骨科患者手术部位感染危险因素分析及预防对策

摘要

目的:探讨骨科患者手术部位感染的危险因素及预防对策.方法:对骨科病区的手术患者2316例进行回顾性分析,查找手术部位感染的危险因素及常见致病菌,探讨其预防对策.结果:2316例患者手术部位感染率为1.6%(37/2316),其中I类手术部位感染率0.45%(10/2214), III类手术部位感染率26.09%(24/92),IV类手术部位感染率30%(3/10).手术部位感染的危险因素主要包括:合并基础疾病、是否急诊、手术级别及手术室环境因素等,其中患者基础疾病和手术室环境为手术部位感染的独立危险因素.手术部位感染的致病菌为G -杆菌23株(62.16%),其中主要为大肠埃希氏菌8株(34.78%),肺炎克雷伯菌7株(30.43%),鲍曼不动杆菌4株(17.39%).G+球菌14株(37.84%),主要为金黄色葡萄球菌6株(42.86%),凝固酶阴性葡萄球菌5株(35. 71%).结论:患者合并基础疾病、是否急诊、手术级别及手术室环境因素等为影响骨科手术部位感染危险因素,感染致病菌各异,其中患者基础疾病和手术室环境为手术部位感染的独立危险因素.应制定相应的预防对策,以期降低手术部位感染的发生率.%Objective:To explore the risk factors and preventive measures of surgical site infection(SSI)in or-thopedic patients.Methods:A retrospective analysis was performed on 2316 surgical patients admitted to orthopedic ward in our hospital.To detect the risk factors and pathogens of SSI and explore preventive strategies.Results:The infection rate of SSI was 1.6%(37/2316)in 2316 patients,of which the infection rate in class I incision was 0.45%(10/2214),class III incision was 26.09%(24/92),the SSI rate was 30%(3/10)in class IV incision.Risk factors for s SSI including:combine underlying diseases,emergency,surgical level and operating room environmental,and patients with underlying diseases and operating room environment were independent risk factors for SSI.The patho-gens for SSI were 23(62.16%)G- bacilli,of which 8(34.78%)were Escherichia coli,7(30.43%)were Klebsiella pneumoniae,4(17.39%)were Acinetobacter baumannii,14(37.84%)G+cocci,including 6(42.86%),Staphylo-coccus aureus,5(35.71%)coagulase-negative Staphylococcus.Conclusions:The risk factors of SSI in orthopedic surgery affected by basic disease,emergency,operation class and operating room environment.The pathogens which found in SSI are vary.The underlying diseases and operating room environment are independent risk factors for SSI. Preventive measures should be developed to reduce the incidence of SSI.