Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: a multi-center incidence study.

INTRODUCTION: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. METHODS: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. RESULTS: In 2019, the cumulative incidence of SSIs was 10.6% (n = 80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. CONCLUTION: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions.

Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: A multi-center incidence study. / Evaluación de la infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio multicéntrico de incidencia.

INTRODUCTION: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. METHODS: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. RESULTS: In 2019, the cumulative incidence of SSIs was 10.6% (n=80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. CONCLUSION: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions.

Sequential antimicrobial therapy in mediastinitis after cardiac surgery: An observational study of 81 cases.

INTRODUCTION: Mediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients. METHODS: A retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route. RESULTS: Eighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2±10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57±34.03 vs. 84.35±45.67; P=0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P=0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P=0.366). CONCLUSION: Sequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs.

Colonization of the nasal airways by Staphylococcus aureus on admission to a major heart surgery operating room: A real-world experience.

INTRODUCTION: Nasal swab culture is used to identify Staphylococcus aureus colonization, as this is a major risk factor for surgical site infection (SSI) in patients who are going to undergo major heart surgery (MHS). We determined nasal carriage of S. aureus in patients undergoing MHS by comparing the yield of a conventional culture with that of a rapid molecular test (Xpert® SA Nasal Complete, Cepheid). METHODS: From July 2015 to April 2017, all patients who were to undergo MHS were invited to participate in the study. We obtained two nasal cultures from each patient just before entering the operating room, independently of a previous test for the determination of nasal colonization by this microorganism performed before surgery. One swab was used for conventional culture in the microbiology laboratory, and the other was used for the rapid molecular test. We defined nasal colonization as the presence of a positive culture for S. aureus using either of the two techniques. All patients were followed up until hospital discharge or death. RESULTS: Overall, 57 out of 200 patients (28.5%) were colonized by S. aureus at the time of surgery. Thirty-three patients had both conventional culture- and PCR-positive results. Twenty-four patients had a negative culture and a positive PCR test. Only twenty-one percent (12/57) of colonized patients had undergone an attempt to decolonise before the surgical intervention. CONCLUSION: A significant proportion of patients undergoing MHS are colonized by S. aureus in the nostrils on entering the operating room. New strategies to prevent SSI by this microorganism are needed. Rapid molecular tests immediately before MHS, followed by immediate decolonisation, must be evaluated. Trial Registration Clinical Trials.gov NCT02640001.

Conservative multimodal management of osteosynthesis material in surgical wounds with polymicrobial superinfection, including methicillin-resistant Staphylococcus aureus. Clinical case. / Manejo multimodal conservador de material de osteosíntesis ante herida quirúrgica con sobreinfección polimicrobiana, incluyendo Staphylococcus aureus resistente a meticilina. Caso clínico.

Retentive treatment of prosthetic material superinfected by resistant microorganisms is a challenge, especially when the causative agent is a methicillin-resistant Staphylococcus aureus. We present the successful conservative management of osteosynthesis material implanted due to ankle fracture in an elderly patient who suffered superinfection by the aforementioned microorganism, in which the antimicrobial treatment consisted of the combination of antibiotic-guided systemic antibiotics (after a first ineffective empirical cycle), together with topical irrigations of sevoflurane, applications of silver sulfadiazine cream, and subsequently coverage of the skin defect with negative pressure therapy. We highlight the novel role of sevoflurane as an analgesic and as a topical antimicrobial agent (in addition to silver sulfadiazine) in the favourable evolution of the wound, especially in the period in which the empirical antibiotic therapy was ineffective and negative pressure therapy had not yet been applied.

