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1.
Rev. Odontol. Araçatuba (Impr.) ; 45(2): 48-51, maio-ago. 2024. ilus
Artículo en Portugués | LILACS, BBO | ID: biblio-1553297

RESUMEN

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)


INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)


Asunto(s)
Humanos , Masculino , Adulto , Lengua/lesiones , Infección de Heridas , Heridas por Arma de Fuego , Paladar Duro/lesiones , Heridas y Lesiones , Heridas Penetrantes , Paladar Duro , Equimosis , Edema , Traumatismos Maxilofaciales
2.
Online braz. j. nurs. (Online) ; 23: e20246673, 02 jan 2024. ilus
Artículo en Inglés, Portugués | LILACS, BDENF | ID: biblio-1527197

RESUMEN

OBJETIVO: mapear evidências científicas sobre a prevenção e o manejo precoce de infecção de sítio cirúrgico por telemonitoramento em pacientes cirúrgicos após alta hospitalar. MÉTODO: revisão de escopo desenvolvida conforme proposto pelo Instituto Joanna Briggs (JBI). Foi realizada a pesquisa nas bases de dados PubMed, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Collaboration, Scopus, CINAHL, MEDLINE, Web of Science e Embase. Os estudos foram adicionados ao gerenciador Endnote Basic e Rayyan por três pesquisadores independentes. RESULTADOS: foram identificados 1.386 estudos e incluídos 31, os quais apresentaram relevância em relação a sinais de alerta precoce e tardio da infecção de sítio cirúrgico, complicações, fatores de risco, prevenção e utilização do telemonitoramento. CONCLUSÃO: observou-se que, embora os estudos abordem a infecção de sítio cirúrgico e o telemonitoramento, faz-se necessário a formulação dos instrumentos utilizados nas consultas telefônicas, contemplando com maior especificidade os critérios indispensáveis a serem abordados.


OBJECTIVE: This study aims to map scientific evidence regarding the prevention and early management of surgical site infection through telemonitoring in surgical patients after discharge from the hospital. METHOD: A scoping review was conducted following the guidelines proposed by the Joanna Briggs Institute (JBI). The search was performed across PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Collaboration, Scopus, CINAHL, MEDLINE, Web of Science, and Embase databases. Three independent researchers collect the identified studies using Endnote Basic and Rayyan. RESULTS: A total of 1,386 studies were identified, of which 31 were included in the analysis. These selected studies demonstrated significance regarding early and late warning signs of surgical site infection, complications, risk factors, prevention strategies, and the utilization of telemonitoring. CONCLUSION: While the studies address surgical site infection and telemonitoring, it is imperative to formulate the instruments employed in telephonic consultations, incorporating a more specific consideration of essential criteria to be addressed.


Asunto(s)
Alta del Paciente , Cuidados Posoperatorios , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/terapia , Telemonitorización , Atención de Enfermería
3.
Braz. j. oral sci ; 23: e242836, 2024. ilus
Artículo en Inglés | LILACS, BBO | ID: biblio-1553439

RESUMEN

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Infección de la Herida Quirúrgica , Bacterias/efectos de los fármacos , Farmacorresistencia Microbiana , Infección Focal Dental , Antibacterianos
5.
Rev. latinoam. enferm. (Online) ; 31: e3798, Jan.-Dec. 2023. tab, graf
Artículo en Inglés | LILACS, BDENF | ID: biblio-1424048

RESUMEN

Abstract Objective: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. Method: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. Results: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. Conclusion: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.


Resumo Objetivo: avaliar as evidências sobre os fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica. Método: revisão integrativa. A busca dos estudos primários foi realizada em quatro bases de dados. A amostra foi composta por 11 pesquisas. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. A análise e a síntese dos dados foram realizadas de maneira descritiva. Resultados: as taxas de infecção de sítio cirúrgico variaram de 0,4% até 7,6%, considerando os resultados dos estudos primários, cujos pacientes foram submetidos à cirurgia por via laparoscópica. Nas pesquisas com os participantes submetidos aos procedimentos cirúrgicos com diferentes abordagens (aberta, via laparoscópica ou robótica), as taxas de infecção variaram de 0,9% até 12%. Com relação aos fatores de risco para o desenvolvimento deste tipo de infecção, ressaltam-se antibioticoprofilaxia, sexo feminino, Índice de Massa Corporal elevado e hiperglicemia perioperatória. Conclusão: a condução da revisão gerou corpo de evidências que reforça a importância na implementação de medidas efetivas para prevenção e controle de infecção de sítio cirúrgico pelos profissionais de saúde após cirurgia bariátrica, promovendo a melhoria da assistência e da segurança do paciente no perioperatório.


Resumen Objetivo: evaluar las evidencias sobre los factores de riesgo para el desarrollo de infección de sitio quirúrgico en cirugía bariátrica. Método: revisión integradora. La búsqueda de estudios primarios se realizó en cuatro bases de datos. La muestra estuvo compuesta por 11 investigaciones. La calidad metodológica de los estudios incluidos se evaluó mediante herramientas propuestas por el Joanna Briggs Institute. El análisis y la síntesis de los datos se realizaron de manera descriptiva. Resultados: las tasas de infección del sitio quirúrgico oscilaron entre 0,4% y 7,6%, considerando los resultados de los estudios primarios, en los que los pacientes fueron sometidos a cirugía mediante laparoscopia. En investigaciones con participantes que se sometieron a procedimientos quirúrgicos con diferentes enfoques (abierto, laparoscópico o robótico), las tasas de infección oscilaron entre el 0,9 % y el 12 %. En cuanto a los factores de riesgo para el desarrollo de este tipo de infección, se destacan la profilaxis antibiótica, el sexo femenino, el Índice de Masa Corporal elevado y la hiperglucemia perioperatoria. Conclusión: la realización de la revisión generó un cuerpo de evidencia que refuerza la importancia de implementar medidas efectivas para la prevención y el control de la infección de sitio quirúrgico, por parte de los profesionales de la salud, después de la cirugía bariátrica, promoviendo la mejora de la atención y la seguridad del paciente en el período perioperatorio.


