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连续七年小肠手术后手术部位感染标准化感染比趋势分析

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目的 采用标准化感染比(standardized infection ratio,SIR)对小肠手术后手术部位感染(surgical site infection,SSI)趋势进行分析,客观评价感染控制效果,为采取感染控制策略提供科学依据。方法 按照美国国家医疗保健安全网(National Healthcare Safety Network,NSHN)的医院感染监测定义和SSI事件监测方法,对宜昌市中心人民医院2016年1月1日-2022年12月31日开展的小肠手术成年住院患者SSI及相关风险因素进行前瞻性监测。对符合国际疾病分类手术编码系统(ICD-10-PCS)定义的小肠手术,使用多因素二元logistic回归模型,以7年监测数据为基线,采用NHSN改良的复杂入院/再入院SSI-SIR模型中小肠手术的风险因素预测模型,计算各年度SIR,采用Mid-P法进行差异统计学检验,采用线性回归模型进行趋势分析。结果 共纳入患者2 436例,其中深部切口感染48例、器官/腔隙感染49例,总体感染发病率为4。0%。2016年-2022年各年度行小肠手术分别为151、244、222、260、320、408和831例。Mid-P法检验显示,2016年-2019年SIR环比差异有统计学意义(P<0。05);2018年较2017年有所上升,2019年-2022年环比差异无统计学意义(P>0。05);SIR趋势分析结果显示差异无统计学意义(P=0。065)。结论 2017年-2022年小肠手术手术部位感染得到控制。除2018年以外,其他5年均取得成效,但2020年-2022年未呈逐年下降趋势。采用SIR为评估感染控制质量提供了新思路。
Surgical site infection after small bowel surgery for seven consecutive years trend analysis of standardized infection ratios
Objective To analyze the trend of standardized infection ratio(SIR)of surgical site infection(SSI)in small bowel surgery,objectively evaluate the effect of infection control,and provide evidence-based strategies for SSI prevention.Methods According to Centers for Disease Control and Prevention(CDC)/National Healthcare Safety Network(NHSN)surveillance definitions for specific types of infections and the monitoring methods of SSI events published by NHSN,the SSI and related risk factors of adult inpatients undergoing small bowel surgery in Yichang Central People's Hospital between January 1,2016 and December 31,2022 were prospectively monitored.The inpatients undergoing small bowel surgery that meets the definition of International Classification of Diseases,10th Revision Clinical Modifications/Procedure Coding System(ICD-10-CM/PCS),a multivariate binary logistic regression model was used to calculate the predicted infections in each year,the model included the risk factors for small bowel surgery in NHSN Complex Admission/Readmission(A/R)SSI Model with 7 years of surveillance data as the baseline.The SIR was calculated by dividing the number of observed SSI by the number of predicted SSI in each year.The Mid-P method was used to test the difference of SIR compared to the previous year,and the linear regression model was used to analyze the trend of SIR.Results A total of 2 436 patients were included,with 48 cases of deep incision infection and 49 cases of organ/cavity infection,and the overall incidence rate of infection was 4.0%.From 2016 to 2022,there were 151,244,222,260,320,408,and 831 patients who underwent small bowel surgery,respectively.The Mid-P test showed that there was a significant difference in SIR from 2016 to 2019(P<0.05),and there was an increase in 2018 compared with 2017.There was no significant difference in SIR compared to the previous year from 2019 to 2022(P>0.05),and there was no significant difference in the trend of SIR of SSI(P=0.065).Conclusions From January 1,2017,to December 31,2022,advances have been made in SSI control practices of small bowel surgery in six consecutive years,except for 2018,but there was no annual downward trend from 2020 to 2022.The use of SIR provides a new approach for evaluating the quality of infection control.

Small bowel surgerysurgical site infectionstandardized infection ratioanalysis of trends

刘荣辉、李高纯、易和平、张长凤、冯林

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三峡大学第一临床医学院,宜昌市中心人民医院医院感染管理办公室(湖北宜昌 443003)

小肠手术 手术部位感染 标准化感染比 趋势分析

宜昌市科学研究与开发项目医疗卫生课题

A13301-15

2024

华西医学
四川大学华西医院

华西医学

CSTPCD
影响因子:0.744
ISSN:1002-0179
年,卷(期):2024.39(3)
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