Caracterización de pacientes con infección de sitio quirúrgico en post-operados de cirugía abdominal de urgencias hospitalizados

Introducción: Las infecciones de sitio quirúrgico están asociadas con infecciones relacionadas a la asistencia sanitaria (IRAS), causadas por bacterias que ingresan a través de las incisiones efectuadas durante un procedimiento quirúrgico. Objetivo: Describir la frecuencia y características de las infecciones de sitio quirúrgico en las cirugías de urgencias en pacientes pediátricos hospitalizados en el Hospital General Pediátrico. Materiales y Métodos: Estudio observacional descriptivo, retrospectivo, de corte transversal. Población: Pacientes de 0 a 18 años sometidos a intervención quirúrgica abdominal de urgencia. Variables estudiadas: Edad, Sexo, Procedencia, Comorbilidad, reingreso hospitalario, tiempo trascurrido entre la intervención quirúrgica y la aparición de la infección en sitio quirúrgico. Datos obtenidos del análisis de fichas clínicas y la base de datos del HIS en el paquete estadístico SPSv23 (IBM SPSS, DEMO) utilizando estadística descriptiva. Resultados: Fueron incluidas 440 fichas de pacientes, la mediana de edad fue de 10 años, el 60,5% fueron del sexo masculino y el 71,4% procedían del Departamento Central. Se observó que el diagnóstico más frecuente fue peritonitis de origen apendicular 53,2%. El estado nutricional de la población en estudio fue normal en 93,2%, y fueron reingresos el 3% de los pacientes intervenidos. Presentaron infección de sitio quirúrgico el 4,8%, de los cuales 11/21 fueron absceso de pared. En cuanto al tiempo trascurrido entre la cirugía y la aparición de la infección la mediana fue de 14 días. Conclusión: La frecuencia de infección del sitio quirúrgico encontrada en este estudio fue del 4,8%. La patología quirúrgica con mayor porcentaje fue la peritonitis y el tipo de infección absceso de pared. La mayoría de los pacientes eran escolares con buen estado nutricional.

Introduction: Surgical-site infections are associated with healthcare-associated infections (HAIs), caused by bacteria that enter through the incisions made during a surgical procedure. Objective: To describe the frequency and characteristics of surgical site infections in emergency surgeries in pediatric patients hospitalized at a Pediatric General Hospital. Materials and Methods: This was a descriptive, retrospective and cross-sectional observational study. Population: Patients aged 0 to 18 years undergoing emergency abdominal surgery. Variables studied: Age, Sex, Origin, Comorbidity, hospital readmission, time elapsed between the surgical intervention and the appearance of the surgical site infection. Data obtained from the analysis of clinical records and the electronic health record database in the SPSv23 statistical package (IBM SPSS, DEMO) using descriptive statistics. Results: 440 patient records were included, the median age was 10 years, 60.5% were male and 71.4% came from the Central Department. It was observed that the most frequent diagnosis was peritonitis of appendiceal origin 53.2%. The nutritional status of the study population was normal in 93.2%, and 3% of the operated patients were readmitted. 4.8% had surgical site infection, of which 11/21 were wall abscesses. Regarding the time elapsed between surgery and the appearance of the infection, the median was 14 days. Conclusion: The frequency of surgical-site infection found in this study was 4.8%. The surgical pathology with the highest percentage was peritonitis and the wall abscess type of infection. Most of the patients were schoolchildren with good nutritional status.

Preoperative skin antisepsis. / Antisepsia cutánea antes de la cirugía.

Surgical wound infection is one of the main complications of patients undergoing surgery and has significant clinical and economical consequences, especially when it affects prosthetic implants or is caused by multidrug resistant bacteria. Cutaneous preparation is one of the main preventive measures. Clinical practice guidelines recommend not to remove the hair from the surgery site unless it interferes with the operation, and that if removal proves necessary, it should be done with a single-use cutter, as close as possible to the time of surgery. With regard to preoperative showering, the current recommendation is to perform it with a soap (whether antimicrobial or otherwise) or an antiseptic product, at least the night before surgery. Regarding preparation of the incision area and surrounding zone, the use of an alcohol-based antiseptic is generally advised, preferably alcoholic chlorhexidine, due to its high antibacterial activity and prolonged residual effect, respecting the evaporation drying time. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

[Antibiotic prophylaxis in prostatic surgery: Adherence to the hospital protocol. Prospective cohort study.] / Profilaxis antibiótica en cirugía de próstata: adecuación al protocolo hospitalario. Estudio de cohortes prospectivo.

OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR=1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR=0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence.

OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata.MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR=1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR=0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico.

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis.