Asunto(s)
Infección de la Herida Quirúrgica/prevención & control , Control de Infecciones , Profilaxis Antibiótica , Cirugía Bariátrica , Periodo Perioperatorio
6.
Arq. bras. cardiol ; 120(12): e20220592, dez. 2023. tab, graf
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1527791

RESUMEN

Resumo Fundamento A infecção do sítio cirúrgico (ISC) é uma importante complicação no pós-operatório de cirurgia cardíaca pediátrica associada ao aumento da morbimortalidade. Objetivos Identificar fatores de risco para a ISC após cirurgias cardíacas para correção de malformações congênitas. Métodos Este estudo caso-controle incluiu 189 pacientes com um ano completo e 19 anos e 11 meses, submetidos à cirurgia cardíaca em hospital universitário terciário de cardiologia de janeiro de 2011 a dezembro de 2018. Foi realizado registro e análise de dados pré, intra e pós-operatórios. Para cada caso foram selecionados dois controles, conforme o diagnóstico da cardiopatia e cirurgia realizada em um intervalo de até 30 dias para minimizar diferenças pré e/ou intraoperatórias. Para a análise dos fatores de risco foi utilizado o modelo de regressão binária logística. Significância estatística definida como valor de p<0,05. Resultados O estudo incluiu 66 casos e 123 controles. A incidência de ISC variou de 2% a 3,8%. Fatores de risco identificados: faixa etária de lactentes (OR 3,19, IC 95% 1,26 - 8,66, p=0,014), síndrome genética (OR 6,20, IC 95% 1,70 - 21,65, p=0,004), RACHS-1 categorias 3 e 4 (OR 8,40, IC 95% 3,30 - 21,34, p<0,001), o valor da proteína C reativa (PCR) de 48 horas pós-operatórias foi demonstrado como fator protetor para esta infecção (OR 0,85, IC 95% 0,73 - 0,98, p=0,023). Conclusão Os fatores de risco identificados não são variáveis modificáveis. Vigilância e medidas preventivas contínuas são fundamentais para reduzir a infecção. O papel do PCR elevado no pós-operatório foi fator protetor e precisa ser melhor estudado.


Abstract Background Surgical site infection is an important complication after pediatric cardiac surgery, associated with increased morbidity and mortality. Objectives We sought to identify risk factors for surgical site infection after pediatric cardiac surgeries. Methods A case-control study included patients aged between 1 year and 19 years and 11 months of age, submitted to cardiac surgery performed at a tertiary cardiac center from January 1 st , 2011, through December 31, 2018. Charts were reviewed for pre-, intra, and postoperative variables. We identified two randomly selected control patients with the same pathophysiological diagnosis and underwent surgery within thirty days of each index case. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Statistical significance was defined as p<0.05. Results Sixty-six cases and 123 controls were included. Surgical site infection incidence ranged from 2% to 3.8%. The following risk factors were identified: Infant age (OR 3.19, 95% CI 1.26 to 8.66, p=0.014), presence of genetic syndrome (OR 6.20, CI 95% 1.70 to 21.65, p=0.004), categories 3 and 4 of RACHS-1 (OR 8.40, CI 95% 3.30 to 21.34, p<0.001), 48 h C-reactive protein level range was detected as a protective factor for this infection (OR 0.85, 95% CI 0.73 to 0.98, p=0.023). Conclusions The risk factors defined in this study could not be modified. Therefore, additional surveillance and new preventive strategies need to be implemented to reduce the incidence of surgical site infection. The increased CRP in the postoperative period was a protective factor that needs further understanding.

7.
Artículo | IMSEAR | ID: sea-220211

RESUMEN

Objective: The goal of this investigation was to look at the frequency and dispersal of bacteria isolated from pus/wound, as well as their susceptibility patterns. Materials and Methods?A study was conducted on 175 patients who provided pus and/or wound discharge samples in different wards (outpatient department or inpatient department). MacConkey agar and blood agar plates were immediately inoculated with samples and incubated at 37°C for 24?hours. The Gram stain and biochemical tests were used to identify all isolates after incubation. Kirby–Bauer's disc diffusion method was used to perform sensitivity tests on Mueller–Hinton agar plates. Results?This study covered 175 patients, with a bacterial isolation rate of 102 (58.28%). Males outnumbered females in the samples (M:F?=?1.8:1), with a median age of 45 years as majority were in the age group of 40 to 60 years which was 41 (40.20%). Total 90.1% samples showed monomicrobial infection, whereas 9.8% showed polymicrobial infection, and total 112 bacterial strains were isolated. Conclusion?Escherichia coli was the most prevalent isolate in present investigation, followed by Pseudomonas aeruginosa. Chloramphenicol is the only antibiotic which is effective for both gram-negative bacilli and gram-positive cocci. This report's susceptibility statistic may be worth considering for developing empiric treatment regimens for pyogenic infections.

