脊柱手术部位感染课件

脊柱手术部位感染俞武良2016-10-12脊柱手术部位感染俞武良2016-10-121

手术部位感染(SurgicalsiteinfectionSSI)是一种相对常见的脊柱手术并发症，发生率为1%-14%，具有潜在的灾难性的后果。手术部位感染(Surgicalsiteinfectio2

美国托马斯杰斐逊大学的Radcliff等筛选并总结了近5年成人脊柱手术后手术部位感染的发生率、危险因素、诊断、预防及治疗的相关研究，发表在2015年TheSpineJournal杂志。美国托马斯杰斐逊大学的Radcliff等筛选并总结了近5年31、Incidenceaprospectivelycollecteddatabaseof108,419cases,theoverallinfectionrateforlumbarsurgerywas2.1%(superficial=0.8%,deep=1.3%)1、Incidenceaprospectivelyco4脊柱手术部位感染课件5TheincidenceofSSIappearstobelowerafterminimallyinvasivespinal(MIS)surgeriesAreviewof1,338MISsurgeriesfrommultipleinstitutionsrevealedaninfectionrateof0.74%infusion/fixationsand0.22%overallareviewbyParkeretalcomparedpostoperativeinfectionafteropenandminimallyinvasivetransforaminallumbarinterbodyfusions.362MISand1,333opensurgeries，infectionrateof4%inopenspinalfusionsversus0.6%afterMIS(p=0.005)

TheincidenceofSSIappearst62、RiskfactorsforinfectionMedicalcomorbidities：anemia,diabetes

mellitus,coronaryarterydisease,diagnosisofcoagulopathy,neoplasmobesityhigherAmericanSocietyofAnesthesiologistscoremalnutrition

2、RiskfactorsforinfectionM7脊柱手术部位感染课件8diabetes,obesityhasbeenfoundtobeariskfactorforSSIskinfoldthicknessandL4spinousprocess-skin

thicknessarespine-specificSSIriskfactorsindependentofbodymassindexthedistributionofadiposetissueandthedepthofadiposetissueoverlyingtheoperativefieldincreasedtheriskofSSI

diabetes,obesityhasbeenfou9theparticulardiagnosisisaninfectionriskfactorpatientsundergoingsurgeryfordegenerativediseasehavealowerinfectionratecomparedtodeformity(1.4%vs.4.2%)Patientsundergoingsurgeryfortraumahaveahigherriskforinfectioncomparedtospinalfusion(9.4%vs.3.7%)theriskofinfectioniscorrelatedwiththeseverity

ofthetraumatheparticulardiagnosisisan10caseordermaycontributetotherateofSSIafterspinesurgerylumbardecompressionperformedlaterintheday(thirdcase)ledtothreetimeshigherincidenceofSSIcomparedwiththoseperformedastheday’sfirstcasecontaminationoftheoperatingroom,cross-contaminationbetweenhealthcareprovidersduringthecourseoftheday,useofflashsterilization,andmid-dayshiftchanges.caseordermaycontributetot11seasonaleffectontherateofpostoperative

effectSSIincidencepeaksinthesummerandfallwithstatisticallysignificantdropsininfectionrateinthespringandwinterseasonaleffectontherateof12complexproceduresmaypresentahigherriskofperioperativecomplicationsmoreextensivetissuedissectionincreasedbloodlosslongeroperativetimecomplexproceduresmaypresent133、DiagnosisIncreasedwounddrainageapproximately10to14daysthemostcommonearlysignofwoundinfectionpresentin67%ofpatientswithSSIincreasedpainfeverwounderythema