OBJECTIVE: To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. METHODS: A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. RESULTS: In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. CONCLUSION: The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

[Presurgical preparation and surgical site infection in neck surgery. The effect of the protocol adequacy in the improvement of the health care quality]. / Impacto de la adecuación del protocolo de preparación prequirúrgica en la incidencia de infección de localización quirúrgica en cirugía cervical.

BACKGROUND: Surgical wound infection is one of the leading causes of healthcare-associated infections. One of the most common measures for its reduction is the pre-surgical preparation. The aim of this study was to evaluate the adequacy to the pre-surgical protocol in patients undergoing neck surgery and the relationship with the incidence of surgical wound infection. MATERIAL AND METHODS: Observational cohort study, conducted from January 2011 to December 2017. Variables related to patient, pre-surgical preparation and infection were collected. Infection rate was calculated after a maximum period of 30days after surgery. The effect of the pre-surgical preparation's adequacy and infection was evaluated. RESULTS: The study included 131 patients. The global adequacy of the pre-surgical protocol was 84.7%, being the main cause of inadequacy the application of the mouthwash (7.6% of the interventions). The overall incidence of surgical wound infection during the follow-up period was 4.6% (95%CI: 1.0%-8.2%). No relationship between the adequacy to the protocol and the presence of infection was found (P=.59). CONCLUSIONS: Adequacy of the pre-surgical preparation in our hospital was high and the incidence of surgical wound infection was low, and no relationship was found between the two. The results show a high safety culture in this surgery. However, there is still room for improvement in the quality of care of our patients.

Development and validity of serious game for teaching-learning in surgical site infection prevention / Desarrollo y validación de un juego serio para la enseñanza-aprendizaje sobre la prevención de infecciones del sitio quirúrgico / Desenvolvimento e validação de serious game para ensino-aprendizagem de prevenção de infecção de sítio cirúrgico

ABSTRACT Objective: To develop and validate serious game for teaching-learning regarding surgical site infection prevention. Method: This is a methodological study conducted in stages: game content development and validity based on virtual simulation (preparation, participation and debriefing) and challenges; game development, following the concept, pre-production, prototype, production and post-production stages; and usability validity, using an instrument called Heuristic Evaluation for Digital Educational Games. To assess the game content and usability, 12 nurses and 08 experts in digital games were involved. Results: The serious game script contained three sequential pre-, intra- and post-operative periods, focusing on nursing interventions aimed at preventing surgical site infections. A Content Validity Coefficient above 0.80 was obtained for game content. Regarding gameplay assessment using the assessed heuristics, all statements present in game script were considered adequate, and adjustments were implemented regarding feedback, access to the theoretical framework on preventing surgical site infections, the inclusion of images in the study material and directing players to the debriefing session. Conclusion: The serious game developed was considered valid and a potential pedagogical tool in nursing for learning how to prevent surgical site infections.

RESUMEN Objetivo: desarrollar y validar el serious game para la enseñanza-aprendizaje sobre la prevención de infecciones del sitio quirúrgico. Método: estudio metodológico realizado por etapas: desarrollo y validación del contenido del juego, basado en simulación virtual (preparación, participación y debriefing) y desafíos; desarrollo de juegos, siguiendo las etapas de concepto, preproducción, prototipo, producción y postproducción; y validación de usabilidad mediante el instrumento Heuristic Evaluation for Digital Educational Games. Para evaluar el contenido y usabilidad del juego participaron 12 enfermeros y 08 expertos en juegos digitales. Resultados: el guión del serious game contenía tres períodos pre, intra y postoperatorios secuenciales, centrándose en intervenciones de enfermería destinadas a prevenir infecciones del sitio quirúrgico. Se obtuvo un Coeficiente de Validez de Contenido superior a 0,80 para el contenido del juego. En cuanto a la evaluación de la jugabilidad mediante las heurísticas evaluadas, todas las afirmaciones presentes en el guión del juego fueron consideradas adecuadas y se implementaron ajustes en cuanto a retroalimentación, acceso al marco teórico sobre prevención de infecciones del sitio quirúrgico, inclusión de imágenes en el material de estudio y orientación del jugador en la sesión de debriefing. Conclusión: el serious game desarrollado se consideró válido y potencial herramienta pedagógica en el área de enfermería para aprender a prevenir infecciones del sitio quirúrgico.

