Risk Factors And Nursing Strategies Of Infections In Surgical Site Of Cleancontaminated Wounds In Maxillofacial Surgery

OBJECTIVE To analyze the risk factors of surgical site infections of cleancontaminated wounds in maxillofacial surgery and provide references for the prevention and control of hospital infection.METHODS In the retrospective survey,we collected the clinical data of 4084 patients with clean-contaminated wounds in maxillofacial surgery from January 2014 to December 2017 in a third-class hospital in Chongqing.The patients with surgical site infections were dependent variables.And main predictor variables included gender,age,length of in-hospital stay,American Association of Anesthesiologists Score(ASA score),diabetes,operation duration,intraoperative blood loss,implant,free flap,wound drainage tube,oral rinse and blood transfusion.We carried out single-factor analysis and multiple-factor regression analysis of logistic on risk factors of surgical site infections.According to the inclusion and exclusion criteria,the patients with surgical site infections were included in infection group and those without surgical site infections were included in control group.RESLUTS 1 Clinical data analysis We selected the patients who had clean-contaminated wounds in maxillofacial surgery during January 2014 to December 2017.Based on inclusion and exclusion criteria,there were 4,084 surgical patients in total,among them,there were 1998 males and 2086 females,with the average age of(33.40±16.75).There were2,330 cases of alveolar surgery,961 cases of benign tumor,366 cases of oral and maxillofacial malignancies,173 cases of cleft lip and palate repair,196 cases maxillofacial fracture and 158 cases orthognathic surgery.There were 66 cases had surgical site infections of clean-contaminated wounds in maxillofacial surgery,the infection rate was 1.62%.There were 42 cases were oral and maxillofacial malignancies,12 cases were benign tumor,5 cases were alveolar surgery,4 cases were orthognathic surgery and 2 cases were maxillofacial fracture,1 case was cleft lip and palate repair.The infection rate of oral and maxillofacial malignancies was the highest,accounting for 11.48%,followed by orthognathic surgery 2.53% and benign tumors 1.25%.Among all SSI cases,oral and maxillofacial malignancies took up the highest proportion of 63.64%.2 Single-factor analysis(1)Result of chi-square Test of Counting Date The occurrence of surgical site infections of clean-contaminated in maxillofacial surgery is not significantly correlated with gender and their situation of combined diabetes and(P > 0.05).Implant,free flaps,ASA scores,wound drainage tube,oral rinse and blood transfusion is related to surgical site infections of clean-contaminated wounds in maxillofacial surgery(P < 0.05).(2)t test of measurement data in normal distribution The average age is(46.55±19.46)and(33.18±16.62)respectively in infection group and control group.According to statistical results,older patients have higher risk of infection(P < 0.05),which indicates that the age is related to surgical site infections of clean-contaminated wounds in maxillofacial surgery.(3)Wilcoxon rank-sum test of measurement data in skewed distribution The M(IQR)of operation duration is 286.50(68.75~431.25)min and 45(30~80)min respectively in infection group and control group.The M(IQR)of blood loss is 300(30~462.5)ml and 30(20~50)ml respectively in infection group and control group.The M(IQR)of hospitalization time is 23(13~33.5)d and 7(5~9)d respectively in infection group and control group.The statistical results showed that compared with patients in control group,the infection group have longer length of in-hospital stay,longer operation time and more blood loss(P < 0.05),which suggests that the surgical site infections of clean-contaminated wounds in maxillofacial surgery are related to length of in-hospital stay,operation time and blood loss.3 Multiple-factor analysis After including the notable factors of single-factor analysis into the multiple-factor regression analysis of logistics and excluding all interference factors,we can obtain: length of in-hospital stay ? 7d(OR=10.150,95%CI: 2.363~43.606,P=0.002),operation duration?3h(OR=3.539,95%CI:1.417~8.837,P=0.007),free flap(OR=3.256,95%CI:1.538~6.892,P=0.002),wound drainage tube ?3d(OR=18.025,95%CI:10.294~31.561,P<0.001).Based on the statistical results,the surgical site infections of clean-contaminated wounds maxillofacial surgery have the following independent risk factors: hospital days,operation duration,free flap and wound drainage tube.CONCLUSION 1 High incidence of surgical site infection in oral and maxillofacial malignancies.The surgical site infections of clean-contaminated wounds in maxillofacial surgery are related to age,implant,free flap,operation duration,ASA scores,blood loss,length of in-hospital stay,wound drainage tube,oral rinse and blood transfusion.2 The surgical site infections of clean-contaminated wounds in maxillofacial surgery have the risk factors as follows: length of in-hospital stay?7d,operation duration?3h,free flap and wound drainage tube?3d.3 There are many factors affecting surgical site infection of cleancontaminated wounds in maxillofacial surgery.Surgical patients should be assessed comprehensively in the perioperative period.And the assessment and prevention shall be implemented for high risk groups in early stage so as to reduce the incidence rate of SSI.