TherearenouniversallyacceptedclinicaldiagnosticcriteriaforSSI.3、DiagnosisIncreasedwounddr14laboratorymarkersC-reactiveprotein(CRP)themostsensitiveandiselevatedinmorethan98%ofcasesCRPrisesandfallsreliablyinnoninfectedpatientsduringthepostoperativeperiodwithapeakoccurringatapproximatelypostoperativeDay3（operativeduration,region,surgerytype,preoperativeCRPlevel,numberoflevels）asecondpeakorfailureofCRPleveltonormalizewasarelativelyaccuratepredictorofpostoperativeinfectionlaboratorymarkersC-reactive15脊柱手术部位感染课件16laboratorymarkersErythrocytesedimentationrate(ESR)alaterpeakthanCRP,typicallyoccurringaround

postoperativeDay4Absoluteneutrophilcount(ANC)nosignificantdifferencebetweenthenormalandinfectedgroupsupto4dayspostoperativelyasignificantriseintheperiods4to7and8to11dayspostoperativelyintheinfectedpatients

laboratorymarkersErythrocyte17laboratorymarkersSerumamyloid-A(SAA)SAAisasuperiormarkerforinfectioncomparedwithCRPbecauseofthemoredramaticchangeinvalueandearlierreturntobaselinewithsimilarkineticsProcalcitonin(PCT)PCTandCRPshowedstatisticallysignificant

correlationswiththedevelopmentofSSIPCTissuperiortoCRPinearlypredictionofSSIlaboratorymarkersSerumamylo18laboratorymarkersInterleukin-6(IL-6)wellstudiedinjointreplacementsurgeryLeukocyteesterasearecentlyreportedmarkerinperiprosthetickneejointinfection80.6%sensitivityand100%specificityindiagnosingjointinfectionInparticular,fewlaboratorymarkershavebeenvalidatedasa‘‘goldstandard’’inassociationwithculture-positiveSSI.laboratorymarkersInterleukin194、Intraoperativemeasuresintraoperativemeasurestoreduceinfectionsskinpreparationintraoperativebehaviorswoundirrigationtopicalantibioticapplicationwoundclosurepostoperativedrainuse4、Intraoperativemeasuresintr20asignificantlevelofwoundcontaminationoccursintraoperatively23%ofpatientshadpositiveintraoperativecultures.Ofthosethatculturedpositive,

11.5%developedanearlySSIImplantsexposedtotheoperatingroomenvironmentsignificantlyreducedwhentheimplantswerecoveredduringthecasethelevelofcontaminationincreasesdirectlywiththeamountoftimeitisopen

intheoperatingfield.asignificantlevelofwoundc21skinpreparationasignificantdecreaseinSSIratewiththeuseofchlorhexidineversusiodineskinprep？Intraoperativetechniquesandbehaviorstheoperativegownsterileinstrumentdrapinguseofintraoperativefluoroscopyoperativescrubcleanliness

skinpreparation22脊柱手术部位感染课件23woundirrigationTheonlyirrigationagenttohavebeendemonstratedtoreduceSSIrateispovidone-iodine(PVP-I)SoakedwithdilutePVP-Ifor3minutes（5%0.35%）

Copiouslyirrigatedwithnormalsalinebeforebonedecortication

woundirrigation24significantdecreaseinSSIafterlocaladministrationofvancomycinpowdersignificantdecreaseinSSIaf25Postoperativeprotocolsanincreasedmeannumberofdaysofclosedsuctionwounddrainageinpatientswithinfectionversuspatientswithoutinfectionuseof2-octyl-cyanoacrylateforskinclosuremaydecreasetherateofinfectionPostoperativeprotocols265、TreatmentTreatmentofSSIreliesonearlyidentificationearlydiagnosisearlyevacuationofgrosspurulentmaterial5、TreatmentTreatmentofSSIr27Treatmentoptionsirrigationanddebridementintravenousantibioticsprimaryclosureclosedvacuumsystemhardwareretentionplasticsurgeryreconstruction(rotationalflaps)

