关键词: 伤口感染, 创伤和损伤, 皮肤清洗, 洗浴, 横断面研究, 多中心研究

Abstract: Background　Posttraumatic bathing is an important means to keep skin clean，but how to bathe has always been controversial. Studies have reported that warm water shower after operation does not increase the wound infection rate，and there is still a lack of evidence to support the feasibility of bathing at home. Objective　To investigate the current situation of home bathing and wound infection in patients with traumatic wounds by a multicenter investigation，and analyze the correlation between bathing and wound infection，and the influencing factors of wound infection，so as to provide the basis for the selection of appropriate bathing methods. Methods　From September 1 to September 30 in 2020，wound patients in wound care clinics of 13 hospitals were selected as the research objects. A questionnaire was designed to investigate the current situation of home bathing and wound infection in patients with traumatic wounds，including demographic data，wounds data，post-traumatic bathing and wound infection data. Anonymous filling and submission of online questionnaire were completed voluntarily through star link，QR code. Descriptive analysis and multivariate Logistic regression analysis were used to analyze the current situation and related factors of home bathing and wound infection. Results　A total of 949 questionnaires were received，excluding 2 invalid questionnaires，including 947 valid questionnaires，and the effective rate was 99.8%.（1）Basic data：460 males and 487 females，aging from 18 to 100 years old，the average age was（50.2±17.9）years. The duration of trauma was（42.7±66.7）d.Full thickness injury and partial thickness injury accounted for 55.8%（528/947） and 44.2%（419/947），respectively. The main causes of injury were sharp cutting injury and falling injury accounted for 43.4%（411/947） and 27.8%（263/947）.（2）The status of home bathing after injury：28.0%（265/947）who never bathed at home after injury，72.0%（682/947）who bathed at home with injury. The main bathing method was warm water wiping bath for 76.7%（523/682），warm water shower by wrapping wound and opening wound accounted for 18.3%（125/682）and 5.0%（34/682）. The bathing frequency was once a week the most，accounting for 38.4%（262/682），followed by twice a week，accounting for 37.4%（255/682）and three times a week，accounting for 24.2%（165/682）.（3）Current status of wound infection：the total wound infection rate was 36.0%（341/947），the wound infection rate of injured home bathers was 24.6%（168/682），and 65.3%（173/265）of those who had never bathed after injury，the difference was statistically significant（χ2=136.900，P<0.001）. Among them，the wound infection rate of warm water bathing，warm water shower by wrapping wound and opening wound were 25.8%（135/523），20.0%（25/125） and 23.5%（8/34），the difference was not statistically significant（χ2=1.860，P=0.385）. The wound infection rates of those who took a bath at home once a week，twice a week and 3 times a week were 32.8%（86/262），22.4%（57/255） and 15.2%（25/165），the difference was statistically significant（χ2=18.173，P<0.001）. （4）Analysis of influencing factors of wound infection：a single factor analysis was conducted by grouping whether the wound was infected or not. The results showed that there were significant differences in home bathing，bathing frequency，antibiotic treatment，wound duration，cause of injury，wound depth and wound site ratio between the wound infection group and the non wound infection group（P<0.05）. Multivariate Logistic regression analysis showed that home bathing〔OR=0.30，95%CI（0.20，0.44），P<0.001〕，bathing frequency〔OR=0.60，95%CI（0.39，0.93），P=0.023〕，antibiotic treatment〔OR=1.67，95%CI（1.20，2.33），P=0.002〕，wound duration〔OR=1.64，95%CI（1.19，2.76），P=0.003〕，and wound site〔OR=5.69，95%CI（2.72，11.90），P<0.001〕 were the influencing factor of wound infection. Conclusion　Bathing at home and increasing bathing frequency do not increase the wound infection rate，which is a feasible skin cleaning method. Antibiotic treatment，wound age more than 30 days and wounds on the waist，hips and extremities may increase the risk of wound infection. Patients can choose appropriate bathing methods and frequencies according to their self-care ability，wound pain，wound odor and other factors.

Key words: Wound infection, Wounds and injuries, Skin cleaning, Bathing, Cross-sectional studies, Multicenter study