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.
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.
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.
Objective To probe the distribution and drug resistance of pathogens causing surgical site infection in patients after gynecologic operation, and provide reference for prevention and treatment. Methods Seventy patients with incision infection after gynecologic operation in West China Second University Hospital of Sichuan University from January 2010 to May 2015 were selected. Species of the pathogens from the submitted specimens and the results of the drug susceptibility testing were analyzed. Results Seventy-two strains of pathogens were isolated, including 36 strains (50.0%) of Gram-negative (G–) bacteria and 36 strains (50.0%) of Gram-positive (G+) bacteria. The main G– bacteria were Escherichia coli (36.1%) and Enterobacter cloacae (5.6%); the main G+ bacteria were Staphylococcus aureus (18.1%), Staphylococcus epidermidis (12.5%), and Enterococcus faecalis (8.3%). Escherichia coli showed low sensitivities to ampicillin, ceftriaxone, and gentamicin, with resistance rates of 76.9%, 61.5%, and 61.5%, respectively. Staphylococcus aureus showed low sensitivities to penicillin G, clindamycin, and erythromycin, with resistance rates of 92.3%, 69.2%, and 61.5%, respectively. Staphylococcus epidermidis showed low sensitivities to erythromycin, penicillin G, and ciprofloxacin, with resistance rates of 88.9%, 77.8%, and 77.8%, respectively. No carbapenem-resistant G– bacteria or vancomycin-resistant G+ bacteria were detected. Conclusion Postoperative surgical site infection is the most common nosocomial infection. The main bacteria related to postoperative incision infection in the gynecology department of the hospital are Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecalis, which become resistant to common antibiotics currently. Therefore more attention should be paid to bacterial isolation and drug susceptibility test results for rational use of antimicrobial drugs and effectiveness of the treatment to nosocomial infection.
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 analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.MethodsThe day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected. We retrospectively collected and analyzed patients’ hospitalization data and return visit data, statistically analyzed their use of antimicrobial agents, explored whether there was an unreasonable phenomenon in the use of antimicrobial agents, and analyzed the reasons.ResultsThere were 4 054 surgeries included in this study, and 1 293 patients using antimicrobial agents, the use rate of antimicrobial agents in day surgery patients reached 31.89%. Aseptic, clean-contaminated, contaminated and dirty surgery accounted for 12.22%, 65.20%, 7.27%, and 15.31% separately. Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision (P=0.073). The most common type of antimicrobial agents used by patients are cephalosporins (57.50%), mainly used as single drugs (97.91%) and mostly oral used in patients’ home. Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital (65.43%). The antimicrobial agents more used by Stemmatological Department (23.98%), Ear/Nose/Throat Department (22.58%) and Obstetrics and Gynecology Department (22.51%). The average used time of antimicrobial agents was (5.37±1.86) days, and 7.42% of patients still had surgical site infections after the use of prophylactic antimicrobial agents, most of them from General Surgery Department.ConclusionsThe unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include: a high proportion of preventive medications for clean-contamination surgery, a high level of initial medication, and most patients take oral medications at home and lack of guidance, and long medication time. There is an urgent need for scientific guidance on the use of antimicrobial agents for patients undergoing day surgery.
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。
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。
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.