8.
European J Med Plants ; 2023 Apr; 34(4): 1-8
Artículo | IMSEAR | ID: sea-219544

RESUMEN

Background: Wound infection comprises numerous different organisms that have the ability to surface colonization of wounds. Multidrug-resistant Pseudomonas aeruginosa is one of the pathogenic bacteria associated with wound infections. Aim: This study isolated and identified multidrug-resistant Pseudomonas aeruginosa from infected wounds and determine the antibacterial activity of Lawsonia inermis leaf extracts against it. Design: This is a Clinical and laboratory-based study involving patients with defined cases of wound infections. Place and Duration of Study: This study was conducted in the Microbiology (Bacteriology) laboratory of Specialist Hospital, Bauchi, Nigeria, from February to November 2021. Methods: Twenty-eight (28) Pseudomonas aeruginosa isolates were recovered from 179 wound swabs using standard laboratory procedures and were screened for multidrug-resistant patterns according to the Kirby-Bauer disc diffusion method. Antibacterial efficacy of the aqueous, ethanolic, and methanolic leaf extracts of Lawsonia inermis was tested against the multidrug-resistant isolates using agar well diffusion techniques. The zone of inhibition was measured and the differences between means were statistically analyzed (p<0.05). Results: A total of twenty-eight (28) multidrug-resistant Pseudomonas aeruginosa were confirmed, showing resistance to Amoxicillin (64.3%), Ceftazidime (85.71%), and Cefotaxime (78.57%) but sensitivity to Imipenem (95.5%). The phytochemical screening revealed the presence of flavonoids, glycosides, saponins, steroids, and tannins among others. MDR P. aeruginosa was inhibited at varied concentrations of the extracts with the diameter mean zone of inhibition increasing as the concentration increased. The Methanol extracts showed the highest antibacterial activity against MDR P. aeruginosa with a mean zone of inhibition of 9.500±0.288mm at 400mg/ml. Conclusion: These results indicated that Lawsonia inermis leaf extracts possess antibacterial activities on Multidrug-resistant Pseudomonas aeruginosa which could be a good source for the production of plant-based antibacterial drugs., although somewhat less than the synthetic standard drugs (Imipenem) having a mean of 13.83±0.288mm.

9.
Rev. bras. ortop ; 58(2): 326-330, Mar.-Apr. 2023. tab
Artículo en Inglés | LILACS | ID: biblio-1449798

RESUMEN

Abstract Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus. Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal. Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001). Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.


Resumo Objetivo A osteotomia tibial alta com cunha de abertura medial (MOWHTO, do inglês medial open wedge high tibial osteotomy) alivia de forma significativa a dor na linha articular medial em casos de osteoartrite do compartimento medial do joelho. Alguns pacientes, porém, se queixam de dor nos tendões dos músculos sartório, grácil e semitendinoso (pata de ganso) mesmo 1 ano após a osteotomia, o que pode exigir a remoção do implante. Este estudo define a taxa de remoção do implante após a MOWHTO devido à dor nos tendões dos músculos sartório, grácil e semitendinoso. Métodos Cento e três joelhos de 72 pacientes submetidos à MOWHTO para tratamento da osteoartrite do compartimento medial entre 2010 e 2018 foram incluídos no estudo. A pontuação de desfecho de lesão no joelho e osteoartrite (KOOS, do inglês Knee Injury and Osteoarthritis Outcome Score), a pontuação dejoelho de Oxford (OKS, do inglês Oxford Knee Score) e a escala visual analógica (EVA) de dor na linha articular medial do joelho (EVA-MJ) foram avaliados antes da cirurgia. A EVA nos tendões dos músculos sartório, grácil e semitendinoso (EVA-PA) foi adicionada a essas avaliações, também realizadas 12 meses após o procedimento e, a seguir, anualmente. A remoção do implante foi recomendada em pacientes com EVA-PA ≥ 40 e consolidação óssea adequada em 12 meses. Resultados Trinta e três (45,8%) pacientes eram homens e 39 (54,2%), mulheres. A média de idade foi de 49,4 ±8,0, e o índice de massa corpórea (IMC) médio foi de 27,0 ± 2,9. O sistema placa-parafuso tibial medial Tomofix (DePuy Synthes, Raynham, MA, EUA) foi utilizado em todos os casos. Três (2,8%) casos foram excluídos devido ao retardo de consolidação e à necessidade de revisão. Os resultados nas escalas KOOS, OKS e EVA-MJ melhoraram significativamente 12 meses após a MOWHTO. A EVA-PA média foi de 38,3 ± 23,9. A remoção do implante para alívio da dor foi necessária em 65 (63,1%) dos 103 joelhos. Três meses após a remoção do implante, a EVA-PA média diminuiu para 4,5 ± 5,6 (p < 0,0001). Conclusão A remoção do implante pode ser necessária em mais de 60% dos pacientes para alívio da dor nos tendões dos músculos sartório, grácil e semitendinoso após a MOWHTO. Os candidatos à MOWHTO devem ser informados sobre esta complicação e sua resolução.


Asunto(s)
Humanos , Osteotomía , Infección de la Herida Quirúrgica , Tibia/cirugía , Placas Óseas , Trasplante Óseo , Remoción de Dispositivos
10.
Online braz. j. nurs. (Online) ; 22(supl.1): e20236609, 03 fev 2023. ilus
Artículo en Inglés, Portugués | LILACS, BDENF | ID: biblio-1414190

RESUMEN

OBJETIVO: Analisar a efetividade de Polihexametileno Biguanida (PHMB), comparado à solução salina na carga microbiana de pacientes com feridas. MÉTODO: Protocolo de revisão sistemática, construído segundo o Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), de acordo com metodologia do Joanna Briggs Institute (JBI). Os estudos serão avaliados por dois pesquisadores independentes, nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), Sistema Online de Busca e Análise de Literatura Médica (MEDLINE)e Excerpta Medica Database (Embase). As pesquisas a serem incluídas serão aquelas publicadas em português, inglês ou espanhol e a busca não definirá recorte temporal. Serão desconsiderados estudos em animais ou in vitro, revisões, cartas ao editor ou estudos de casos. Após a seleção dos estudos, a extração de dados ocorrerá de maneira sistemática e os registros correspondentes serão feitos de forma narrativa e tabular.


