123MInfectionPreventionDivision23MInfectionPreventionDivision

InstituteofMedicine’sToErrisHuman.Washington DC:TheNationalAcademyPress,1999.

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1.AstagneauP,L'HeriteauF,DanielFetal.Reducingsurgicalsiteinfectionincidencethrougha network, resultsfromtheFrenchISO-RAISINsurveillancesystem.J.Hosp.Infect.72,127–134(2009). 2.Manni?nJ,vandenHofS,MuilwijkJetal.TrendsintheincidenceofsurgicalsiteinfectioninTheNetherlands.Infect.ControlHosp.Epidemiol.29,1132–1138(2008).2醫(yī)學(xué)PPT3133MInfectionPreventionDivision13BolonMk,etal,ClinInfectDis2009;48:1223-1229143MInfectionPreventionDivision14

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3MInfectionPreventionDivisionMellingAC,AliB,ScottEM,LeaperDJ.Effectsofpreoperativewarmingontheincidenceofwoundinfectionaftercleansurgery:arandomisedcontrolledtrial.Lancet358,876–880(2001)343MInfectionPreventionDivision34353MInfectionPreventionDivision35363MInfectionPreventionDivision36LathamR,etal.InfectControlHospEpidemiol.2001;22:607-6126醫(yī)學(xué)PPTRef:ChristopherT.Drake,Ann.Surgery1977.7373MInfectionPreventionDivision37383MInfectionPreventionDivision38393MInfectionPreventionDivision39403MInfectionPreventionDivision40=100/g=1,000,000/g

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CareHospitals3.Chlorhexidinegluconatepreoperativeskinpreparationinitiateda100%reduction ofincisionalCesareansectioninfectionswhileotherriskfactorswereevaluatedand correctedUniversityofMinnesotaMedicalCenter,Fairview,Minneapolis,MN,2008443MInfectionPreventionDivision44Jan.2010453MInfectionPreventionDivision45463MInfectionPreventionDivision46473MInfectionPreventionDivision471.FrenchML,EitzenHE,RitterMA.Theplasticsurgicaladhesivedrape:anevaluationofitsefficacyasamicrobialbarrier.AnnSurg1976;184:46.2.JohnstonDH,FaircloughJA,BrownEM,etal.Rateofbacterialecolonizationoftheskinafterpreparation:fourmethodscompared.BrJSurg1987;74:64.3.AlexanderJW,AerniS,PlettnerJP.Developmentofasafeandeffectiveone-minutepreoperativeskinpreparation.ArchSurg1985;120:1357.483MInfectionPreventionDivision488醫(yī)學(xué)PPTCFU949491011010010001000010000010000001000000010000

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skinpreparation.ArchSurg 120:1357–1361,1985.1513MInfectionPreventionDivision513MInfectionPreventionDivision

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1.HsiehHF,ChiuHH,LeeFP.Surgicalhandscrubsinrelationtomicrobialcounts: systematicliteraturereview.JAdvNurs2006;55:68. 2.PereiraLJ,LeeGM,WadeKJ.Anevaluationoffiveprotocolsforsurgicalhandwashing inrelationtoskinconditionandmicrobialcounts.JHospInfect1997;36:49533MInfectionPreventionDivision531.NelsonCL.Preventionofsepsis.ClinOrthopRelatRes1987;222:66.2.DaviesRR,NobleWC.Dispersalofbacteriaondesquamatedskin.Lancet1962;2:1295.3.WalterCW,KundsinRB.Theairbornecomponentofwoundcontaminationandinfection.ArchSurg1973;107:588.4.BSEN13795-1:2002543MInfectionPreventionDivision549醫(yī)學(xué)PPT10553MInfectionPreventionDivision55563MInfectionPreventionDivision56573MInfectionPreventionDivision57BodeLGM,etal.PreventingSSIinnasalcarriersofStaphaureus.NEJM2010;362:9-17583MInfectionPreventionDivision58593MInfectionPreventionDivision59603MInfectionPreventionDivision60SSI??10醫(yī)學(xué)PPT11613MInfectionPreventionDivision61623MInfectionPreventionDivision62633MInfectionPreventionDivision63AnnalsofSurgery?Volume248,Number5,November2008643MInfectionPreventionDivision64653MInfectionPreventionDivision65663MInfectionPreventionDivision661.LettsRM,DoermerE.Conversationintheoperatingtheaterasacauseofairbornebacterialcontamination.JBoneJointSurgAm1983;65:35711醫(yī)學(xué)PPT1267671.BlomgrenG,HobornJ,NystromB.Reductionofcontaminationattotalhipreplacementbyspecialworkingclothes.JBoneJointSurgBr1990;72:985.2.WhyteW,BaileyPV,HamblenDL,etal.Abacteriologicallyocclusiveclothingsystemforuseintheoperatingroom.JBoneJointSurgBr1983;65:502.3.CharnleyJ,EftekharN.RelatedPenetrationofgownmaterialbyorganismsfromthesurgeon'sbody.Lancet.1969Jan25;1(7587):172-3

4.MoylanJA,FitzpatrickKT,DavenportKE,‘Reducingwoundinfections.Improvedgownanddrape barrierperformance’,ArchSurg1987,122-152-1573MInfectionPreventionDivision683MInfectionPreventionDivision681.2.3.DavisN,CurryA,GambhirAK,etal.Intraoperativebacterialcontaminationinoperationsforjointreplacement.JBoneJointSurgBr1999Sep;81(5):886–9.SeboldEJ,JordanLR.Intraoperativegloveperforation.Acomparativeanalysis.ClinOrthopRelatRes1993Dec;297:242–4.DoylePM,AlviS,JohansonR.Theeffectivenessofdou