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1、The Journal of Bone and Joint Surgery (American). 2021;92:232-239.Perioperative Strategies for Decreasing InfectionA Comprehensive Evidence-Based Approach降低感染率的围手术期策略：综合性循证医学路径 Joseph A. Bosco, III, MD1, James D. Slover, MD, MS1 and Janet P. Haas, RN, PhD2 1 Department of Orthopaedic Surgery, NYU Ho
2、spital for Joint Diseases, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for J.A. Bosco III: joseph.bosconyumc.org. E-mail address for J.D. Slover: james.slovernyumc.org2 Infection Prevention and Control, Westchester Medical Center, 100 Woods Ro
3、ad, Macy Pavilion SW246, Valhalla, NY 10595. E-mail address: Haasjwcmc An Instructional Course Lecture, American Academy of Orthopaedic Surgeons Introduction 引言 Surgical site infections associated with orthopaedic surgical procedures are devastating complications. They increase morbidity, mortality,
4、 and cost and result in outcomes that are worse than those in uninfected cases1. Decreasing the incidence of surgical site infections is not only of interest to patients and surgeons, it is also a major focus of several groups of interested parties. These range from payers, including the Centers for
5、 Medicare and Medicaid Services (CMS, Baltimore, Maryland), to institutions represented by the Surgical Care Improvement Project (SCIP), a multiple-institution partnership between major public and private health-care organizations, including the Joint Commission on Accreditation of Healthcare Organi
6、zations (Oakbrook Terrace, Illinois). Decreasing the incidence of surgical site infections is, and will continue to be, a major focus in medicine. 对于骨科手术而言，手术部位的感染是一种消灭性的并发症，往往会导致致残率、致死率以及医疗费用的增加，并且与没有发生感染的病例相比，最终的治疗结果通常也会更差【1】。减少手术部位的感染率，不仅对患者和医生都很有意义，也是利益相关的各方非常关注的问题。如出资方，包括医疗保险与医疗辅助效劳中心CMS，Baltim
7、ore, Maryland；以外科医疗改进工程SCIP为代表的相关机构；介于群众公共机构与私人医疗保健机构之间的多机构合作组织，包括医疗机构评审联合委员会JCAHO，Oakbrook Terrace, Illinois等。减少手术部位的感染率现在是，将来也仍会是，医学领域关注的焦点问题。To effectively prevent surgical site infections, the clinician must consider preoperative, intraoperative, and postoperative factors and interventions. Preo
8、perative strategies for reduction of infection rates include identification of high-risk patients, screening and decolonization of patients with methicillin-sensitive Staphylococcus aureus and methicillin-resistant Staphylococcus aureus colonization, preoperative preparation of the patient with chlo
9、rhexidine gluconate, utilization of proper hair-removal techniques, and addressing preexisting dental and nutritional issues prior to surgery. 为了有效地防止手术部位的感染，临床医生必须审慎地考虑到手术前、手术中以及手术后的相关因素和干预措施。降低感染的术前策略包括识别高风险的患者，对甲氧西林敏感的金黄色葡萄球菌和耐甲氧西林的金黄色葡萄球菌定植的患者进行筛查，并去除定植菌，术前应用洗必泰葡萄糖酸盐进行清洗，应用适宜的方法去除毛发，术前妥善处理先前存在的牙
10、齿及营养相关的问题。There are a variety of perioperative strategies that can and should be employed to decrease the risk of surgical site infections. Intraoperative interventions that have been shown to decrease surgical site infection rates include the proper selection, timing, and doses of prophylactic anti
11、biotics and utilization of best practices for hand hygiene and surgical site preparation. Maintaining a sterile operating-room environment by decreasing operating-room traffic, monitoring for breaks in sterile technique, and decreasing the use of flash sterilization is vital. Finally, postoperative
12、strategies for the reduction of surgical site infection rates include the proper use and duration in situ of urinary catheters and surgical drains; standardization of wound care; use of antibiotic-impregnated bandages; and, perhaps most importantly, maintenance of proper hand hygiene, isolation prec
13、autions, and room cleaning. 有多种围手术期的策略可以并且必须应用以减少手术部位的感染。术中的一些干预因素已经证实可以降低手术部位的感染率，包括选择适宜的种类、时机和剂量预防性应用抗生素，手卫生及术区消毒均采用最优化的方案。通过减少手术室的穿行、监视有无违反无菌技术的操作、减少快速消毒的应用对于维持手术的无菌环境是至关重要的。最后，降低手术部位感染率的术后策略包括合理地应用和维持原有的导尿管和术区引流管，对创口进行标准化护理；应用抗生素浸润的绷带，以及，可能最为重要的是，保持正确的手卫生、隔离预防和室内清洁。Preoperative Considerations 术前
14、考前须知Although every precaution should be taken to prevent infection for all orthopaedic patients, the identification of high-risk patients enables clinicians to provide maximal prevention strategies for them. Furthermore, the identification of patients at high risk for infection allows appropriate pr
15、eoperative counseling for shared decision-making and establishes appropriate patient expectations regarding surgical risks. 虽然对于所有骨科患者，都应该采用各种预防措施以防止感染，但临床医生识别出高风险的患者后，便可针对其制定最大限度的防范策略。此外，识别出感染的高风险患者后可进行适当的术前告知谈话，这样可与患者共同制定治疗决策，并使患者对于手术风险树立合理的期望值。Numerous high-risk patient populations and risk facto
16、rs that place patients at high risk for infection after total joint replacement or spine surgery have been described in the literature. Some of these factors can be modified, while others cannot. An explanation of the risk factors that cannot be modified should be included when patients are counseled about their increased risk of infection with the proposed surgical procedure. In this way, patients will more complet