OBJECTIVE: To analyze the effectiveness of polyhexamethylene biguanide (PHMB) compared to saline on the microbial load of wounds. METHOD: Systematic review protocol, built according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Joanna Briggs Institute's (JBI) methodology. Studies will be evaluated by two independent researchers in the following databases: Latin America and the Caribbean Literature on Health Sciences (LILACS), Nursing Database (BDENF), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica Database (Embase). Studies published in Portuguese, English, or Spanish will be included, and the search will not be restricted by publication date. Animal or in vitro studies, reviews, letters to the editor, and case studies will be excluded. After selecting studies, data extraction will take place systematically, and the corresponding records will be presented in a narrative and tabular way.


Asunto(s)
Humanos , Adulto , Anciano , Cicatrización de Heridas , Infección de Heridas , Heridas y Lesiones , Biguanidas , Carga Bacteriana , Solución Salina , Biopelículas
11.
Braz. J. Anesth. (Impr.) ; 73(1): 10-15, Jan.-Feb. 2023. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1420647

RESUMEN

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.


Asunto(s)
Humanos , Cirugía Colorrectal , Alcaloides Opiáceos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Estudios Retrospectivos , Analgesia Controlada por el Paciente/métodos , Absceso/complicaciones , Analgésicos Opioides
12.
Chinese Journal of Trauma ; (12): 538-544, 2023.
Artículo en Chino | WPRIM | ID: wpr-992632

RESUMEN

Objective:To compare the efficacy between deep continuous irrigation combined with vacuum sealing drainage (VSD) and routine dressing change in treating multidrug-resistant bacterial infections at the surgical wound site in patients with major vascular injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 28 patients with surgical wound infections by multidrug-resistant bacteria after major vascular injury treated at the First Affiliated Hospital of Henan University of Science and Technology from March 2015 to December 2021. There were 15 males and 13 females, aged 15-65 years [(41.8±12.9)years]. All patients received vascular graft surgery after major vascular injury. Postoperative microbiological culture indicated that the wound infections were caused by Carbapenem-resistant organisms (CRO) or vancomycin- resistant Enterococci (VRE), with no available sensitive antibiotics for treatment. The patients received surgical debridement every five days after vascular graft surgery and were divided into two groups to receive the subsequent treatments including a routine dressing change (routine dressing group, 14 patients) or a deep continuous irrigation combined with VSD (irrigation combined with VSD group, 14 patients). On the first day post-operation and then every 3 days, inflammatory indicators [white blood cell count, neutrophils, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin] were observed in the two groups (repeat tests when a patient′s condition changed). Microbiological cultures were applied with patient samples every 5 days to observe the wound and infection control. Comparisons were made between the two groups regarding the duration to normal levels of inflammatory indicators, duration to negative CRO or VRE cultures, visual analogue score (VAS) before and at 1, 2 and 3 hours after changing the irrigation fluid (changing the dressing), conditions of wound skin grafting or flap repair, and incidences of anastomotic fistula.Results:All patients were followed up for 12-24 months [(14.3±2.4)months], during which no wound redness, rupture, purulent discharge or infection recurrence was noted. The duration to normal levels was (9.4±2.4)days for white blood cells, (9.6±2.8)days for neutrophils, (9.8±3.1)days for CRP, (12.2±3.6)days for ESR, and (7.6±1.9)days for procalcitonin in the irrigation combined with VSD group, significantly shorter than those in the routine dressing group [(15.2±3.1)days, (13.6±3.4)days, (14.2±3.9)days, (19.9±3.3)days, and (12.9±4.1)days, respectively] (all P<0.01). The duration to negative CRO or VRE cultures was (13.9±3.1)days in the irrigation combined with VSD group, significantly shorter than that in the routine dressing group [(19.2±6.9)days] ( P<0.05). The VAS before and at 1, 2 and 3 hours after changing the irrigation fluid was (4.2±0.7)points, (4.1±0.9)points, (4.2±0.9)points and (4.1±0.8)points in the irrigation combined with VSD group, respectively, and was (4.3±0.6)points, (6.9±0.7)points, (5.4±0.9)points and (4.5±0.9)points in the routine dressing group, respectively. The VAS score in the irrigation combined with VSD group was significantly lower than that in the routine dressing group at 1 hour and 2 hours after changing the irrigation fluid (all P<0.01), while no significant differences were found before and at 3 hours after changing the irrigation fluid (all P>0.05). After infection control, 5 patients (35.7%) in the irrigation combined with VSD group required skin grafting or flap repair at the wound site, lower than 11 patients (78.6%) in the routine dressing group ( P<0.01). The incidence of anastomotic fistula was 7.1% (1/14) in the irrigation combined with VSD group, lower than 42.9% (6/14) in the routine dressing group ( P<0.05). Conclusion:When multidrug-resistant bacterial infections occur at the surgical wound site after major vascular injury, deep continuous irrigation combined with VSD performs better than routine dressing change in controlling infection as well as in reducing pain, rate of wound skin grafting or flap repair and incidence of anastomotic fistula, without reliance on antibiotics.

