影响手术部位感染的危险因素分析:环境因素

ynosmile

影响手术部位感染的危险因素分析:环境因素

背景：部分研究试图通过弄清手术部位感染控制中许多重要因素性质来解决手术部位感染（surgical site infection，SSI）。本研究试图探索包括环境因素在内的多种风险因素与手术部位感染之间的联系,以进行预防管理。

    大多数作者认为手术部位感染（SSI）是患者介入后可能出现的最严重的并发症之一。许多重要方面受到这些感染的影响，包括死亡率、发病率、假体的变化、功能依赖和诉讼，延长住院的相关费用，增加的保健、社会和劳动力成本。世界范围内的许多研究从不同的角度关注这个问题，细化手术部位感染参数和风险因素的定义，关注哪些因素是手术部位感染的重要因素，以及如何在临床层面上控制这些因素的认识。

在过去的几年里，在这个领域已经取得了重大的进展，可能会对手术部位感染的减少产生影响。这些进展包括更有效的手术灭菌程序、层流、高效微粒吸收过滤器（HEPA）、紫外线照射、空气更新、湿度控制、温差和气压、粒子计数、表面菌落计数和抗生素预防使用。然而，其他因素，如缩短住院时间，对临床条件较差的患者进行更积极的干预，可能导致手术部位感染的发生率增加。

方法：2014年，进行了一项纵向前瞻性研究，选定西班牙地中海沿岸规模相近的8家医院，以确定接受介入治疗的所有患者的手术部位感染情况，8家医院床位数350–600张，在过去的一年中，手术部位感染的发病率几乎相同（2％-3％）。与手术室有关的危险因素包括真菌和细菌污染水平、温度和湿度、空气更新和气压差。与患者相关的变量包括年龄、性别、合并症、营养水平和输血。其他因素包括抗生素预防使用、电动剃须和手动剃须、美国麻醉师学会身体状况分类、干预类型、干预的持续时间和术前住院时间。

结果：浅表手术部位感染最常与环境因素有关，如真菌对环境的污染(来自2个集落形成单位)和细菌对表面污染。当手术室没有污染时，没有发现手术部位感染。决定深部和器官/腔隙手术部位感染的因素往往与患者的特征(年龄、性别、输血、鼻饲和营养，由血液中的白蛋白水平衡量)、干预类型和术前住院时间相关。预防使用抗生素和用电动剃须刀剃须这是感染的两种保护因素。而干预的持续时间和干预分类为“脏”是共同的风险因素。

表手术感染和环境因素的Logistic回归分析

因素	浅表手术部位感染 OR (95% CI)* p值		深部器官/腹腔手术部位感染
			OR (95% CI)*	p 值
ASA 分类*
2			1.86 (1.01–3.42)	0.041
3			1.96 (1.15–3.34)	0.018
4			3.74 (1.45–9.62)	< 0.001
5			5.83 (2.03–16.69)	< 0.001
低白蛋白			1.93 (1.09–3.41)	0.023
环境污染细菌	1.75 (1.52–2.02)	< 0.001
环境污染真菌
1
2–5	3.41 (1.02–11.39)	0.04
≥6	6.23 (2.02–19.13)	< 0.001
表面污染细菌	1.96 (1.49–2.16)	< 0.001
表面污染真菌	1.61 (1.22–2.58)	< 0.001
合并症			1.85 (1.48–2.31)	< 0.001
年龄			1.03 (1.01–1.05)	< 0.001
术前住院时间			1.22 (1.01–1.49)	0.041
湿度	1.35 (1.28–1.43)	< 0.001
免疫抑制
气压差	1.31 (1.22–1.42)	< 0.001
预防&#8224;	0.29 (0.12–0.66)	< 0.001	0.29 (0.12–0.66)	< 0.001
脱毛&#8225;	0.15 (0.06–0.36)	< 0.001	0.15 (0.06–0.36)	< 0.001
空气更新率
性别§			2.28 (1.19–4.36)	0.016
鼻胃管			1.12 (1.02–1.23)	0.027
温度	1.27 (1.09–1.47)	< 0.001
干预的持续时间	2.05 (1.64–2.57)	< 0.001	6.56 (1.5–28.62)	0.015
干预类型&#182;
清洁污染			3.22 (1.47–7.02)	< 0.001
污染			3.87 (1.58–9.44)	< 0.001
脏	1.71 (1.03–2.83)	0.03	5.16 (1.75–15.2)	< 0.001
输血			3.11 (1.4–6.91)	< 0.001
ASA =美国麻醉师学会; CI =置信区间; OR =比值比; SSI =手术部位感染。 *ASA1级是参考组。 &#8224;Yes是参考组。 &#8225;手动剃须是参考组。 § 男性是参考组。 &#182;洁净是参考组.

