OR 95% CI, 1. 19 - 9. 28) , diabetes (OR 95% CI, 1.25-7.23), duration of operation (OR 95% CI, 1. 14 - 6. 69), age (OR 95% CI, 1. 13-3. 99) , intraoperative bleeding (OR 95% CI, 1. 25 - 2. 78), length of hospital stay (OR 95% CI, 1. 38 - 2. 39), preoperative injection focus (OR 95%CI, 1. 21 - 1. 50). SSI mainly concentrated in departments of hepatobiliary surgery(6. 53%) , cardio thoracic surgery(4. 87%) and urology(3. 91 %) ; a total of 506 psihogenic isolates were detected, the majority were Pseudomonas aeruginosa (22. 33%) ,Acinetobacler baumannii (14. 62%) and Enlerococcus faecalis(11. 07%). Conclusion The occurrence of SSI is related to multiple factors, incision infection surveillance should be intensified.