13.
Chinese Journal of Practical Nursing ; (36): 625-630, 2023.
Artículo en Chino | WPRIM | ID: wpr-990229

RESUMEN

Objective:To analyze the relationship between skin cleaning status and wound infection after emergency treatment of skin wounds, so as to provide guidance for clinical work and home care of patients.Methods:Using retrospective research methods, a total of 349 patients with skin wounds admitted to the Department of Emergency Medicine of Lishui People′s Hospital from January 2016 to February 2022 were selected for cross-sectional investigation. And the wound-infected patients were set as the wound-infected group and the non-wound-infected patients were set as the non-wound-infected group. The patients′ clinical data, skin cleaning status and wound infection status were collected to compare the differences in the basic data between the two groups and further analyze whether there was an association between skin cleaning and wound infection using binomial Logistic regression.Results:There were 134 cases of wound infection in 349 patients with skin trauma, accounting for 38.40%, including 66 cases of acute wound infection and 68 cases of chronic wound infection.The cleaning frequency of 1 time/week, 2 times/week and ≥ 3 times/week in open wound bath cleaning was 2.99%(4/134), 0.74% (1/134) and 0 in the wound-infected group, respectively, which was significantly different from 2.79%(6/215), 7.91% (17/215) and 1.86%(4/215) in the non-wound-infected group ( χ2 = 11.42, P<0.05). Multifactorial analysis revealed that trauma area ≥8 cm 2, total cortical damage, long duration of trauma, and antibiotic treatment were independent risk factors for wound infection after emergency management of skin trauma ( OR values were 1.05-2.02, all P<0.05), the protective factors for wound infection after emergency treatment of skin trauma were bath cleaning of open wound and its cleaning times 2 times/week ( OR = 0.54, 0.62, both P<0.05). Conclusions:The choice of warm water bath cleaning after emergency treatment of skin trauma does not increase the risk of wound infection. On the contrary, it helps to prevent wound infection, but it should be noted that local disinfection should be carried out in time after the completion of cleaning.

14.
China Tropical Medicine ; (12): 33-2023.
Artículo en Chino | WPRIM | ID: wpr-974106

RESUMEN

@#Abstract: Objective To analyze the distribution characteristics of the main pathogens of HIV/AIDS patients with wound infections and provide basis for clinical diagnosis and treatment. Methods The clinical data of 294 patients with positive secretions or pus specimens from 2016 to 2020 were analyzed retrospectively. Results A total of 357 strains of pathogenic bacteria were isolated from 294 cases, of which 123 strains of Gram-negative bacilli (G-b), accounting for 34.5%, were mainly Escherichia coli (15.4%), Klebsiella pneumoniae (3.9%), and Pseudomonas aeruginosa (3.6%); Gram-positive bacilli (G+b) 14 strains, accounting for 3.9%; 108 Gram-positive cocci (G+c), accounting for 30.3%, of which 44 strains were coagulase-positive Staphylococcus aureus (12.3%), Coagulase-negative staphylococci were mainly Staphylococcus epidermidis (4.2%) and Staphylococcus hemolyticus (2.8%); 37 strains of fungi, accounting for 10.4%, were mainly Candida albicans (5.9%); 75 strains of Mycobacterium, accounting for 21.0%, including 41 strains of Mycobacterium tuberculosis (11.5%) and 34 strains of non-tuberculosis mycobacteria (9.5%). 52 of the 294 HIV/AIDS patients had mixed infections, accounting for 17.7%. There was significant difference in the distribution of G+c, G-b, mycobacteria and mixed infection among different specimen sources (P<0.05), and there was significant difference in the distribution of mycobacteria among different CD4+T lymphocyte counts (P<0.05). There was significant difference in the level of CD4+T lymphocytes between patients of different ages (P<0.05), and there was significant difference in the level of CD4+T lymphocytes from postoperative incision and other parts (P<0.05). Conclusions Patients with HIV/AIDS are prone to combined wound infections with various pathogenic bacteria. We should strengthen the research on wound infection in HIV/AIDS patients, and timely send patients with a low number of CD4+T lymphocytes for secretion or pus culture, so as to carry out targeted treatment and improve the prognosis of patients.

15.
Singapore medical journal ; : 105-108, 2023.
Artículo en Inglés | WPRIM | ID: wpr-969653

RESUMEN

INTRODUCTION@#The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population.@*METHODS@#This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups.@*RESULTS@#There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable.@*CONCLUSION@#Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.


Asunto(s)
Humanos , Femenino , Anciano , Hernia Incisional/cirugía , Infección de la Herida Quirúrgica/epidemiología , Estudios Retrospectivos , Seroma/cirugía , Herniorrafia/efectos adversos , Mallas Quirúrgicas , Recurrencia , Hernia Ventral/cirugía , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/cirugía
16.
Ciênc. cuid. saúde ; 22: e66055, 2023. tab
Artículo en Portugués | LILACS-Express | LILACS, BDENF | ID: biblio-1447930

