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

摘要： 背景　创伤后洗浴是保持皮肤清洁的重要手段，但如何洗浴一直存有争议，有研究报道术后温水淋浴不增加伤口感染率，居家洗浴是否可行尚缺乏证据支持。目的　多中心调查创伤伤口患者居家洗浴及伤口感染的现况，分析居家洗浴与伤口感染的相关性以及伤口感染的影响因素，为选择适宜的洗浴方法提供依据。方法　2020年9月纳入13所医院伤口护理门诊创伤伤口患者为研究对象，设计创伤伤口患者居家洗浴与伤口感染现况的调查问卷，包括人口学资料、创伤伤口资料、创伤后洗浴及伤口感染资料等。通过问卷星链接或二维码自愿完成在线问卷的匿名填写及提交。分别采用描述性分析和多因素Logistic回归分析居家洗浴和伤口感染的现况及其影响因素。结果　共收到949份问卷，剔除2份无效问卷，有效问卷947份，有效率为99.8%。（1）基本资料：男460例，女487例；年龄18~100岁，平均年龄（50.2±17.9）岁。创伤持续时间（42.7±66.7）d，全皮层损伤和部分皮层损伤分别占55.8%（528/947）和44.2%（419/947）；致伤原因中以利器切割伤和跌倒外伤为主，分别占43.4%（411/947）和27.8%（263/947）。（2）伤后居家洗浴现况：伤后从未洗浴者占28.0%（265/947），带伤居家洗浴者占72.0%（682/947）；洗浴方式以温水擦浴为主，占76.7%（523/682），包裹和敞开伤口温水淋浴分别占18.3%（125/682）和5.0%（34/682）；洗浴以1次/周最多，占38.4%（262/682），其次为2次/周37.4%（255/682）和3次/周24.2%（165/682）。（3）伤口感染现况：伤口总感染率为36.0%（341/947），带伤居家洗浴者伤口感染率为24.6%（168/682），伤后从未洗浴者伤口感染率为65.3%（173/265），差异有统计学意义（χ2=136.900，P<0.001）；其中温水擦浴、包裹和开放伤口温水淋浴者伤口感染率分别为25.8%（135/523）、20.0%（25/125）和23.5%（8/34），差异无统计学意义（χ2=1.860，P=0.395）；居家洗浴频次1次/周者、2次/周者和3次/周者伤口感染率分别为32.8%（86/262）、22.4%（57/255）和15.2%（25/165），差异有统计学意义（χ2=18.173，P<0.001）。（4）伤口感染影响因素分析：以伤口是否感染分组进行单因素分析，结果显示，伤口感染组居家洗浴情况、洗浴频次、抗生素治疗情况、创伤持续时间、致伤原因、创伤深度、创伤部位比例与无伤口感染组比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，居家洗浴情况〔OR=0.30，95%CI（0.20，0.44），P<0.001〕、洗浴频次〔OR=0.60，95%CI（0.39，0.93），P=0.023〕、抗生素治疗情况〔OR=1.67，95%CI（1.20，2.33），P=0.002〕、创伤持续时间〔OR=1.64，95%CI（1.19，2.76），P=0.003〕和创伤部位〔OR=5.69，95%CI（2.72，11.90），P<0.001〕是伤口感染的影响因素。结论　居家洗浴和增加洗浴频次不增加伤口感染率，是可行的皮肤清洗方法。抗生素治疗、创伤持续时间超过30 d和腰臀部及四肢伤口可能增加伤口感染风险，患者可根据自理能力和伤口疼痛、伤口异味等因素选择适宜的洗浴方式和频次。

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