手术部位医院感染与控制.ppt

* * In a 1998 meta-analysis of 28 prospective studies (N=9,478) comparing single- and multiple-dose surgical prophylaxis in major surgery, McDonald and colleagues found no additional benefit of multiple doses of antibiotics in the prevention of SSIs. The combined OR for single-dose vs multiple-dose by the fixed-effects model was 1.06 (95% CI, 0.89–1.25), and was 1.04 for the random-effects model (95% CI, 0.86–1.27).1 Whereas a number of the studies included in this meta-analysis had small sample sizes, a series of fixed-effect validation analyses confirmed the validity of the group’s conclusions.1 Reference: 1. McDonald M, Grabsch E, Marshall C, Forbes A. Single- versus multiple-dose  antimicrobial prophylaxis for major surgery: a systematic review.  Aust NZ J Surg. 1998;68:388–396. * * * * * Hair removal the night before surgery is linked to significantly higher SSI rates than hair removal by depilatory or no hair removal at all. Shaving causes microscopic cuts, in which bacteria may multiply.1 Alexander and colleagues found that the use of a clipper the morning of the operation (AM clipper) was associated with significantly fewer infections than were the other methods evaluated – that is, PM and AM razor and PM clipper – both at discharge and at 30-day follow-up.2 Patients should be instructed to not do the surgical team a “favor” by shaving the surgical site the day before they come into the hospital.3 References: 1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, the Hospital  Infection Control Practices Advisory Committee. Guideline for  prevention of surgical site infection, 1999. Am J Infect Control.  1999;27:97–134. 2. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ. The  influence of hair-removal methods on wound infections. Arch Surg.  1983;118:347–352. 3. Bratzler DW. Surgical Infection Prevention and Surgical Care  Improvement. Available at:  /scip/pdf/spkrnotesSIP_to_SCIP_101205.ppt.  Accessed