RESUMEN

RESUMO Objetivo: analisar a incidência das infecções de sítio cirúrgico (ISC) em pacientes submetidos a cirurgias neurológicas e ortopédicas e seus determinantes em um hospital público. Método: estudo de coorte retrospectivo, conduzido entre pacientes submetidos a cirurgias neurológicas e ortopédicas, de janeiro de 2015 a dezembro de 2020. Resultados: dos 3.029 procedimentos cirúrgicos realizados, 1.327 (43,8%) foram neurocirúrgicos; e 1.702 (56,2%), ortopédicos. A incidência da ISC foi 6,7% (89) em neurocirurgias e 3,3% (56) em ortopedias. A taxa global e de óbitos foi 4,8% e 12,4%, respectivamente. Na análise univariada, os fatores de risco associados às ISC em neurocirurgiasenvolveram tempo cirúrgico (>231 minutos), pontuação da American Society of Anesthesiologistsmaior que doise cirurgias emergenciais; para os procedimentos ortopédicos: cirurgias emergenciais, tempo de internação pré-operatório (>quatro dias) e cirúrgico (>149 minutos). Na análise multivariada, permaneceram cirurgias emergenciais e maior tempo cirúrgico como fatores de risco de ISC para ambas as especialidades;e, para as cirurgias ortopédicas e neurológicas, tempo de internação pré-operatório e classificação ASA, respectivamente. Conclusão: a taxa de incidência das ISC e de mortalidade bem como os fatores de risco identificados neste estudo devem ser considerados para elaborar estratégias destinadas a prevenir e controlar essas infecções.


RESUMEN Objetivo: analizar la incidencia de las infecciones de sitio quirúrgico (ISC) en pacientes sometidos a cirugías neurológicas y ortopédicas y sus determinantes en un hospital público. Método: estudio de cohorte retrospectivo, realizado entre pacientes sometidos a cirugías neurológicas y ortopédicas, de enero de 2015 a diciembre de 2020. Resultados: de los 3.029 procedimientos quirúrgicos realizados, 1.327 (43,8%) fueron neuroquirúrgicos; y 1.702 (56,2%), ortopédicos. La incidencia de la ISC fue 6,7% (89) en neurocirugía y 3,3% (56) en ortopedias. La tasa global y de muertes fue 4,8% y 12,4%, respectivamente. En el análisis univariado, los factores de riesgo asociados a las ISC en neurocirugía involucraron tiempo quirúrgico (>231 minutos), puntuación de la American Society of Anesthesiologists (ASA) mayor que dos y cirugías de emergencia; para los procedimientos ortopédicos: cirugías de emergencia, tiempo de internación preoperatorio (> cuatro días) y quirúrgico (>149 minutos). En el análisis multivariado, permanecieron cirugías de emergencia y mayor tiempo quirúrgico como factores de riesgo de ISC para ambas especialidades; y, para las cirugías ortopédicas y neurológicas, tiempo de internación preoperatorio y clasificación ASA, respectivamente. Conclusión: la tasa de incidencia de las ISC y de mortalidad, así como los factores de riesgo identificados en este estudio, debenser consideradosa la hora de elaborar estrategias para prevenir y controlar estas infecciones.


ABSTRACT Objective: to analyze the incidence of surgical site infections (SSI) in patients submitted to neurological and orthopedic surgeries and their determinants in a public hospital. Method: retrospective cohort study, conducted between patients submitted to neurological and orthopedic surgeries, from January 2015 to December 2020. Results: of the 3,029 surgical procedures performed, 1,327 (43.8%) were neurosurgical; and 1,702 (56.2%) were orthopedic. The incidence of SSI was 6.7% (89) in neurosurgeries and 3.3% (56) in orthopedic surgery. The overall rate and death rates were 4.8% and 12.4%, respectively. In the univariate analysis, the risk factors associated with SSI in neurosurgeries involved surgical time (>231 minutes), an American Society of Anesthesiologists score greater than two and emergency surgeries; the risk factors for orthopedic procedures were emergency surgeries, preoperative hospitalization time (> four days), and surgical procedures (>149 minutes). In the multivariate analysis, emergency surgeries and longer surgical time remained as risk factors for SSI for both specialties; the SSI risk factors for orthopedic and neurological surgeries were preoperative hospitalization time and ASA classification, respectively. Conclusion: the incidence rate of SSI and mortality, as well as the risk factors identified in this study, should be considered in order to develop strategies aimed at preventing and controlling these infections.

17.
Rev. Esc. Enferm. USP ; 57: e20220459, 2023. tab
Artículo en Inglés, Portugués | LILACS, BDENF | ID: biblio-1449198

RESUMEN

ABSTRACT Objective: To analyze the perception of patients and health professionals regarding patients' participation in surgical site infection prevention. Methods: Cross-sectional study conducted in two hospitals in the city of São Paulo, with a convenience sample of 123 patients in the postoperative period of elective surgeries and 92 health professionals (physicians and nurses) acting in direct care of surgical patients. Results: Patients (78.9%) and professionals (79.4%) fully agreed with the importance of patient participation to prevent surgical site infection. The impact of patient participation on infection rates was significant for those undergoing previous surgery (p = 0.021). Patients and professionals disagreed about the best time to prepare the patient about the topic (p<0.001). The participation strategies considered most effective by patients and professionals were, respectively, oral presentation (47.2% and 75%), videos (40.7% and 58.7%) and leaflets (30.9% and 58.7%). Conclusion: Patients and health professionals believe that patient participation in surgical site infection prevention is important.


RESUMEN Objetivo: Analizar la percepción de pacientes y profesionales de salud sobre la participación de los pacientes en la prevención de la infección del sitio quirúrgico. Método: Estudio transversal realizado en dos hospitales de la ciudad de São Paulo, con una muestra de conveniencia de 123 pacientes en el postoperatorio de cirugías electivas y 92 profesionales de salud (médicos y enfermeros) que actúan en el cuidado directo de pacientes quirúrgicos. Resultados: Los pacientes (78,9%) y los profesionales (79,4%) estuvieron totalmente de acuerdo con la importancia de la participación de los pacientes para prevenir la infección del sitio quirúrgico. El impacto de la participación de los pacientes en las tasas de infección fue significativo para los sometidos a cirugía previa (p = 0,021). Pacientes y profesionales discreparon sobre el mejor momento para preparar al paciente sobre el tema (p < 0,001). Las estrategias de participación consideradas más eficaces por pacientes y profesionales fueron, respectivamente, la presentación oral (47,2% y 75%), los vídeos (40,7% y 58,7%) y los folletos (30,9% y 58,7%). Conclusión: Los pacientes y los profesionales de salud creen que la participación de los pacientes en la prevención de la infección del sitio quirúrgico es importante.


