基于流行特征与专家调研构建手术相关感染暴发调查表单

doi:10.12114/j.issn.1007-9572.2023.0630

中国全科医学 ›› 2026, Vol. 29 ›› Issue (13): 1776-1783.DOI: 10.12114/j.issn.1007-9572.2023.0630

• 论著·方法学研究 • 上一篇

基于流行特征与专家调研构建手术相关感染暴发调查表单

曹煜隆¹, 单娇², 王斌³, 王琰⁴, 王艳槟⁵, 怀伟⁶, 包小源⁷, 金梦⁷, 匡季秋¹, 高燕¹^,^*()

1．100044　北京市，北京大学人民医院感染管理-疾病预防控制处
2．100035　北京市，首都医科大学附属北京积水潭医院医院感染管理处
3．100044　北京市，北京大学人民医院神经外科
4．100044　北京市，北京大学人民医院肾内科
5．100044　北京市，北京大学人民医院妇产科
6．100191　北京市，北京大学第三医院急诊科
7．100191　北京市，北京大学临床医学高等研究院医学信息学中心

收稿日期:2024-08-31 修回日期:2024-12-25 出版日期:2026-05-05 发布日期:2026-04-14
通讯作者: 高燕
作者贡献：
曹煜隆提出主要研究目标，负责研究方案设计与实施，撰写论文；单娇负责调查问卷数据的统计学处理，图、表的绘制，根据审稿意见进行修改；王斌、王琰、王艳槟、怀伟负责专家深度访谈；包小源、金梦负责词向量构建、数据提取与标注整理；匡季秋、高燕负责课题组织协调、指导实施，对文章整体进行监督管理。
基金资助:
国家卫生健康委医院管理研究所医疗人工智能临床应用研究项目(YLXX24AID001); 北京高层次创新创业人才支持计划春蕾项目(G202533208); 北京大学人民医院研究与发展基金管理研究项目(RDM2023-05)

Construction of an Investigation Form for Postoperative Infection Outbreak Based on Epidemiological Characteristics and Specialist Research

CAO Yulong¹, SHAN Jiao², WANG Bin³, WANG Yan⁴, WANG Yanbin⁵, HUAI Wei⁶, BAO Xiaoyuan⁷, JIN Meng⁷, KUANG Jiqiu¹, GAO Yan¹^,^*()

1. Department of Hospital-Acquired Infection Control, Peking University People's Hospital, Beijing 100044, China
2. Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
3. Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, China
4. Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
5. Department of Gynaecology and Obstetrics, Peking University People's Hospital, Beijing 100044, China
6. Department of Emergency, Peking University Third Hospital, Beijing 100191, China
7. Medical Informatics Center, Institute of Advanced Clinical Medicine, Peking University, Beijing 100191, China

Received:2024-08-31 Revised:2024-12-25 Published:2026-05-05 Online:2026-04-14
Contact: GAO Yan

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摘要/Abstract

摘要： 背景术后感染暴发（PIO）是医院感染危害性的集中体现，如何及时、有效控制PIO的发生是当前医院感染管理的重点。目前，部分感控人员缺乏应急处置经验，在面对感染聚集事件时缺乏调查可疑感染来源的能力。目的建立PIO个案调查表单，以期在感染聚集的早期探寻感染来源，防止感染暴发。方法于2023年1—5月，选取全球医院感染暴发数据库（WDNO）、PubMed、中国知网（CNKI）等中、英文数据库检索，并纳入PIO相关研究后，进行数据提取与标注，在PubMed数据库中下载感染控制相关文献的标题、摘要文本信息，清洗后归集，并基于Skip-Gram生成大规模训练集构建词向量模型，根据资料提取人工标注后词向量模型构建的分类结果，初步总结PIO危险因素。随后邀请15名咨询专家采用改良德尔菲法评价PIO危险因素的重要性，运用层次分析法计算指标体系中各一级指标和二级指标的权重及组合权重来确定感染暴发的可能来源，基于此构建PIO个案调查表单。结果最终纳入共203篇PIO相关研究。改良德尔菲法共计咨询15名专家，两轮专家咨询问卷全部回收，专家积极系数均为100.00%；15名专家咨询2轮的平均权威系数（Cr）为（0.86±0.10），平均熟悉程度（Cs）为（0.81±0.10），平均判断系数（Ca）为（0.92±0.10）；专家咨询两轮后的肯德尔和谐系数（Kendall's W）为0.351（P<0.005），显示专家意见共识性较好。经两轮改良德尔菲法修订，构建4个一级指标和19个二级指标。指标体系中，7个一级指标的权重为22.23%~27.50%，二级指标的组合权重为3.32%~6.29%，基于此构建PIO个案调查表单，主要包含患者基本信息、感染情况、围术期相关因素、人员与环境5大方面。结论本研究基于流行特征与专家调研，构建了可用于手术相关感染暴发的早期调查表单，内容涵盖可能引起手术相关感染的主要危险因素与重点环节，为识别感染暴发潜在来源提供参考。

