目的 探讨综合干预模式对降低剖宫产手术部位感染的影响.方法 按统一的纳入标准纳入研究对象,分为对照组(500例):某院2011年1-12月符合纳入标准的全部急诊行剖宫产手术的患者;干预组(501例):按照1∶1比例配对,2012年1-12月符合相应配对条件的急诊剖宫产手术患者,采取综合干预措施.比较两组手术部位感染率,以及采取综合干预模式后,剖宫产手术部位感染患者与非感染患者的平均住院时间和住院费用.结果 综合干预后,外科洗手正确率由干预前的54.55%提高至90.48%;切口异常病原学送检率由18.42%提高至89.66%;发生切口感染后及时上报率由16.67%提高至80.00%,各项指标比较,差异均有统计学意义(均P＜0.05).干预组患者手术部位感染率为1.00%(5/501),对照组为3.60%(18/500),两组比较,差异有统计学意义(χ2=8.40,P＜0.01).23例手术部位感染患者平均住院时间为(16.61±4.81)d,显著长于978例非感染患者的(6.09±1.37)d(t=32.60,P＜0.01);住院费用,感染患者为(7 042.43±1 229.57)元,显著高于非感染患者的( 5 085.80±737.14)元(t=12.34,P<0.01).结论 采用综合干预模式可以有效降低剖宫产手术部位感染率,有效预警医院感染流行与暴发.%Objective To evaluate the influence of comprehensive intervention model on reducing surgical site in-fection(SSI) in patients with caesarean section. Methods Patients were divided into two groups: control group included 500 patients who were undergone emergency caesarean in January-December 2011; intervention group included 501 patients who were undergone emergency caesarean section in January-December 2012, patients were matched in a 1 : 1 ratio. SSI rates between two groups were compared, the average hospitalization days and hospitalization expense between infected patients and non-mfected patients after comprehensive intervention were compared. Results After intervention, the rate of correct surgical hand-washing increased from 54. 55% before intervention to 90. 48% ; pathogenic detection rate increased from 18. 42% to 89. 66% ; timely reporting rate of SSI increased from 16. 67% to 80. 00% (all P＜0. 05); SSI in intervention and control group was 1. 00% (5/501 ) and 3. 60% (18/ 500) respectively (x2 = 8. 40, P＜0. 01). The average length of hospital stay of 23 SSI patients was significantly longer than 978 non-infected patients ([16. 61 ±4. 81) d vs [6. 09 ± 1. 37] d, t = 32. 60, P＜0. 01); hospitalization expense in SSI patients was significantly higher than non-infected patients ([7 042. 43 ± 1 229. 57] yuan vs [5 085. 80 ± 737. 14] yuan, t= 12. 34, P＜0. 01). Conclusion Comprehensive intervention can effectively reduce SSI following caesarean section and warn the outbreak and epidemic of HAI.
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