结论：结果表明了环境和表面污染控制对预防外科手术部位感染的重要性。

原文

Analyzing the risk factors influencing surgical siteinfections: the site of environmental factors

Background: Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management.

Most authors accept that surgical site infection (SSI) is one of the worst complications that a patient can experience after an intervention.

Many important aspects are affected by these infections, including mortality, morbidity, changes in prostheses, functional dependence and lawsuits as well as the associated costs of a prolonged hospital stay and increased total health care, social and labour costs.

A multitude of studies worldwide focus on this issue from different scientific perspectives, refining the definitions of SSI parameters and risk factors as well as increasing our knowledge of what factors are important contributors to SSIs and how to control them at a clinical level.

In the past few years, important advances have been achieved in the field that may have had an impact on the reduction of surgical site infection.

These include more effective surgical sterilization procedures, laminar flow, high-efficiency particulate absorbing (HEPA) filters, ultraviolet radiation, air renewal, humidity control, differential temperature and air pressure, particle count, surface colony count and antibiotic prophylaxis.

     However, other factors, such as decreased length of hospital stay, and more aggressive interventions performed on patients with worse clinical conditions, probably contribute to an increased incidence of surgical site infection.

Methods: We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the editerraneancoast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay.

Results: Superficial SSI was most often associated with environmental factors, suchas environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as “dirty” were shared risk factors.

Table  Logistic regression of surgical infections and environmental factors

Factor	Superficial SSI OR (95% CI)* p value		Deep organ/space SSI
			OR (95% CI)*	p value
ASA class*
2			1.86 (1.01–3.42)	0.041
3			1.96 (1.15–3.34)	0.018
4			3.74 (1.45–9.62)	< 0.001
5			5.83 (2.03–16.69)	< 0.001
Low albumin			1.93 (1.09–3.41)	0.023
EC bacteria	1.75 (1.52–2.02)	< 0.001
EC fungi
1
2–5	3.41 (1.02–11.39)	0.04
≥6	6.23 (2.02–19.13)	< 0.001
SC bacteria	1.96 (1.49–2.16)	< 0.001
SC fungi	1.61 (1.22–2.58)	< 0.001
Comorbidity			1.85 (1.48–2.31)	< 0.001
Age			1.03 (1.01–1.05)	< 0.001
Preoperative stay			1.22 (1.01–1.49)	0.041
Humidity	1.35 (1.28–1.43)	< 0.001
Immunosupression
Differential air pressure	1.31 (1.22–1.42)	< 0.001
Prophylaxis&#8224;	0.29 (0.12–0.66)	< 0.001	0.29 (0.12–0.66)	< 0.001
Depilation&#8225;	0.15 (0.06–0.36)	< 0.001	0.15 (0.06–0.36)	< 0.001
Air renewal rate
Sex§			2.28 (1.19–4.36)	0.016
Nasogastric tube			1.12 (1.02–1.23)	0.027
Temperature	1.27 (1.09–1.47)	< 0.001
Duration of intervention	2.05 (1.64–2.57)	< 0.001	6.56 (1.5–28.62)	0.015
Intervention type&#182;
Clean–contaminated			3.22 (1.47–7.02)	< 0.001
Contaminated			3.87 (1.58–9.44)	< 0.001
Dirty	1.71 (1.03–2.83)	0.03	5.16 (1.75–15.2)	< 0.001
Transfusion			3.11 (1.4–6.91)	< 0.001
ASA = American Society of Anaesthesiologists; CI = confidence interval; EC = environmental contamination; OR = odds ratio; SC = surface contamination; SSI = surgical site infection. *ASA class 1 is the reference group. &#8224;Yes is the reference group. &#8225;Manual razor is the reference group. § Men are the reference group. &#182;Clean is the reference group.

Conclusion: Our results suggest the importance of environmental and surface contamination control to prevent SSI.

guoli2008

学习了，谢谢分享，谢谢了。。。。。

小白天使

结果：浅表手术部位感染最常与环境因素有关，如真菌对环境的污染(来自2个集落形成单位)和细菌对表面污染。当手术室没有污染时，没有发现手术部位感染。决定深部和器官/腔隙手术部位感染的因素往往与患者的特征(年龄、性别、输血、鼻饲和营养，由血液中的白蛋白水平衡量)、干预类型和术前住院时间相关。预防使用抗生素和用电动剃须刀剃须这是感染的两种保护因素。而干预的持续时间和干预分类为“脏”是共同的风险因素。
关注环境因素，保障患者手术安全。。。

ynosmile

其实在平时工作中，外科主任非常关注环境。

秋荷寄语

说明环境物表的清洁很重要

1980gaooag

学习了，谢谢分享，谢谢了。。。。。

ynosmile

环境清洁，是医院感染管理最基础的要求。

zcy_all

路过学习了，感谢老师分享！