Treatmentoptions28PostoperativeInfectionTreatmentScorefortheSpine7–14lowrisk21–33highriskPostoperativeInfectionTreatm296、ConclusionsPostoperativespinalSSIscanbedevastatingcomplicationsforboththepatientandthesurgeonDiagnosisofaSSIaftersurgeryonthespineisstillverymuchaclinicaldiagnosis6、ConclusionsPostoperativesp30amultifacetedapproachtopreventionisthekeytomanaginginfectionrisktheimportanceofstrictsterileconductduringtheoperationisreemphasizedeffortsshouldbemadetominimizetimespentintheoperatingsuite(preoperative

andintraoperative)applyinglocalvancomycintothesurgicalregularuseofantibiosisinhighriskpatientsamultifacetedapproachtopre31后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用后面内容直接删除就行32主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！主要经营：网络软件设计、图文设计制作、发布广告等33致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划34感谢您的观看和下载Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield感谢您的观看和下载Theusercandemonstr35脊柱手术部位感染俞武良2016-10-12脊柱手术部位感染俞武良2016-10-1236

手术部位感染(SurgicalsiteinfectionSSI)是一种相对常见的脊柱手术并发症，发生率为1%-14%，具有潜在的灾难性的后果。手术部位感染(Surgicalsiteinfectio37

美国托马斯杰斐逊大学的Radcliff等筛选并总结了近5年成人脊柱手术后手术部位感染的发生率、危险因素、诊断、预防及治疗的相关研究，发表在2015年TheSpineJournal杂志。美国托马斯杰斐逊大学的Radcliff等筛选并总结了近5年381、Incidenceaprospectivelycollecteddatabaseof108,419cases,theoverallinfectionrateforlumbarsurgerywas2.1%(superficial=0.8%,deep=1.3%)1、Incidenceaprospectivelyco39脊柱手术部位感染课件40TheincidenceofSSIappearstobelowerafterminimallyinvasivespinal(MIS)surgeriesAreviewof1,338MISsurgeriesfrommultipleinstitutionsrevealedaninfectionrateof0.74%infusion/fixationsand0.22%overallareviewbyParkeretalcomparedpostoperativeinfectionafteropenandminimallyinvasivetransforaminallumbarinterbodyfusions.362MISand1,333opensurgeries，infectionrateof4%inopenspinalfusionsversus0.6%afterMIS(p=0.005)

TheincidenceofSSIappearst412、RiskfactorsforinfectionMedicalcomorbidities：anemia,diabetes

mellitus,coronaryarterydisease,diagnosisofcoagulopathy,neoplasmobesityhigherAmericanSocietyofAnesthesiologistscoremalnutrition

2、RiskfactorsforinfectionM42脊柱手术部位感染课件43diabetes,obesityhasbeenfoundtobeariskfactorforSSIskinfoldthicknessandL4spinousprocess-skin

thicknessarespine-specificSSIriskfactorsindependentofbodymassindexthedistributionofadiposetissueandthedepthofadiposetissueoverlyingtheoperativefieldincreasedtheriskofSSI

diabetes,obesityhasbeenfou44theparticulardiagnosisisaninfectionriskfactorpatientsundergoingsurgeryfordegenerativediseasehavealowerinfectionratecomparedtodeformity(1.4%vs.4.2%)Patientsundergoingsurgeryfortraumahaveahigherriskforinfectioncomparedtospinalfusion(9.4%vs.3.7%)theriskofinfectioniscorrelatedwiththeseverity

ofthetraumatheparticulardiagnosisisan45caseordermaycontributetotherateofSSIafterspinesurgerylumbardecompressionperformedlaterintheday(thirdcase)ledtothreetimeshigherincidenceofSSIcomparedwiththoseperformedastheday’sfirstcasecontaminationoftheoperatingroom,cross-contaminationbetweenhealthcareprovidersduringthecourseoftheday,useofflashsterilization,andmid-dayshiftchanges.caseordermaycontributetot46seasonaleffectontherateofpostoperative

effectSSIincidencepeaksinthesummerandfallwithstatisticallysignificantdropsininfectionrateinthespringandwinterseasonaleffectontherateof47complexproceduresmaypresentahigherriskofperioperativecomplicationsmoreextensivetissuedissectionincreasedbloodlosslongeroperativetimecomplexproceduresmaypresent483、DiagnosisIncreasedwounddrainageapproximately10to14daysthemostcommonearlysignofwoundinfectionpresentin67%ofpatientswithSSIincreasedpainfeverwounderythema