关键词: 围手术期医学, 术后感染暴发, 调查表单, 感染来源, 德尔菲技术

Abstract:

Background

Postoperative infection outbreak (PIO) is a concentrated manifestation of the harmfulness of hospital-acquired infections, and how to effectively control the occurrence of PIO promptly is currently the focus of infection control. At present, some infection prevention personnel lack emergency response experience and ability to investigate suspected sources of infection in the face of infection clusters.

Objective

To develop an investigation form for PIO, and identify the sources of infection in the early stage to prevent outbreaks.

Methods

From January to May 2023, Worldwide Database for Nosocomial Outbreaks (WDNO), PubMed, CNKI, and other databases were searched for studies related to PIO. Data extraction and annotation were performed. After cleaning the title and abstract text information of infection control literature downloaded from the PubMed database, a large-scale training set was constructed to build a word vector model based on the Skip-Gram method. Preliminary identification of risk factors for PIO was summarized based on the classification results of the word vector model constructed. Subsequently, 15 consulting experts were invited to evaluate the importance of PIO risk factors using a modified Delphi method. The Analytic Hierarchy Process (AHP) was adopted to calculate weight and combined weight for the primary and secondary indicators to determine the possible sources of infection outbreaks. Based on this, an investigation form for PIO was constructed.

Results

A total of 203 PIO-related studies were finally included. A total of 15 experts were consulted by the modified Delphi method, and all the questionnaires for the two rounds of expert consultation were returned with a positive coefficient of 100.00%. The average authoritative coefficient (Cr) of 15 experts was (0.86±0.10), the average familiarity (Cs) was (0.81±0.10), and the average judgment (Ca) was (0.92±0.10). Kendall's W coefficient (Kendall's W) of concordance after two rounds of expert consultation was 0.351 (P<0.005), which showed that the consensus of expert opinion was good, indicating a good consensus among expert opinions. After two rounds of the modified Delphi method, 4 primary indicators and 19 secondary indicators were constructed. Within the indicator system, the weights of the 7 primary indicators ranged from 22.23% to 27.50%, and the combined weights of the secondary indicators ranged from 3.32% to 6.29%. Based on this, the PIO investigation questionnaire was developed, primarily including five aspects of patient basic information, infection status, perioperative factors, personnel, and environment.

Conclusion

Based on epidemiological characteristics and expert consultation, a form used for PIO investigation was constructed. The content covers the main risk factors and critical points that may lead to outbreaks, providing a reference for identifying potential sources of PIO.

Key words: Perioperative medicine, Postoperative infection outbreak, Investigation form, Source of infection, Delphi technique

中图分类号:

R 619

曹煜隆,单娇,王斌,等. 基于流行特征与专家调研构建手术相关感染暴发调查表单[J]. 中国全科医学, 2026, 29(13): 1776-1783. DOI: 10.12114/j.issn.1007-9572.2023.0630.
CAO Yulong,SHAN Jiao,WANG Bin, et al. Construction of an Investigation Form for Postoperative Infection Outbreak Based on Epidemiological Characteristics and Specialist Research[J]. Chinese General Practice, 2026, 29(13): 1776-1783. DOI: 10.12114/j.issn.1007-9572.2023.0630.

图/表 4

参考文献 35

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基本情况	人数	构成比（%）
性别
男	9	60.00
女	6	40.00
年龄
30~39岁	7	46.67
40~49岁	4	26.67
≥50岁	4	26.67
工作年限
5~10年	2	13.33
11~20年	7	46.67
≥21年	6	40.00
学历
硕士研究生	5	33.33
博士研究生	10	66.67
职称
中级	2	13.33
副高级	6	40.00
高级	7	46.67
专业领域
感染或感染控制	6	40.00
外科相关专业	9	60.00

基本情况	人数	构成比（%）
性别
男	9	60.00
女	6	40.00
年龄
30~39岁	7	46.67
40~49岁	4	26.67
≥50岁	4	26.67
工作年限
5~10年	2	13.33
11~20年	7	46.67
≥21年	6	40.00
学历
硕士研究生	5	33.33
博士研究生	10	66.67
职称
中级	2	13.33
副高级	6	40.00
高级	7	46.67
专业领域
感染或感染控制	6	40.00
外科相关专业	9	60.00