RESUMO Objetivo: desenvolver e validar serious game para o ensino-aprendizagem referente à prevenção de infecção de sítio cirúrgico. Método: estudo metodológico conduzido por etapas: desenvolvimento e validação do conteúdo do jogo, baseados na simulação virtual (preparação, participação e debriefing) e desafios; desenvolvimento do jogo, seguindo as etapas de conceito, pré-produção, protótipo, produção e pós-produção; e, validação da usabilidade, por meio do instrumento Heuristic Evaluation for Digital Educational Games. Para avaliação do conteúdo e usabilidade do jogo, contou-se com 12 enfermeiros e 08 especialistas em jogos digitais. Resultados: o script do serious game conteve três períodos sequenciais pré, intra e pós-operatório, com enfoque em intervenções de enfermagem voltadas para prevenção de infecção de sítio cirúrgico. Obteve-se um Coeficiente de Validade de Conteúdo acima de 0,80 para o conteúdo do jogo. Referente à avaliação da jogabilidade pelas heurísticas avaliadas, todas as afirmativas presentes no script do jogo foram consideradas adequadas e houve a implementação de ajustes no que se refere ao feedback, ao acesso ao referencial teórico sobre prevenção de infecção de sítio cirúrgico, à inclusão de imagens no material de estudo e ao direcionamento do jogador à sessão de debriefing. Conclusão: o serious game desenvolvido foi considerado válido e potencial ferramenta pedagógica na área de enfermagem para aprendizagem da prevenção de infecção de sítio cirúrgico.

Factores clínicos asociados con mortalidad y multirresistencia en pacientes quirúrgicos de un hospital de alta complejidad / Clinical factors associated with mortality and multi-drug-resistance among surgical patients at a high complexity hospital

Introducción: el aumento de la morbimortalidad causada por gérmenes multirresistentes debido a la dicultad cada vez mayor para encontrar opciones de tratamiento, hace que hoy sea importante la identicación de los principales factores clínicos que se asocian con multirresistencia en pacientes quirúrgicos. Objetivo: determinar los factores clínicos relacionados con mortalidad y multirresistencia en quienes se someten a procedimientos quirúrgicos en un hospital de alta complejidad en Cartagena, Colombia. Materiales y Métodos: estudio descriptivo de corte transversal retrospectivo, con muestra proyectada de 150 pacientes quirúrgicos que cumplieran con los criterios de elegibilidad, a quienes se realizaron análisis uni y bivariados para establecer asociación entre muerte e infección por bacterias multirresistentes. Resultados y discusión: los factores clínicos asociados estadísticamente con mortalidad, en su mayoría se relacionan con antecedentes como hipertensión (p=0,001), anemia (p=0,044) e inmunosupresión (p=0,012), y con la multirresistencia son anemia (p=0,009), insuciencia cardiaca (p=0,017) y ser de procedencia urbana (p=0,013) Conclusiones: la mortalidad de pacientes quirúrgicos se asocia de manera importante con los antecedentes clínicos y la multirresistencia no está determinada por los procedimientos médicos, ni por el tipo de intervención quirúrgica.

Introduction: the increase of morbidity and mortality caused by multi-drug-resistant bacteria due to the expanding difficulty in finding treatment options, makes identifying the main clinical factors associated with multi-drug -resistance among surgical patients, important. Objective: to determine the clinical factors related to mortality and multi-drug ­ resistance (MDR) in patients who undergo surgical procedures at a high complexity hospital in Cartagena, Colombia. Materials and Methods: a descriptive retrospective cross-sectional study, including a projected sample size of 150 surgical patients who met the eligibility criteria, using univariate and bivariate analyses to establish the association between death and infection by multi-resistant bacteria. Results and Discussion: the leading clinical factors statistically associated with mortality are antecedent hypertension (p=0.001), anemia (p=0.044) and immunosuppression (p=0.012), and factors associated with the development of MDR are anemia (p=0.009), heart failure (p=0.017) and urban origin (p=0.013) Conclusions: mortality among surgical patients is significantly associated with past clinical history. MDR is not determined by medical procedures, nor by the type of surgical intervention.

