【摘要】：目的研究外來醫(yī)療器械在預(yù)防某三級甲等醫(yī)院骨科手術(shù)部位感染的效果。方法采用流行病學(xué)類試驗的研究方法,開展干預(yù)前后比較。2014年1月1日-2015年12月31日,對骨科腰椎手術(shù)、關(guān)節(jié)置換術(shù)(膝或髖關(guān)節(jié))開展手術(shù)部位感染前瞻性、目標性監(jiān)測,了解手術(shù)部位感染發(fā)生率;抽檢上述兩類手術(shù)的外來醫(yī)療器械,評價清洗質(zhì)量;2016年1月1-2016年12月31日,采取干預(yù)措施(外來醫(yī)療器械集中清洗、滅菌)、提高器械清洗合格率,根據(jù)干預(yù)前后的各項監(jiān)測指標評價手術(shù)部位感染預(yù)防效果。結(jié)果 2014年1月1日-2016年12月31日共行腰椎手術(shù)、關(guān)節(jié)置換術(shù)(膝或髖關(guān)節(jié))1 825臺;研究期間,1 825例腰椎手術(shù)、關(guān)節(jié)置換術(shù)(膝或髖關(guān)節(jié))的手術(shù)部位感染率為1.8%,通過采取干預(yù)措施,SSI從1.8%下降至0.3%,差異有統(tǒng)計學(xué)意義(P0.05),相對危險度(RR值)及95%置信區(qū)間(95%CI)為0.172(0.040~0.736)。器械清洗合格率從干預(yù)前28.7%上升至85.0%,差異有統(tǒng)計學(xué)意義(χ2=33.835,P0.05)。術(shù)后患者發(fā)熱平均時長從干預(yù)前(4.11±1.18)d下降至干預(yù)后(3.01±0.99)d,差異有統(tǒng)計學(xué)意義(t=14.141,P0.05);術(shù)后3日發(fā)熱患者比例從干預(yù)前52.4%下降至40.7%,差異有統(tǒng)計學(xué)意義(χ~2=64.707,P0.05);抗菌藥物使用強度從干預(yù)前46.66DDDs/百床日下降至干預(yù)后31.22DDDs/百床日;抗菌藥物使用時長從416.67天/千床日下降至272.73天/千床日。結(jié)論通過規(guī)范外來醫(yī)療器械的管理,提高了手術(shù)器械清洗質(zhì)量,并且通過多項評價指標監(jiān)測數(shù)據(jù)的變化,全面、綜合評價規(guī)范外來醫(yī)療器械管理的效果,從而為管理層制定相關(guān)規(guī)范提供更多的數(shù)據(jù)支持。
[Abstract]:Objective to study the effect of external medical devices on preventing infection of orthopedic surgery site in Grade 3A Hospital. Methods from January 1, 2014 to December 31, 2015, the surgical site infection of orthopedic lumbar vertebrae surgery, arthroplasty (knee or hip joint) was prospectively studied. Objective monitoring to understand the incidence of infection in the surgical site; The external medical instruments of the above two types of surgery were selected and the cleaning quality was evaluated. From January 1 to December 31, 2016, intervention measures (centralized cleaning and sterilization of external medical devices) were taken to improve the qualified rate of cleaning equipment, and to evaluate the preventive effect of surgical site infection according to the monitoring indexes before and after intervention. Results from January 1, 2014 to December 31, 2016, a total of 1 825 lumbar vertebrae operations were performed with arthroplasty (knee or hip joint). During the study period, the infection rate of arthroplasty (knee or hip joint) was 1.8% in 1 825 cases of lumbar surgery. The SSI decreased from 1.8% to 0.3% through intervention (P0.05). The relative risk (RR) and 95% confidence interval (95%CI) were 0.172 (0.040 鹵0.736). The qualified rate of instrument cleaning increased from 28.7% to 85.0%, the difference was statistically significant (蠂 2, 33.835, P 0.05). The average duration of postoperative fever decreased from (4.11 鹵1.18) days before intervention to (3.01 鹵0.99) days after intervention, and the difference was statistically significant (t = 14.141). The proportion of fever patients decreased from 52.4% before intervention to 40.7, the difference was statistically significant (蠂 ~ 2 ~ (2) 64.707), the intensity of antimicrobial drug use decreased from one hundred bed days before intervention to one hundred bed days in 31.22DDDs/ after intervention. The duration of antimicrobial use decreased from 416.67 days per thousand bed days to 272.73 days per thousand bed days. Conclusion by standardizing the management of external medical devices, the cleaning quality of surgical instruments is improved, and the effect of standardizing the management of external medical devices is comprehensively evaluated by monitoring the change of data of many evaluation indexes. In order to provide more data support for management to formulate relevant specifications.
【作者單位】： 北京醫(yī)院國家老年醫(yī)學(xué)中心醫(yī)院感染管理處;北京大學(xué)人民醫(yī)院感染管理辦公室;北京醫(yī)院國家老年醫(yī)學(xué)中心醫(yī)院供應(yīng)室;北京醫(yī)院國家老年醫(yī)學(xué)中心醫(yī)院手術(shù)麻醉科;北京協(xié)和醫(yī)院急診科;
【基金】：北京醫(yī)院科研科技新星基金資助項目(BJ-2016-04) 中美新發(fā)和再發(fā)傳染病合作基金資助項目(5U2GGH000018)
【分類號】：R687
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本文編號：2384927