摘要
目的通过对某医院发生剖宫产术后切口愈合不良进行调查，寻找感染来源、危险因素，为控制医院感染提供依据和对策。方法对2012年3月1日-5月25日感染病例进行主动搜索，开展病例个案因素调查及采集标本进行实验室相关检测。结果某医院在两个多月内708例剖宫产手术产妇中有16例发生术后切口愈合不良，临床表现-致，罹患率为2．3％；对手术相关因素调查发现，导致阳性结果主要为剖宫产手术前胎心监测使用的某批次耦合剂受到洋葱伯克霍尔德菌污染，菌落总数10^4～10^5CFU／g；一次性使用医用粘贴敷料检出芽胞杆菌；该医院手术室使用聚维酮碘消毒液进行术前皮肤消毒，载体浸泡定量杀菌试验结果显示，聚维酮碘原液对涂抹了污染耦合剂染有大肠埃希菌布片作用30S平均杀灭率为30．76％、聚维酮碘原液对涂抹了污染耦合剂染有金黄色葡萄球菌布片作用1min的平均杀灭率为55．55％；经停用某批次受到洋葱伯克霍尔德菌污染的耦合剂，加强无菌操作后未再出现类似病例。结论该院短期内发生-起剖宫产术后切口愈合不良暴发事件，经加强耦合剂和一次性医疗用品的管理，做好消毒隔离工作，快速控制了医院感染。
OBJECTIVE To investigate the outbreak of incision infection after cesarean section in a hospital and find out the infection sources and risk factors so as to provide guidance for control of nosocomial infections. METHODS From Mar 1, 2012 through May 25, 2012, the cases of infections were retrieved, then the epidemidogy surgery was conducted, and the specimens were sampled for laboratory test. RESULTS Of totally 708 pregnant women who underwent cesarean section within more than two months, the adverse incision healing occurred in 16 cases, with the same clinical manifestations, and the morbidity rate was 2. 3%. The investigation of the surgery-related factors showed that the major positive result was the coupling agent that used before the cesarean section for fetal heart monitoring was contaminated by Burleholderia cepacia, and the bacterial colony counts varied from 104 CFU/g to 107 CFU/g. Bacillus was detected in the disposable medical adhesive dressings. The povidone iodine （iodophor） disinfectant was used in operating room for the preoperative skin disinfection; the result of quantitative carrier tests showed that the average killing rate of povidone iodine stock solution with 30 s action against Escherichia coli on cloth stained with the coupling agent was 30.76%, and the average killing rate of povidone iodine stock solution with 1 min action against Staphylococcus aureusi on cloth stained with the coupling agent was 55. 55%; such cases no longer occurred through the termination of use of coupling agent contaminated by Burkholderia cepacia and enhancement of aseptic operation. CONCLUSION This case of adverse incision healing occurs within a short term after the cesarean section and is rapid under control through intensified management of coupling agent and disposable medical items as well as the disinfection and isolation.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第6期1518-1520,共3页
Chinese Journal of Nosocomiology
基金
广东省医学科研基金项目(WSTJJ20101228440102197112105141)
关键词
剖宫产
切口感染
洋葱伯克霍尔德菌
消毒
Cesarean section
Incision infection
Burkholderia cepacia
Disinfection
