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。
Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.
目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料，比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。 结果术后常规组57例患者中，有43例切口愈合等级为甲级，5例为乙级，9例为丙级，SSI发生率为24.56%（14/57）。浸泡组35例患者的切口愈合均良好，均为甲级愈合，SSI发生率为0，低于常规组（P<0.05）。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生，值得临床推广应用。
ObjectiveTo establish a predictive model of surgical site infection (SSI) following colorectal surgery using machine learning.MethodsMachine learning algorithm was used to analyze and model with the colorectal data set from Duke Infection Control Outreach Network Surveillance Network. The whole data set was divided into two parts, with 80% as the training data set and 20% as the testing data set. In order to improve the training effect, the whole data set was divided into two parts again, with 90% as the training data set and 10% as the testing data set. The predictive result of the model was compared with the actual infected cases, and the sensitivity, specificity, positive predictive value, and negative predictive value of the model were calculated, the area under receiver operating characteristic (ROC) curve was used to evaluate the predictive capacity of the model, odds ratio (OR) was calculated to tested the validity of evaluation with a significance level of 0.05.ResultsThere were 7 285 patients in the whole data set registered from January 15th, 2015 to June 16th, 2016, among whom 234 were SSI cases, with an incidence of SSI of 3.21%. The predictive model was established by random forest algorithm, which was trained by 90% of the whole data set and tested by 10% of that. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 76.9%, 59.2%, 3.3%, and 99.3%, respectively, and the area under ROC curve was 0.767 [OR=4.84, 95% confidence interval (1.32, 17.74), P=0.02].ConclusionThe predictive model of SSI following colorectal surgery established by random forest algorithm has the potential to realize semi-automatic monitoring of SSIs, but more data training should be needed to improve the predictive capacity of the model before clinical application.
ObjectiveTo evaluate existing predictive models for surgical site infection (SSI) following colorectal cancer (CRC) surgery, aiming to provide a scientific basis for refining risk prediction models and developing clinically practical and widely applicable screening tools. MethodA comprehensive review of existing literature on predictive models for SSI following CRC surgery, both domestically and internationally, were conducted. ResultsThe determination of SSI following CRC surgery primarily relied on the Centers for Disease Control and Prevention standard of USA, which presented issues of consistency and accuracy. Various predictive models had been developed, including traditional statistical models and machine learning models, with 0.991 of an area under the operating characteristic curve of predictive model. However, most studies were based on retrospective and single-center data, which limited their applicability and accuracy. ConclusionsAlthough existing models provide strong support for predicting SSI following CRC surgery, there is a need for multi-center, prospective studies to enhance the generalizability and accuracy of these models. Additionally, future research should focus on improving model interpretability to better apply them in clinical practice, providing personalized risk assessments and intervention strategies for patients.
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.
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。
ObjectiveTo study the present situation of hospital orthopedic surgery incision infection, in order to provide the basis for further intervention. MethodsProspective investigation combined with retrospective investigation method was adopted in our study to perform a statistical analysis on orthopedic surgery incision infections among 545 patients in our hospital between January and December 2012. ResultsDuring the one year of follow-up, there were 10 cases of surgical incision infection among all the 545 patients, with an infection rate of 1.83%. The infection rate of class-Ⅰ incision was 0.46%, of class-Ⅱ was 5.13%, and of class-Ⅲ/Ⅳ was 12.12%, and the Cochrane-Armitage trend chi-square test showed significant trend among them (χ2=28.273, P<0.001). Based on different operation risk index, patients with index 1, 2, 3 had a surgical site infection rate of 0.82%, 2.60%, and 18.75%, respectively. The higher the index, the higher the surgery incision infection rate, and the trend was statistically significant (χ2=12.916, P<0.001). The infection rate was 1.43% for elective surgical procedures, and was 3.15% for emergency surgery, but there was no significant difference (P>0.05). ConclusionOrthopedic surgery has a high-risk surgical site infection rate, and incision classification and surgical risk index have statistical correlation with the incidence of hospital infection. In order to ensure the security of patients and reduce medical disputes, we should pay close attention to orthopedic surgery infection.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.