RESUMO Objetivo: Analisar a percepção de pacientes e profissionais de saúde sobre a participação dos pacientes na prevenção de infecção do sítio cirúrgico. Método: Estudo transversal realizado em dois hospitais da cidade de São Paulo, com amostra por conveniência de 123 pacientes no período pós-operatório de cirurgias eletivas e 92 profissionais de saúde (médicos e enfermeiros) atuantes no cuidado direto a pacientes cirúrgicos. Resultados: Pacientes (78,9%) e profissionais (79,4%) concordaram totalmente com a importância da participação do paciente para a prevenção de infecção do sítio cirúrgico. O impacto da participação do paciente nas taxas de infecção foi significativo para aqueles submetidos à cirurgia prévia (p = 0,021). Pacientes e profissionais discordaram quanto ao melhor momento para preparar o paciente sobre a temática (p<0,001). As estratégias de participação consideradas mais efetivas pelos pacientes e profissionais foram, respectivamente, exposição oral (47,2% e 75%), vídeos (40,7% e 58,7%) e panfletos (30,9% e 58,7%). Conclusão: Pacientes e profissionais de saúde julgam ser importante a participação do paciente na prevenção de infecção do sítio cirúrgico.


Asunto(s)
Humanos , Enfermería Perioperatoria , Educación en Salud , Control de Infecciones , Participación del Paciente , Infección de la Herida Quirúrgica
18.
Rev. venez. cir ; 76(2): 114-119, 2023. ilus
Artículo en Español | LILACS, LIVECS | ID: biblio-1553865

RESUMEN

Objetivo: Analizar la evidencia más actualizada sobre el cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su impacto en el riesgo de infecciones. Métodos: Se realizó una búsqueda bibliográfica, en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: A la fecha, la evidencia sumamente escasa sobre el potencial impacto del cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal, y su relación con la incidencia de infección en el sitio operatorio. Sin embargo, no deja de ser un tema de interés en cirugía global. El estudio ChEETAh, ensayo realizado en siete países de bajos y medianos ingresos, que evaluó el cambio rutinario tanto de guantes como de instrumental quirúrgico en cirugía abdominal y su relación con la infección, demostró que, la frecuencia de infección en sitio operatorio fue del 16% (n=931) en el grupo intervención, comparado a un 18,9% (n=1280) en el grupo control (RR 0,87; IC 95%: 0,79 ­ 0,95; p=0,0032). Así, podría existir cierta protección adicional con el cambio rutinario de guantes e instrumental en cirugía abdominal. Conclusión: Aunque la evidencia es limitada y heterogénea, existe una tendencia respecto a un potencial beneficio frente a la incidencia de infección en sitio operatorio, en el cambio rutinario de guantes e instrumental quirúrgico en cirugía abdominal(AU)


Objective: To analyze the most recent evidence regarding the routine change of surgical instruments and gloves in abdominal surgery and its impact on the risk of infections. Methods: A literature search was conducted in the PubMed, ScienceDirect, Web of Science, and MEDLINE databases. Results: To date, the evidence regarding the potential impact of routine changes in surgical instruments and gloves in abdominal surgery and their relationship with the incidence of surgical site infections is extremely scarce. Nevertheless, it remains a topic of interest in global surgery. The ChEETAh study, conducted in seven low and middle-income countries, which assessed the routine change of both gloves and surgical instruments in abdominal surgery and its relation to infection, demonstrated that the frequency of surgical site infection was 16% (n=931) in the intervention group compared to 18.9% (n=1280) in the control group (RR 0.87; 95% CI: 0.79 ­ 0.95; p=0.0032). Thus, there may be some additional protection with the routine change of gloves and instruments in abdominal surgery. Conclusion: Although the evidence is limited and heterogeneous, there is a trend suggesting a potential benefit in reducing the incidence of surgical site infections through the routine change of gloves and surgical instruments in abdominal surgery(AU)


Asunto(s)
Humanos , Masculino , Femenino , Complicaciones Posoperatorias , Cirugía General , Factores de Riesgo , Cavidad Abdominal
19.
Acta Paul. Enferm. (Online) ; 36: eAPE01714, 2023. tab
Artículo en Portugués | LILACS-Express | LILACS, BDENF | ID: biblio-1505428

