Surgical site infection prevention bundle for children submitted to cardiac surgery.

OBJECTIVE: To build and validate the content and appearance of a surgical site infection prevention bundle for children submitted to cardiac surgery. METHOD: Methodological study in two phases: 1) Bundle construction from an integrative literature review from which interventions have been extracted to compose the instrument; 2) Bundle content and appearance validation by 24 judges. RESULTS: The 24 found articles presented 17 interventions for surgical site infection prevention in this population. Out of them, seven intervention proposals have been chosen to compose the bundle and sent for assessment by judges. The final proposal includes all the seven items chosen in the construction phase and has achieved a content validity index over 0.8 in all items referring to content and appearance. CONCLUSION: The content and appearance of the developed bundle proposes care for the prevention of surgical site infection throughout the perioperative period.

Surgical site infection prevention bundle for children submitted to cardiac surgery / Bundle para la prevención de la infección de sitio quirúrgico en los niños sometidos a cirugía cardíaca / Bundle de prevenção de infecção de sítio cirúrgico em crianças submetidas à cirurgia cardíaca

ABSTRACT Objective: To build and validate the content and appearance of a surgical site infection prevention bundle for children submitted to cardiac surgery. Method: Methodological study in two phases: 1) Bundle construction from an integrative literature review from which interventions have been extracted to compose the instrument; 2) Bundle content and appearance validation by 24 judges. Results: The 24 found articles presented 17 interventions for surgical site infection prevention in this population. Out of them, seven intervention proposals have been chosen to compose the bundle and sent for assessment by judges. The final proposal includes all the seven items chosen in the construction phase and has achieved a content validity index over 0.8 in all items referring to content and appearance. Conclusion: The content and appearance of the developed bundle proposes care for the prevention of surgical site infection throughout the perioperative period.

RESUMEN Objetivo: Construir y validar el contenido y la apariencia de un bundle para la prevención de las infecciones de sitio quirúrgico en niños sometidos a cirugía cardiaca. Método: Estudio metodológico en dos etapas: 1) Construcción del bundle a través de una revisión integrativa de la literatura de la cual se extrajeron las intervenciones para componer el instrumento; 2) Validación de contenido y apariencia del bundle, con 24 jueces. Resultados: Se encontraron 24 artículos que evidenciaron 17 intervenciones para la prevención de la infección de sitio quirúrgico en esta población. De estas, siete propuestas de intervención fueron elegidas para componer el bundle y enviadas para la apreciación de los jueces. La propuesta final incorpora todos los siete ítems elegidos en la etapa de construcción, llegando a un índice de validez de contenido superior a 0.8 para todos los ítems referentes al contenido y a la apariencia. Conclusión: El contenido y apariencia del bundle desarrollado propone cuidados para la prevención de la infección de sitio quirúrgico en todo el período perioperatorio.

RESUMO Objetivo: Construir e validar o conteúdo e a aparência de um bundle de prevenção de infecções de sítio cirúrgico em crianças submetidas à cirurgia cardíaca. Método: Estudo metodológico em duas etapas: 1) Construção do bundle a partir de uma revisão integrativa da literatura, na qual foram extraídas as intervenções para compor o instrumento; 2) Validação de conteúdo e aparência do bundle, com 24 juízes. Resultados: Foram encontrados 24 artigos que evidenciaram 17 intervenções para prevenção de infecção de sítio cirúrgico na referida população. Destas, sete propostas de intervenção foram elencadas para compor o bundle e enviadas para apreciação dos juízes. A proposta final incorpora todos os sete itens elencados na fase de construção, alcançando um índice de validade de conteúdo superior a 0,8 para todos os itens referentes ao conteúdo e aparência. Conclusão: O conteúdo e aparência do bundle desenvolvido propõe cuidados para prevenção de infecção de sítio cirúrgico em todo o período perioperatório.

Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS-1 Risk Score in a Brazilian Single Center.

Introduction: Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective: To analyze the in-hospital mortality in pediatric patients (<18 years) submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods: A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results: Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48%) and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014). Conclusion: RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.