Cambio rutinario de instrumental y guantes quirúrgicos en cirugía abdominal: ¿cuál es el impacto sobre el riesgo de infección? / Routine change of surgical instruments and gloves in abdominal surgery: what is the impact on the risk of infection?

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)

Tecnologias de cuidados de enfermagem em unidade de terapia intensiva no contexto da infecção de sítio cirúrgico / Nursing care technologies in intensive care units in the context of surgical site infection / Tecnologías de cuidados de enfermería en unidades de cuidados intensivos en el contexto de la infección del sitio quirúrgico

Objetivo: explanar as tecnologias de cuidados utilizadas pelos enfermeiros intensivistas na prevenção de ISC e no tratamento de feridas operatórias infectadas. Método: revisão integrativa da literatura com abordagem descritiva exploratória e natureza qualitativa. Os descritores ""Tecnologias em saúde", Tecnologias de cuidado em Enfermagem", "Enfermagem", "Enfermeiro intensivista" "Unidade de Terapia Intensiva", "Infecção de Sítio Cirúrgico", "Ferida operatória infectada" e "Infecção de ferida cirúrgica", foram explorados em bancos de dados virtuais. A partir da análise dos dados foram criadas duas categorias para realização da análise temática. Resultados: Após a análise, doze artigos foram selecionados. Ressaltou-se a relevância da lista de verificação de cirurgia segura, classificada como tecnologia em saúde leve ­ dura, ser atentada pelos profissionais de enfermagem, a fim de prevenir as ISC. O estudo apresentou dados corroborando a redução do número de ocorrências diante da observância do checklist de segurança cirúrgica ao constatar, portanto, a eficiência preventiva dessa tecnologia. Conclusão: destaca-se a necessidade de pesquisas voltadas a atuação do enfermeiro intensivista na utilização de tecnologias do cuidado em saúde classificadas como dura, junto a metodologias de pesquisas mais confiáveis.

Objective: to explain the care technologies used by intensive care nurses in the prevention of SSI and in the treatment of infected surgical wounds. Method: integrative literature review with exploratory descriptive approach and qualitative nature. The descriptors "Health Technologies", Nursing Care Technologies", "Nursing", "Intensive Care Nurse" "Intensive Care Unit", "Surgical Site Infection", "Infected Surgical Wound" and "Surgical Wound Infection", were explored in virtual databases. From the data analysis, two categories were created to perform the thematic analysis. Results: After the analysis, twelve articles were selected. The relevance of the safe surgery checklist, classified as light health technology ­ hard, was emphasized, being attentive by nursing professionals, in order to prevent SAIs. The study presented data corroborating the reduction in the number of occurrences in view of the observance of the surgical safety checklist, thus verifying the preventive efficiency of this technology. Conclusion: we highlight the need for research focused on the role of intensive care nurses in the use of health care technologies classified as harsh, together with more reliable research methodologies.

Objetivo: explicar las tecnologías de cuidado utilizadas por las enfermeras de cuidados intensivos en la prevención de la ISQ y en el tratamiento de heridas quirúrgicas infectadas. Método: revisión integradora de la literatura con enfoque descriptivo exploratorio y de naturaleza cualitativa. Los descriptores "Tecnologías de la Salud", Tecnologías de Cuidados de Enfermería", "Enfermería", "Enfermera de Cuidados Intensivos", "Unidad de Cuidados Intensivos", "Infección del Sitio Quirúrgico", "Herida Quirúrgica Infectada" e "Infección de herida quirúrgica", fueron explorados en bases de datos virtuales. A partir del análisis de los datos, se crearon dos categorías para realizar el análisis temático. Resultados: Tras el análisis, se seleccionaron doce artículos. Se enfatizó la relevancia de la lista de verificación de cirugía segura, clasificada como tecnología de salud ligera ­ dura, siendo atenta por los profesionales de enfermería, con el fin de prevenir las EFS. El estudio presentó datos que corroboran la reducción en el número de ocurrencias en vista de la observancia de la lista de verificación de seguridad quirúrgica, verificando así la eficiencia preventiva de esta tecnología. Conclusión: destacamos la necesidad de investigación centrada en el papel de las enfermeras de cuidados intensivos en el uso de tecnologías de atención médica clasificadas como duras, junto con metodologías de investigación más confiables.

