ABSTRACT
INTRODUCTION: In liver transplant (LT) recipients, surgical site infection (SSI) represents an important cause of morbidity and mortality. OBJECTIVE: This study measures the impact of a multimodal approach to the incidence of surgical site infection in LT recipients. MATERIALS AND METHODS: All of the LT recipients in our department were registered on the national database in solid organ transplant. A study was performed in two analytical-interventional phases. Phase 1 took place between July 14, 2009, and February 20, 2014. Phase 2 took place between February 21, 2014, and July 15, 2015. The multimodal change implemented during phase 1 was that 0.5% alcoholic chlorhexidine and ether were applied to the surgical field; surgical prophylaxis was primarily with ampicillin/sulbactam plus cefazolin. In phase 2, 2% alcoholic chlorhexidine alone was applied to the surgical field. The prior standard prophylaxis was changed to piperacillin tazobactam administered during surgery as a continuous infusion of 13.5 g over 8 hours with a pre-incision loading dose of 4.5 g. The loading dose of piperacillin tazobactam was combined with a single dose of gentamicin of 5 mg/kg. RESULTS: One hundred eight patients have received transplants since the start of the program: 82 patients during phase one and 26 patients during phase two. During phase 1, 13 cases of SSI were recorded, representing a rate of 15.85 per 100 transplants. Sixteen micro-organisms were isolated during phase 1, of which 12 corresponded to gram-negative bacilli. With regard to resistance profiles, 13 showed multidrug resistant and extensively drug resistant profiles. During phase 2, no cases of SSI were recorded (relative risk = 0.158 [95% confidence interval 0.0873-0.255], P = .0352]. CONCLUSION: A multimodal approach allowed for the reduction of the incidence of SSI in LTs and offered a protective strategy.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Gram-Negative Bacterial Infections/prevention & control , Gram-Positive Bacterial Infections/prevention & control , Liver Transplantation/methods , Surgical Wound Infection/prevention & control , Administration, Cutaneous , Adult , Ampicillin/administration & dosage , Anti-Infective Agents, Local/administration & dosage , Antibiotic Prophylaxis/methods , Cefazolin/administration & dosage , Chlorhexidine/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination , Ether/administration & dosage , Female , Gentamicins/administration & dosage , Humans , Infusions, Intravenous , Male , Middle Aged , Penicillanic Acid/administration & dosage , Penicillanic Acid/analogs & derivatives , Piperacillin/administration & dosage , Piperacillin, Tazobactam Drug Combination , Sulbactam/administration & dosage , Transplant RecipientsABSTRACT
The use of oxygen as treatment for cardiorespiratory pathology in newborns is an accepted, regular practice. The prolonged use and high concentration of oxygen in premature newborn infants has been associated with an increase in cases of Proliferate Retinopathy in Premature Infants. This article publishes the results obtained over the past two years from the application of a treatment procedure which followed the recommendations made by the Standards Commission of the Spanish Association of Pediatricians regarding the measurement, administration and monitoring of oxygen to at risk newborn infants while evaluating the number of cases of retinopathy and their severity. Included in this study are all the newborns attended to at the Neonatal Intensive Care Unit of the "Arquitecto Marcide-Novoa Santos" Clinical Hospital in Ferrol from March 1995 to February 1997 which weighed less than 1500 grams or were born before the 36th week of gestation and received oxygen at a concentration above 50%. We encountered one case of level 3 retinopathy. In this case, we noticed a significant relationship among the point of gestation completed at birth, weight at birth and the severity of Proliferate Retinopathy in Premature Infants. We also proved that a painstaking control of oxygen allows a medical team to lower the degree of retinopathy in premature infants.
Subject(s)
Intensive Care, Neonatal/methods , Neonatal Nursing/methods , Oxygen Inhalation Therapy/methods , Retinopathy of Prematurity/nursing , Retinopathy of Prematurity/prevention & control , Birth Weight , Drug Monitoring/methods , Female , Gestational Age , Humans , Infant, Newborn , Male , Nursing Evaluation Research , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/nursing , Practice Guidelines as Topic , Retinopathy of Prematurity/etiology , Risk Factors , Severity of Illness IndexABSTRACT
After studying the factors which most often lead to the hospitalization, recuperation and treatment facilitating release from hospitalization of newborns affected by myelomeningocele, we present this treatment plan. One commences with an evaluation, after which various problems are detected. Once identified, establish priorities setting objectives to meet and their corresponding dates; continue by drawing up an action plan which lists those activities that help achieve one's objectives. The purpose of this plan is to provide individualized quality treatments as well as to create a relaxed, confidential atmosphere in which parents express their fears while becoming secure in their practice of those treatments their child needs in their home.
