课件：SSI危险因素与预防措施HX.ppt

* * * * * * * * * * * * * * * * * * * * * This approach should facilitate discussion because it will challenge assumptions that some professionals live with and taken for granted as fact. The first assumption that must be challenged is that Antiseptics their use and effect is well understood and supported by evidence. * * * The need for Isolation increases with the proximity of the surgical site to a known sources of contamination and movement or manipulation of the sterile field during surgery * * * * * 备皮 AORN 推荐： 经培训人员才能进行备皮 应尽量尽可能接近手术开始时间，除了使用脱毛膏（须准备时间及皮肤测试时间) 应在术间外进行，毛发飞散易导致手术部位及无菌区域的污染 应采用保持皮肤完整的备皮方法 备皮与手术的时间间隔越长，感染的发生率越大 Seropian Reynolds: “Wound infection after preoperative depilatory vs razor preparation,” American Journal of Surgery 121 (March 1971) 251-254 备皮操作建议 剃刀 vs 不备皮 手术区域无需备皮时，不备皮 比剃刀剃毛更利于降低SSI(IB) 剃刀 vs 备皮器 备皮器备皮是预防SSI的更好的 方法(IA) 剃刀 vs 化学脱毛剂 腹部清洁伤口手术，化学脱毛 剂更利于降低SSI(IB) 术前备皮的时间 使用备皮器备皮，建议术前2小 时以内进行(IB) 手术区域皮肤消毒原则 去除皮肤上的污染和种植的细菌 在最短的时间内尽可能的减少常驻菌 尽量少的皮肤损伤 预防微生物的再繁殖 “碘伏，含酒精消毒剂和洗必泰是最常见的手术野皮肤消毒剂；对于这些消毒剂对于SSI的风险，没有充分的研究比较其有效性” Centers for Disease Control and Prevention, “Guideline for Prevention of Surgical Site Infections,” Infection Control and Hospital Epidemiology, Vol 20, No 4, April 1999. 病人术前皮肤消毒 FDA标准: 快速，广谱，持久活性 最低要求 干燥部位↓2 Log (腹部) 潮湿部位↓3Log (腹股沟) FDA TFM 皮肤消毒的局限性 皮肤不能被灭菌，大约20%常驻菌不能被外科洗手和皮肤消毒杀灭 消毒5小时后，皮肤表面的细菌数量又会恢复 Sebben JE. Surgical antiseptics. J Am Acad Dermatol. 1983 ov;9(5):759-65. Ayliffe GA Surgical scrub and skin disinfection. Infect Control. 1984 Jan;5(1):23-7. 如何在手术切口周围创造无菌表面? 良好的皮肤消毒 + 使用带有良好的粘性的手术薄膜 无菌区域污染 “骨科手术术后，一半的手术衣外层带菌” Charnley J, Eftekhar N.Related Penetration of gown material by organisms from the surgeons body. Lancet. 1969 Jan 25;1(7587):172-3 薄膜“卷边”与感染率 Alex