Aplicabilidade da Nursing Activities Score para avaliação da carga de trabalho da enfermagem nas unidades de terapia intensiva / Applicability of nursing activities score to assess nursing workload in intensive care units / Puntuación de aplicabilidad de las actividades de enfermería para evaluar la carga de trabajo de enfermería en unidades de cuidados intensivos

Objetivo: Analisar as produções científicas quanto ao uso da Nursing Activities Score e a carga de trabalho da enfermagem nas Unidade de Terapia Intensiva. Método: Trata-se de uma pesquisa de revisão integrativa, com abordagem qualitativa, exploratória e descritiva. A pesquisa ocorreu entre os meses de novembro e dezembro, ano de 2022. Nas seguintes bases de dados: Portal de Periódicos da CAPES, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrievel System Online, Google acadêmico e Scientific Electronic Library Online. Resultados: A pesquisa reuniu 10 artigos sobre o tema, o quais foram analisados conforme o Sistema GRADE e colocados em quadro único para melhor exposição. Conclusão: planejar e organizar uma UTI baseada em evidências traz benefícios. Uma assistência fundamentada e com direcionamento promove a saúde dos pacientes de forma eficaz

Objective: To analyze the scientific production regarding the use of the Nursing Activities Score and the nursing workload in the intensive care unit. Method: This is an integrative review research, with a qualitative, exploratory and descriptive approach. The research took place between November and December, in the year 2022. In the following databases: Portal de Periódicos da CAPES, Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, Google Scholar and Scientific Electronic Library Online. Results: The research brought together 10 articles on the subject, which were analyzed according to the GRADE System and placed in a single frame for better exposure. Conclusion: planning and organizing an evidence-based ICU brings benefits. A reasoned and targeted assistance promotes the health of patients effectively.

Objetivo: evidenciar a través de una revisión integradora los resultados clínicos actuales de la suplementación con glutamina en la mejora de la salud intestinal, a través de síntomas y pruebas bioquímicas. Método: Revisión integradora de la literatura realizada en el periodo de septiembre de 2021 en las bases de datos Pubmed y Scielo. Resultados: Se realizó una búsqueda de los descriptores de salud definidos y se seleccionaron 08 producciones científicas que cumplieron con los criterios de inclusión. Conclusión: Se sugiere investigación adicional para dilucidar las dosis, los efectos secundarios y las respuestas terapéuticas de la glutamina en los parámetros de salud intestinal

Análise dos fatores da infeção do local cirúrgico em doentes submetidos a cirurgia ortopédica major / Analysis of risk factors for surgical site infection in patients undergoing major orthopedic surgery / Análisis de los factores de infección del sitio quirúrgico en pacientes sometidos a cirugía ortopédica mayor

Resumo Enquadramento: A infeção do local cirúrgico afeta um terço dos doentes cirúrgicos e a incidência varia consoante múltiplos fatores. Objetivo: Analisar os fatores associados à infeção do local cirúrgico na cirurgia ortopédica major. Metodologia: Estudo transversal analítico, realizado em 589 doentes submetidos a cirurgia ortopédica major entre 2020 e 2021. Recolheu-se informação constante do Sclínico, através de grelha de registo, sobre o doente, cirurgia e cumprimento de bundles. Aprovação da Comissão de Ética (N.º 46/2022). Resultados: A frequência de infeção foi (3,9%), maioritariamente do sexo masculino (56,5%), entre os 57 e 78 anos (60,9%,) índice de massa corporal elevado (91,3%), hipertensão arterial (73,9%), tabagismo (14,09%), insuficiência cardíaca (9,3%) e tremor (33,3%). Verifica-se associação, estatisticamente significativa, entre infeção do local cirúrgico e tabagismo, insuficiência cardíaca, tremor, duração da cirurgia, tempo pós-operatório e tipo de cirurgia. Conclusão: A frequência de infeção foi significativa para os fumadores com insuficiência cardíaca, tremor, maiores tempos cirúrgicos e de internamento. Sugere-se a redução tabágica, controlo da insuficiência cardíaca e diminuição dos tempos cirúrgicos e de internamento.

Abstract Background: Surgical site infection affects one-third of surgical patients. Its incidence varies according to multiple factors. Objective: To analyze risk factors for surgical site infection in patients undergoing major orthopedic surgery. Methodology: Analytical cross-sectional study with 589 patients who underwent major orthopedic surgery between 2020 and 2021. Information on the patient, the surgery, and the compliance with bundles was collected from the Sclínico platform using a registration grid. Favorable opinion of the Ethics Committee (No. 46/2022). Results: Twenty-three participants (3.9%) developed surgical site infections. They were mostly men (56.5%), aged 57 to 78 years (60.9%,) with a high body mass index (91.3%), hypertension (73.9%), smoking habits (14.09%), heart failure (9.3%), and tremor (33.3%). A statistically significant association was found between surgical site infection and smoking, heart failure, tremor, duration of surgery, postoperative time, and type of surgery. Conclusion: The frequency of infection was significant in patients with smoking habits, heart failure, tremor, and longer surgical and hospitalization times. We recommend reducing smoking, controlling heart failure, and decreasing surgical and hospitalization times.

Resumen Marco contextual: La infección del sitio quirúrgico afecta a un tercio de los pacientes quirúrgicos y su incidencia varía en función de múltiples factores. Objetivo: Analizar los factores asociados a la infección del sitio quirúrgico en una cirugía ortopédica mayor. Metodología: Estudio transversal analítico realizado en 589 pacientes sometidos a cirugía ortopédica mayor entre 2020 y 2021. La información sobre el paciente, la cirugía y el cumplimiento de los paquetes de medidas se recogió del Sclínico mediante una plantilla de registro. Aprobado por el Comité de Ética (N.º 46/2022). Resultados: La frecuencia de infección fue del 3,9%, mayoritariamente masculina (56,5%), entre 57 y 78 años (60,9%,) con índice de masa corporal elevado (91,3%), hipertensión (73,9%), tabaquismo (14,09%), insuficiencia cardiaca (9,3%) y temblor (33,3%). Hubo una asociación estadísticamente significativa entre la infección del sitio quirúrgico y el tabaquismo, la insuficiencia cardíaca, el temblor, la duración de la intervención, el tiempo posoperatorio y el tipo de cirugía. Conclusión: La frecuencia de infección fue significativa en los fumadores con insuficiencia cardiaca, temblor y tiempos quirúrgicos y de hospitalización más largos. Se propone la reducción del tabaquismo, el control de la insuficiencia cardiaca y la reducción de los tiempos quirúrgicos y de hospitalización.

Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study / Factores asociados a la infección del sitio quirúrgico en la revascularización miocárdica: estudio longitudinal retrospectivo / Fatores associados à infecção de sítio cirúrgico em revascularização miocárdica: estudo longitudinal retrospectivo

ABSTRACT Objectives: to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization. Methods: an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed. Results: surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p<0.001), and the occurrence of infection. Conclusions: body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.

RESUMEN Objetivos: analizar la influencia de variables sociodemográficas y clínicas, así como del puntaje de adherencia a la lista de verificación quirúrgica en aparición de infección del sitio quirúrgico en pacientes sometidos a revascularización miocárdica. Métodos: estudio observacional, longitudinal y retrospectivo realizado en un hospital universitario con 266 expedientes de pacientes sometidos a cirugía de revascularización miocárdica. Se utilizaron instrumentos que contenían variables sociodemográficas, clínicas y relacionadas con la incidencia de infecciones del sitio quirúrgico, así como la Lista de Verificación de Seguridad Quirúrgica Perioperatoria. Se realizaron análisis descriptivos, bivariados y de regresión logística. Resultados: la infección del sitio quirúrgico se produjo en 89 (33,5%) pacientes. Hubo una asociación estadísticamente significativa entre la temperatura fuera del rango de 36°C a 36,5°C(p=0,01), la presencia de dispositivos invasivos(p=0,05) y los procedimientos quirúrgicos con previsión de eventos críticos(p<0,001) y la aparición de infección. Conclusiones: la temperatura corporal, presencia de dispositivos invasivos y los procedimientos quirúrgicos con previsión de eventos críticos fueron factores significativos para aumentar el riesgo de infección.

