感染控制与抗菌药物管理措施干预对骨科手术部位感染的影响

探讨感染控制与抗菌药物管理措施干预对骨科手术部位感染(surgical site infection, SSI)的影响，为有效降低SSI的发生提供循证依据。以2013—2018年在上海市杨浦区中心医院骨科住院的 8 916 例手术患者作为研究对象，其中干预前 2 462 例，干预后 4 636 例，强化干预 1 818 例。采取综合性感染控制集束化管理与抗菌药物管理干预措施，分为干预前(2013—2014年)、干预后(2015—2017年)和强化干预(2018年)3个阶段，主要措施包括术前手卫生及患者准备、术中保温及围术期合理用药等。对骨科SSI情况及干预效果进行评估。结果显示，实施感染控制的集束化措施与有效的抗菌药物管理措施后，手术患者SSI发生率由干预前的1.58%下降至0.61%(P<0.05)。干预前、后及强化干预Ⅰ、Ⅱ类切口预防用抗菌药物的品种合理率分别为54.83%、79.82%和99.04%，时机合理率分别为51.99%、78.53%和89.97%，疗程合理率分别为52.98%、82.19%和91.97%，结果显示抗菌药物品种选择、给药时机及疗程的合理率明显改善(P<0.05)，且平均住院天数及抗菌药物占住院总费用的比例明显下降(P<0.05)，表明长期连续的综合性感染控制与抗菌药物管理干预可有效降低骨科手术患者SSI的发生。

Effect of infection control and antimicrobial management intervention on orthopedic surgery site infection

To evaluate the impact of infection control and antibacterial drug management interventions on surgical site infection (SSI) in the orthopedics of our hospital, the clinical cases from 2013 to 2018 of orthopedic in Yangpu District Central Hospital were subjected into this study. The patients were divided into pre-intervention group (2013-2014), after intervention group (2015-2017) and intensive intervention group (2018). Then the SSI of orthopedic was studied and the effect of intervention was evaluated. The SSI in orthopedic surgical patients decreased from 1.58% to 0.61% (P＜0.05) after the implementation of infection control and antibacterial drug management interventions. The reasonable variety rates of antibiotics of type I and II incision before, after and intensive intervention were 54.83%, 79.82% and 99.04%, respectively. And the reasonable timing rates were 51.99%, 78.53% and 89.97%, respectively. The reasonable duration rates were 52.98%, 82.19% and 91.97%, respectively. The results showed that the incidence of SSI decreased significantly after the implementation of infection control and antimicrobial management intervention. The results had shown that the variety, the timing and duration of antibiotics were obviously improved (P＜0.05). The average length of hospital stay was significantly reduced and the average costs of antibacterial drugs in total hospitalization costs decreased significantly (P＜0.05). It is shown that long-term continuous comprehensive infection control and antibacterial drug management intervention can effectively reduce the incidence of infection in orthopedic surgery patients.