ABSTRACT
BACKGROUND: Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies. METHODS: A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures. RESULTS: Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions. CONCLUSION: Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.
Subject(s)
Qualitative Research , Surgical Wound Infection/prevention & control , Antibiotic Prophylaxis , Antisepsis , Chlorhexidine/therapeutic use , Humans , Practice Guidelines as Topic , Therapeutic IrrigationABSTRACT
Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows.
Subject(s)
Abscess/etiology , Abscess/surgery , Fractures, Bone/complications , Hematoma/etiology , Hematoma/surgery , Nasal Septum/injuries , Nose/injuries , Child , Humans , MaleABSTRACT
El hematoma septal tras traumatismo nasal es una complicación que de no ser diagnosticada y tratada precozmente puede evolucionar a un absceso septal. Presentamos el caso de un varón de 10 años que sufrió traumatismo nasal con fractura de huesos propios y un hematoma septal que no fue diagnosticado, y cuya evolución fue un absceso septal. Durante el drenaje de este absceso se evidenció una necrosis del cartílago cuadrangular. Posteriormente el paciente presentó un hundimiento del dorso nasal y una desviación del tabique nasal. Esta secuela se corrigió mediante la utilización de un injerto osteocondral costal. Ante cualquier traumatismo nasal es importante explorar correctamente el tabique nasal para descartar un hematoma, que si no se drena de forma precoz, puede evolucionar a un absceso por compresión del cartílago cuadrangular, cuyas consecuencias son su necrosis en pocos días y posterior hundimiento del dorso nasal en el curso del desarrollo del niño
Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows
