Hiệu quả phòng ngừa nhiễm khuẩn vết mổ khi áp dụng sàng lọc và giảm khuẩn Staphylococcus aureus quần cư trên người bệnh phẫu thuật chấn thương chỉnh hình tại Bệnh viện Vinmec Times City=Effectiveness of Staphylococcus aureus screening and decolonization for preventing surgical site infection on orthopedic operations at Vinmec Times City Hospital

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Tác giả: Đoàn Thu Giang Đỗ, Hồng Thái Đỗ, Thị Thanh Thủy Lê, Thị Nga Phan

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.36-42

Bộ sưu tập: Metadata

ID: 478181

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Describe the compliance rate of screening and decolonization treament of colonized Staphyloccocus aureus (S. aureus) and evaluate the effect of interventions for incidence of surgical site infection (SSI) on high risk orthopedic operations: osteosarcoma and joint replacement surgeries. Methods: A prospective quasi-experimental study was conducted from January 2022 to June 2024 and divided into two periods: preintervention and intervention. The interventions were performed: S. aureus screening, decolonization with 2% mupirocin and 4% chlorhexidine gluconate bath (CHG), and changing to prophylactic antibiotics if MRSA (+). Results: There were 144 patients in the preintervention period. Of the 280 patients in the intervention period, 91.1% (255/280) were screened. The proportions of MRSA and MSSA carriers were 12.8% (29/255) and 0.9% (2/255). There were 89.6% (26/29) S. aureus positive patients decolonized with mupirocin 2% and 93.1% (27/29) patients bathed with 4% CHG at least 3 days. The percentage of MRSA carriers who changed to prophylactic antibiotics was 89.3% (25/28). S. aureus screening and decolonization reduced the incidence of S. aureus SSI in the pre-intervention period from 2.1% (3/144) to 0.7% (2/280) in the intervention period (p = 0.3), the average treatment days decreased statistically significantly from 8.3 days to 7.1 days (p = 0.018). Conclusion: Preoperative screening and decolonization of S. aureus protocol lowered the incidence of S. aureus SSI on high-risk orthopedic operations such as osteosarcoma and joint replacement surgeries.Mô tả tỷ lệ tuân thủ sàng lọc và giảm khuẩn Staphylococcus aureus (S. aureus) quần cư và đánh giá hiệu quả của biện pháp can thiệp đối với tỷ lệ nhiễm khuẩn vết mổ (NKVM) ở người bệnh (NB) phẫu thuật chấn thương chỉnh hình nguy cơ cao: phẫu thuật ung thư xương và thay khớp. Phương pháp: Nghiên cứu (NC) tiến cứu giả thực nghiệm được thực hiện từ tháng 1/2022 đến tháng 6/2024 và chia làm 2 giai đoạn (GĐ): Trước và GĐ can thiệp. Biện pháp can thiệp được thực hiện là sàng lọc S. aureus quần cư, giảm khuẩn S. aureus bằng mupirocine 2%, tắm chlorhexidine gluconate 4% (CHG) và thay đ ổi kháng sinh dự phòng nếu MRSA (+). Kết quả: Có 144 NB tham gia NC ở GĐ trước can thiệp và số 280 NB ở GĐ can thiệp. Ở GĐ can thiệp, 91,1% (255/280) NB được thực hiện sàng lọc S. aureus. Tỷ lệ NB mang MRSA và MSSA tương ứng là 12,8% (29/255) và 0,9% (2/255). 89,6% (26/29) NB mang S. aureus được sử dụng mupirocine 2% và 93,1% (27/29) NB tắm bằng xà phòng khử khuẩn CHG 4% ít nhất 3 ngày. Tỷ lệ NB mang MRSA được thay đổi kháng sinh dự phòng là 89,3% (25/28). Tỷ lệ NKVM do S. aureus ở nhóm trước can thiệp là 2,1% (3/144) và can thiệp là 0,7% (2/280) (p = 0,3). Số ngày điều trị trung bình giảm có nghĩa thống kê từ 8,3 ngày ở nhóm trước can thiệp xuống 7,1 ngày ở nhóm can thiệp (p = 0,018). Kết luận: Sàng lọc và giảm khuẩn S. aureus trước phẫu thuật có thể làm giảm tỷ lệ NKVM ở các phẫu thuật chấn thương chỉnh nguy cơ cao như ung thư xương và thay khớp.

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