TherearenouniversallyacceptedclinicaldiagnosticcriteriaforSSI.3、DiagnosisIncreasedwounddr49laboratorymarkersC-reactiveprotein(CRP)themostsensitiveandiselevatedinmorethan98%ofcasesCRPrisesandfallsreliablyinnoninfectedpatientsduringthepostoperativeperiodwithapeakoccurringatapproximatelypostoperativeDay3（operativeduration,region,surgerytype,preoperativeCRPlevel,numberoflevels）asecondpeakorfailureofCRPleveltonormalizewasarelativelyaccuratepredictorofpostoperativeinfectionlaboratorymarkersC-reactive50脊柱手术部位感染课件51laboratorymarkersErythrocytesedimentationrate(ESR)alaterpeakthanCRP,typicallyoccurringaround

postoperativeDay4Absoluteneutrophilcount(ANC)nosignificantdifferencebetweenthenormalandinfectedgroupsupto4dayspostoperativelyasignificantriseintheperiods4to7and8to11dayspostoperativelyintheinfectedpatients

laboratorymarkersErythrocyte52laboratorymarkersSerumamyloid-A(SAA)SAAisasuperiormarkerforinfectioncomparedwithCRPbecauseofthemoredramaticchangeinvalueandearlierreturntobaselinewithsimilarkineticsProcalcitonin(PCT)PCTandCRPshowedstatisticallysignificant

correlationswiththedevelopmentofSSIPCTissuperiortoCRPinearlypredictionofSSIlaboratorymarkersSerumamylo53laboratorymarkersInterleukin-6(IL-6)wellstudiedinjointreplacementsurgeryLeukocyteesterasearecentlyreportedmarkerinperiprosthetickneejointinfection80.6%sensitivityand100%specificityindiagnosingjointinfectionInparticular,fewlaboratorymarkershavebeenvalidatedasa‘‘goldstandard’’inassociationwithculture-positiveSSI.laboratorymarkersInterleukin544、Intraoperativemeasuresintraoperativemeasurestoreduceinfectionsskinpreparationintraoperativebehaviorswoundirrigationtopicalantibioticapplicationwoundclosurepostoperativedrainuse4、Intraoperativemeasuresintr55asignificantlevelofwoundcontaminationoccursintraoperatively23%ofpatientshadpositiveintraoperativecultures.Ofthosethatculturedpositive,

11.5%developedanearlySSIImplantsexposedtotheoperatingroomenvironmentsignificantlyreducedwhentheimplantswerecoveredduringthecasethelevelofcontaminationincreasesdirectlywiththeamountoftimeitisopen

intheoperatingfield.asignificantlevelofwoundc56skinpreparationasignificantdecreaseinSSIratewiththeuseofchlorhexidineversusiodineskinprep？Intraoperativetechniquesandbehaviorstheoperativegownsterileinstrumentdrapinguseofintraoperativefluoroscopyoperativescrubcleanliness

skinpreparation57脊柱手术部位感染课件58woundirrigationTheonlyirrigationagenttohavebeendemonstratedtoreduceSSIrateispovidone-iodine(PVP-I)SoakedwithdilutePVP-Ifor3minutes（5%0.35%）

Copiouslyirrigatedwithnormalsalinebeforebonedecortication

woundirrigation59significantdecreaseinSSIafterlocaladministrationofvancomycinpowdersignificantdecreaseinSSIaf60Postoperativeprotocolsanincreasedmeannumberofdaysofclosedsuctionwounddrainageinpatientswithinfectionversuspatientswithoutinfectionuseof2-octyl-cyanoacrylateforskin