外科部位感染(Surgical Site Infection)是個很常見的臨床問題. 每個外科醫生在入門時都作為重中之重來學習. 但多年來, 儘管在抗生素預防上採用強制或反復監督的醫務制度, 而手術部位無菌式處理方面每間醫院都是相當重視的, 但傷口感染尤其在腸胃外科中還是較為常見的狀況.
之前專科組已試過更換強力抗生素, 傷口反復清洗消毒, 手術後繼續注射抗生素等方法, 均沒有收到很好效果. 內裡思考: 醫學裡是否存在某個盲點而一直我們沒有注意呢?
自去年上半年, 參看多種預防感染的文獻和書籍後, 本人手術的病人採用新的方法, 結果初步發現手術後病人腹部傷口感染明顯減少, 但還沒有總結定論的時候. 上週看到美國外科醫生協會的最新關於感控的論文, 馬上同感: 我們針對傷口局部的處理並不能將感染控制好, 是因為我們一直將之當成是局部的問題, 是忽略傷口感染本來就是全身問題的表現部份.
綜合論文和最近體會, 外科部位感染防控焦點:
1)手術時間: 愈長感染率愈高;
2)手術時輸血: 術中貧血, 感染率增;
3)外科培訓醫生: 愈多經驗不純熟, 感染率增;
4)手術房接台手術數: 每天接台手術愈多, 感染率增;
5)傷口部位縫合技術和防菌措施;
6)術前預防性抗生素
Useful information:
Predictors of Surgical Site Infections
Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion -- Results of the First American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative
Campbell, J Am Coll Surg. 2008
Summary: Wound infection data gathered from 117 private-sector hospitals enrolled in the American College of Surgeons quality improvement project.
The 20 hospitals with the lowest wound infection rates were compared with the 13 hospitals with the highest infection rates. Factors associated with higher infection rates were identified, including increased number of trainees (P ≤ .0001), increased operative time (P = .03), anemia at time of surgery (P = .01), and amount of operating room foot traffic (P ≤ .05).