一级指标	CV	权重（%）
操作	0.13	24.05
C1：患者定植筛查	0.19	3.91
C2：术前备皮	0.20	5.36
C3：术野消毒准备	0.20	5.61
C4：术中体温	0.20	3.32
C5：预防用药	0.18	5.44
C6：免疫抑制剂使用	0.22	4.68
C7：术后换药	0.13	5.87
C8：无菌原则	0.05	6.29
人员	0.12	26.14
C9：个人防护	0.14	5.70
C10：个人消毒准备	0.08	6.12
C11：医务人员定植筛查	0.24	4.68
物品	0.11	27.57
C12：手术器械	0.00	6.38
C13：无菌物品	0.07	6.21
C14：供体	0.23	4.68
C15：植入物	0.05	6.29
C16：血液	0.18	5.44
环境	0.14	22.23
C17：空调通风系统	0.17	5.27
C18：排供水	0.22	4.00
C19：设备设施	0.21	4.76

一级指标	CV	权重（%）
操作	0.13	24.05
C1：患者定植筛查	0.19	3.91
C2：术前备皮	0.20	5.36
C3：术野消毒准备	0.20	5.61
C4：术中体温	0.20	3.32
C5：预防用药	0.18	5.44
C6：免疫抑制剂使用	0.22	4.68
C7：术后换药	0.13	5.87
C8：无菌原则	0.05	6.29
人员	0.12	26.14
C9：个人防护	0.14	5.70
C10：个人消毒准备	0.08	6.12
C11：医务人员定植筛查	0.24	4.68
物品	0.11	27.57
C12：手术器械	0.00	6.38
C13：无菌物品	0.07	6.21
C14：供体	0.23	4.68
C15：植入物	0.05	6.29
C16：血液	0.18	5.44
环境	0.14	22.23
C17：空调通风系统	0.17	5.27
C18：排供水	0.22	4.00
C19：设备设施	0.21	4.76

1.一般信息
姓名：	性别：	年龄：	病历号：	入院日期：
科室：	病房：		床号：	发病序号：
2.感染信息
临床症状：
感染日期：	感染部位：		感染诊断：
采样日期：	标本类型：		病原体：
最高体温：	开始发热时间：术后__天，持续时间：
治疗用药：（种类、剂量、持续时间）
感染相关标志物：白细胞：　中性粒：　C反应蛋白：　降钙素原：　白介素6：
3.手术
手术名称：		手术日期：	术间：
切口类型：		ASA评分：	麻醉方式：
手术持续时间：			植入物情况：是□否□
术前因素：
定植筛查：是□否□，结果：			使用无创式备皮：是□否□，具体方式：
预防用药：是□否□，种类、剂量、给药时间：
术中及术后因素：
术中对患者采取保温措施：　是□否□			手术器械灭菌情况监测正常：是□否□
术野消毒到位，无菌屏障完好：　是□否□			外来器械经过合格的灭菌程序：是□否□
正确刷手及手卫生：是□否□			无一次性无菌耗材二次灭菌情况：是□否□
术后换药、管路维护等无菌操作正确：是□否□
其他医疗设备（自查，如无问题请画√）
超声探头□体外循环装置□内窥镜□呼吸机□
4.人员
医务人员
主管医生：	上级医生：		主管护士：
主刀：	一助：		器械护士：
麻醉师：	其他参与手术人员：
患者情况：
高血压□ 　糖尿病□ 　慢性肺病□ 　恶性肿瘤□ 　心脏病□ 　肥胖□ 　肝病□ 　脑血管疾病□ 　贫血□
营养不良□ 　免疫缺陷或使用免疫抑制剂□ 　长期使用抗生素□ 　接受输血及血制品□ 　其他□：
陪护等相关人员
陪护人员为：无陪护□、家属□、护工□（护工姓名：　一对一□/多对一□）
同病房/同病区/同医护诊疗行为等周围相关人员是否有相似症状：是□否□具体情况：
5.环境
按要求进行术后术间消毒，保证净化系统自净时间：是□ 　否□
空气净化系统定期维保，监测合格：是□ 　最近一次监测时间：　　；　否□
供、排水系统定期维保，监测合格：是□ 　最近一次监测时间：　　；　否□
设备设施物表环境微生物学监测合格：是□ 　最近一次监测时间：　　；　否□

基于流行特征与专家调研构建手术相关感染暴发调查表单

Construction of an Investigation Form for Postoperative Infection Outbreak Based on Epidemiological Characteristics and Specialist Research

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