Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery
Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery
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DOI：
10.1016/j.jhin.2005.08.007
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发表时间：
2006-02-01
影响因子：
6.9
通讯作者：
Busscher, HJ
中科院分区：
文献类型：
--
作者：
Knobben, BAS;van Horn, JR;Busscher, HJ
本研究的目的是评估行为和系统措施是否会减少全髋关节或膝关节置换术中的术中污染。在18个月的随访期内，还研究了这些措施对随后伤口排液时间延长、浅表手术部位感染和假体周围深部感染的影响。在207例手术开始和结束时，从手术工具中采集4个拭子。取出骨材料。（在髋关节的情况下为髋臼和股骨;在膝关节的情况下为股骨和胫骨）也进行了污染测试。最初，包括在原始控制条件下进行的70次操作，之后引入了第一个行为措施（即更好地使用增压室）。在67次手术中使用更好地使用增压室（第1组）进行培养，然后采取纪律措施并安装新的层流系统。在第二次干预后监测了70例手术（第2组）。对照组术中污染率为32.9%（23/70），第1组为34.3%（23/67），第2组为8.6%（6/70）。第2组中伤口排液时间延长和浅表手术部位感染显著减少，假体周围深部感染的发生率也显著减少;然而，撕裂未达到统计学显著性。这项研究表明，手术室中全身和行为变化的结合显著降低了术中细菌污染、随后伤口排液时间延长和浅表手术部位感染的发生率。随访18个月后，假体周围深部感染也有所减少。(c)2005年，医院感染协会。由爱思唯尔有限公司出版。保留所有权利。
The aim of this study was to evaluate whether behavioural and systemic measures wilt decrease intra-operative contamination during total hip or knee replacements. The influence of these measures on subsequent prolonged wound discharge, superficial surgical site infection and deep periprosthetic infection was also investigated during an 18-month follow-up period. Four swabs were taken from instruments at the beginning and end of the procedure for 207 procedures. Removed bone material. (acetabulum and femur in case of the hip joint; femur and tibia in case of the knee joint) was also tested for contamination. Initially, 70 operations performed under original control conditions were included, after which the first behavioural measure was introduced (i.e. better use of the plenum). Cultures were taken during 67 operations using better use of the plenum (Group 1), followed by disciplinary measures and the installation of a new laminar flow system. Seventy operations were monitored after this second intervention (Group 2). The control group showed intra-operative contamination in 32.9% (23/70) of cases, Group 1 showed contamination in 34.3% (23/67) of cases and Group 2 showed contamination in 8.6% (6/70) of cases. Prolonged wound discharge and superficial surgical site infection decreased significantly in Group 2, as did the incidence of deep periprosthetic infection; however, the tatter did not reach statistical significance. This study shows that the combination of systemic and behavioural changes in an operating room significantly decreases the incidence of intra-operative bacterial contamination, subsequent prolonged wound discharge and superficial surgical site infection. After 18 months of follow-up, there was also a decrease in deep periprosthetic infection. (c) 2005 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.