RESUMEN

Resumo Objetivo Avaliar a adesão às ações de prevenção e controle da infecção de sítio cirúrgico, adotadas na prática clínica de acordo com as recomendações propostas pela Organização Mundial de Saúde: realização da auditoria de momento da administração de antibiótico, tricotomia com tricotomizador elétrico/lâmina descartável, confirmação da esterilidade dos materiais e, vigilância e divulgação das taxas de infecção de sítio cirúrgico. Métodos Estudo observacional transversal, realizado em 30 hospitais de grande porte do estado de Minas Gerais, de fevereiro de 2018 a abril de 2019, a partir de uma auditoria de um procedimento cirúrgico, diagnóstico situacional e entrevista com os Serviços de Controle de Infecção Hospitalar. Resultados Em 93,3% dos Serviços de Controle de Infecção Hospitalar foram referidos protocolos para uso de antibiótico profilático e auditorias de adesão, 69% informaram tricotomia com tricotomizador elétrico; todos realizavam a vigilância da infecção de sítio cirúrgico, no entanto, apenas 63,3% realizavam a divulgação das taxas. No diagnóstico situacional, a tricotomia foi realizada em 76,7% dentro da sala cirúrgica com tricotomizador elétrico (56,7%). Na auditoria do momento de administração do antimicrobiano profilático entre 30-60 minutos antes da incisão cirúrgica identificou-se conformidade em 63,3%; 93,3% dos serviços confirmavam a esterilidade dos materiais por meio de indicadores de processo. Conclusão Verificou-se divergências entre recomendações do Serviço de Controle de Infecção Hospitalar e adesão às boas práticas durante diagnóstico situacional e auditoria de procedimentos cirúrgicos, reforçando a necessidade de treinamentos e auditorias visando adesão efetiva às práticas dos profissionais a tais medidas.


Resumen Objetivo Evaluar la adhesión a las acciones de prevención y control de infecciones del sitio quirúrgico adoptadas en la práctica clínica, de acuerdo con las recomendaciones propuestas por la Organización Mundial de la Salud: realización de auditoría del momento de administración del antibiótico, tricotomía con tricotomizador eléctrico/lámina descartable, confirmación de esterilidad del material y control y difusión de índices de infección del sitio quirúrgico. Métodos Estudio observacional transversal, realizado en 30 hospitales de gran tamaño del estado de Minas Gerais, de febrero de 2018 a abril de 2019, a partir de una auditoría de un procedimiento quirúrgico, diagnóstico situacional y entrevista con los Servicios de Control de Infecciones Hospitalarias. Resultados En el 93,3 % de los Servicios de Control de Infecciones Hospitalarias se citaron protocolos para el uso de antibiótico profiláctico y auditorías de adhesión, el 69 % informó tricotomía con tricotomizador eléctrico, todos realizaban el control de infecciones del sitio quirúrgico, pero solo el 63,3 % realizaba la difusión de los índices. En el diagnóstico situacional, la tricotomía fue realizada en el 76,7 % dentro del quirófano con tricotomizador eléctrico (56,7 %). En la auditoría del momento de administración del antimicrobiano profiláctico de 30 a 60 minutos antes de la incisión quirúrgica, se identificó conformidad en el 63,3 %, el 93,3 % de los servicios confirmó la esterilidad del material por medio de indicadores de proceso. Conclusión Se verificaron divergencias entre las recomendaciones del Servicio de Control de Infecciones Hospitalarias y la adhesión a las buenas prácticas durante el diagnóstico situacional y auditoría de procedimientos quirúrgicos, lo que refuerza la necesidad de capacitaciones y auditorías para una efectiva adhesión de las prácticas de los profesionales a tales medidas.


Abstract Objective To assess compliance with actions for surgical site infection prevention and control, adopted in clinical practice in accordance with the recommendations proposed by the World Health Organization: auditing the moment of antibiotic administration, trichotomy with an electric clipper/disposable blade, material sterility confirmation, and surveillance and dissemination of surgical site infection rates. Methods This is a cross-sectional observational study, carried out in 30 hospitals in the state of Minas Gerais, from February 2018 to April 2019, based on an audit of a surgical procedure, situational diagnosis and interview with Hospital Infection Control Services. Results In 93.3% of Hospital Infection Control Services, protocols for prophylactic antibiotic use and compliance audits were reported, 69% reported trichotomy with an electric clipper. All carried out surgical site infection surveillance, however, only 63.3% carried out rate disclosure. In the situational diagnosis, trichotomy was performed in 76.7% inside the operating room with an electric clipper (56.7%). In the audit of the moment of antimicrobial administration between 30-60 minutes before surgical incision, compliance was identified in 63.3%; 93.3% of services confirmed material sterility through process indicators. Conclusion Differences were found between recommendations from the Hospital Infection Control Service and compliance with good practices during situational diagnosis and auditing of surgical procedures, reinforcing the need for training and audits aimed at effectively complying with professionals' practices regarding such measures.

20.
Rev. bras. cir. cardiovasc ; 38(4): e20210607, 2023. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1449560

RESUMEN

ABSTRACT Introduction: Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). We observed the role of routine use of BITA and off-pump coronary artery bypass grafting (OPCABG) in the incidence of DSWI and associated risk factors. Methods: Between January 2010 and December 2020, 1,207 patients were treated with isolated coronary artery bypass grafting. In all cases, OPCABG was attempted, and BITA was used whenever there was a need for a second arterial graft for the left coronary artery. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple linear regression analysis was employed to model the risk of DSWI. Results: The incidence of DSWI was 0.58%. Mortality rate was higher in DSWI group than in no-DSWI group (28.57% vs. 1.25%; P<0.001). No significant difference in DSWI incidence was observed when BITA (70.6%) or single internal thoracic artery (29.4%) were used (P=0.680). The prevalence of diabetes (100% vs. 40.7%; P=0.001), hyperlipidemia (100% vs. 85.9%; P=0.045), and obesity (71.4% vs. 26.8%; P-0.017) was significantly elevated in DSWI group, when compared with no-DSWI group. Diabetes (P=0.0001), unstable angina (P=0.0064), previous myocardial infarction > 30 days (P=0.0009), left ventricular ejection fraction < 50% (P=0.0074), and emergency surgery (P=0.0002) were independent risk factors. Conclusion: The results of routine use of skeletonized BITA after OPCABG were satisfactory regarding DSWI incidence and operative mortality in a single-center experience.

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