在外科领域,预防性使用抗生素占有相当重要的地位,这主要是为了预防外科手术部位感染，包括外科手术后的切口感染和手术部位的深部腔隙或器官感染，如胸腔感染、腹腔感染、脓肿形成等。此类感染约占医院全部感染的14%～16%，占外科患者感染的38%［1］，其重要性不容忽视。
每位外科医师均会遭遇到外科感染，这是手术技术自身所决定了的，外科手术必然破坏人体宿主抵抗力的第一道防线皮肤和粘膜屏障，使得细菌得以进入体内。从外科发展历史看，因外科感染而死亡是很常见的，特别是在19世纪末叶以前，当时截肢术死亡率在25%~90%之间，美国内战时期则为50%左右，这主要是外源性感染所致。但从现代外科学观点看，外科感染的内涵已发生了许多重要变化，如医院内获得性感染超过了患者原有的感染； 体内的内源性正常菌群感染多于外源性致病细菌感染； 外科手术后的手术部位感染（surgical site infection，SSI）多于需要外科处理的一般化脓性感染。其中SSI已成为值得关注的临床课题。
目的 了解医院外科患者手术部位感染的危险因素，以采取预防与控制干预措施，降低手术部位感染率。 方法 以回顾性调查方法对2011年1月－6月外科手术患者统计手术部位感染率；以前瞻性调查的方法对2012年1月－6月外科手术部位患者进行目标性监测。 结果 2011年1月－6月手术部位感染率为1.01%，2012年1月－6月手术部位感染率为0.63%，两者比较，差异有统计学意义（P＜0.05）。患者年龄、手术类型、手术时间、手术性质是手术部位感染的高危因素。 结论 实施目标性监测，加强危险因素管理，采取干预措施，能有效降低外科手术部位感染率。
目的 分析外科手术部位感染率过低的原因，掌握手术部位感染诊断标准，减少医院感染漏报，及时发现医院感染流行趋势，采取控制措施，防止医院感染暴发。 方法 选择开展较多、手术部位一旦发生感染对患者安全威胁性较大的手术：包括胆囊切除或（和）胆管手术，结肠、直肠切除术，阑尾切除术，疝手术，乳房切除术，剖宫产，子宫切除术及附件切除术，全髋关节置换术，食道贲门手术，腰椎间盘摘除术，监测时间为2011年1月1日－6月30日及2012年1月1日－6月30日，共监测1 180例手术，对手术部位感染率进行对比分析。 结果 2011年半年监测手术部位感染率1.99%，调整感染率4.74%；比国内报道低6～9倍；通过分析原因，对医院感染诊断标准再培训、加强病原微生物送检等，2012年半年监测手术部位感染率4.68%，调整感染率32.12%；与2011年比较差异有统计学意义（χ2=141.841，P=0.000）。 结论 手术部位感染率偏低的原因是医生漏报所致；采取整改措施后，提高了手术部位感染的识别能力，减少了漏报，对及时发现医院感染暴发具有重要意义。
Objective To investigate the correlated risk factors of deep venous thrombosis (DVT) after the laparoscopic surgery. Methods Clinical records of 16 patients with DVT and 148 patients without DVT after laparoscopic surgery in Huashan hospital from Mar.2007 to Jan.2008 were analyzed retrospectively. Results There were several factors which could induce DVT after the laparoscopic surgery, including operation time ＞1 h 〔OR=4.15 （95% CI： 1.36-12.68）〕, operative site located in hypogastrium 〔OR=2.94 （95% CI： 1.07-8.08）〕 and the number of high risk factors ≥3 〔OR=3.94 （95% CI： 1.38-11.23）〕. Conclusions The long time of operation， hypogastric operation of laparoscopic surgery and high risk factors could induce DVT. Prevention measures should be made in preoperative period.
ObjectiveTo explore the risk factors for and preventive measures of orthopedic perioperative surgical site infection. MethodsWe retrospectively analyzed the clinical data of 2 752 cases of orthopedic surgery performed from January 2010 to December 2012. The risk factors for such infection were analyzed and certain preventive measures were put forward. ResultsA total of 97 patients were infected with a surgical site infection rate of 3.52%. The surgical site infection was closely related to ages, basic diseases, surgical site, types of incision, preoperative hospital stay, operative time, urgent elective surgery, the use of antibiotics, medical staff hand hygiene and other factors, of which the rate of infection after amputation was the highest, reaching 23.81% (20/84). ConclusionMaking full preparations before operation, strengthening medical staff's hand disinfection, prophylactic antibiotics, good precautions and regulations in operation, and nursing meticulously after operation can be taken to prevent and reduce surgical site infection in orthopedic operation patients effectively.
ObjectiveTo analyze the relevant factors for surgical site infection. MethodsA total of 677 cases of surgery in one hospital from July 1 to December 31 in 2012 were surveyed (not including implant and cardiac intervention surgeries), which were divided into different groups according to the preoperative incision contamination level, and the postoperative healing of incisions were observed closely. After the patients were discharged, we investigated the situation of incisions by phone or periodic review, and forms were filled in on schedule. ResultsBy follow-up evaluation of the 677 cases, the incisions in 12 cases were infected and the infection rate was 1.77%. Polluted and infected (14.28%, 30.76%) incisions caused more infection than the clean and clean-polluted incisions (0.00%, 0.59%). The patients who stayed in hospital for 4 or more than 4 days before surgeries (infection rate was 4.55%) took more risk of infection than the patients whose preoperative time in hospital were 2-3 days (infection rate was 0.60%) and 1 or shorter than 1 day (0.68%). Perioperative use of antibiotics for longer than 72 hours will increase the risk of incision infection than those within 48 hours (7.69%, 0.00%; P=0.002). ConclusionSurgical site infection is related to the incision type. Shortening the preoperative in-hospital time will reduce the risk of infection. Long time use of antibiotics in perioperative period cannot prevent the postoperative infection effectively, but may increase the risk of infection.
ObjectiveTo probe into the risk factors for postoperative surgical site infections in the Department of Cardiothoracic Surgery, and put forward correspondent preventive and treatment measures. MethodA total of 360 patients who underwent operations between February 2011 and March 2013 were the study subjects. The age, sex, basic diseases, surgical time, hospitalization time, surgical implants, and incision category were recorded carefully, and were analyzed for their correlation with surgical site infections. ResultsThere were 27 cases of surgical site infections with an infection rate of 7.50%. Age, hospitalization time, surgical time, basic diseases, surgical implants and incision category were risk factors for surgical site infections (P<0.05). ConclusionsBased on the analysis of risk factors for surgical site infections, we can help patients recover as early as possible by taking preventive measures beforehand.
ObjectiveTo study the effects of PDCA cycle in the control of surgical site infection (SSI). MethodsA total of 1 761 surgeries between January 2012 and December 2013 were chosen to be monitored. PDCA cycle was used as a tool of total quality management evaluation to enhance the control of SSI. ResultsAfter 2 to 4 cycles of PDCA, the preventive medication rate of ClassⅠ operation incision was decreased significantly (χ2=309.513，P<0.001) and the postoperative incision infection rate did not change significantly (χ2=1.474，P=0.669). ConclusionUsing PDCA cycle can increase SSI management level and quality significantly and total quality management can be operated effectively.