RESUMO Objetivos: analisar a influência de variáveis sociodemográficas e clínicas e do escore de adesão ao checklist cirúrgico sobre a ocorrência de infecção de sítio cirúrgico entre pacientes submetidos à revascularização miocárdica. Métodos: estudo observacional, longitudinal, retrospectivo, realizado em hospital universitário, com 266 prontuários de pacientes submetidos à cirurgia de revascularização miocárdica. Utilizaram-se instrumentos contendo variáveis sociodemográficas, clínicas e relacionadas à incidência de infecções de sítio cirúrgico; e a Lista de Verificação de Segurança Cirúrgica Perioperatória. Empregaram-se análises descritivas, bivariadas e regressão logística. Resultados: a infecção de sítio cirúrgico ocorreu em 89 (33,5%) pacientes. Houve associação estatisticamente significativa entre temperatura fora da faixa entre 36°C e 36,5°C (p=0,01), presença de dispositivos invasivos (p=0,05) e procedimentos cirúrgicos com previsão de eventos críticos (p<0,001) e ocorrência de infecção. Conclusões: temperatura corporal, presença de dispositivos invasivos e procedimentos cirúrgicos com previsão de eventos críticos foram fatores significativos para o aumento do risco de infecção.

Infecção do sítio cirúrgico em pacientes submetidos a cirurgias neurológicas e ortopédicas / Infección del sitio quirúrgico en pacientes sometidos a cirugía neurológica y ortopédica / Surgical site infection in patients submitted to neurological and orthopedic surgeries abstract

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.

Toalhas impregnadas com gluconato de clorexidina na prevenção da infecção do sítio cirúrgico: ensaio clínico randomizado piloto / Toallas impregnadas con gluconato de clorhexidina en la prevención de infecciones del sitio quirúrgico: ensayo clínico aleatorizado piloto / Chlorhexidine gluconate-impregnated cloth in prevention surgical site infection: pilot randomized clinical trial

Resumo Objetivo Comparar o uso de toalhas impregnadas com gluconato de clorexidina 2% e gluconato de clorexidina 2% líquida no preparo pré-operatório da pele para prevenir a ocorrência de infecção do sítio cirúrgico em pacientes submetidos a cirurgias eletivas potencialmente contaminadas. Métodos Ensaio clínico randomizado, piloto paralelo, simples-cego composto por 48 pacientes submetidos a cirurgias eletivas potencialmente contaminadas que foram aleatoriamente designados para o grupo intervenção (n=25, toalhas impregnadas com gluconato de clorexidina 2%) e grupo controle (n=23, banho pré-operatório com gluconato de clorexidina líquida 2%). O desfecho primário foi infecção do sítio cirúrgico dentro de 30 dias após a cirurgia. Os pacientes foram instruídos a usar os produtos na noite anterior e na manhã da cirurgia e receberam instruções verbais e escritas sobre o uso. Foram utilizados os testes Wilcoxon-Mann-Whitney, teste T para duas amostras, Pearson X2 e testes exatos de Fisher, risco relativo (RR) e intervalo de confiança de 95%. O nível de significância para todas as variáveis foi estabelecido em α = 5%. Resultados Oito (16,7%) dos 48 pacientes analisados desenvolveram infecção do sítio cirúrgico. Não houve diferenças estatisticamente significativas entre os grupos quanto à incidência de infecção do sítio cirúrgico (RR: 0,92; IC 95%: 0,25-3,25; p=0,898), contudo, não houve casos de infecção do sítio cirúrgico incisional superficial no grupo intervenção. Conclusão O uso de toalhas impregnadas com gluconato de clorexidina 2% para preparo pré-operatório da pele não apresentou diferença estatisticamente significativa na prevenção de infecção do sítio cirúrgico em comparação com o uso de banho pré-operatório com gluconato de clorexidina 2% líquida. Registro brasileiro de ensaios clínicos: RBR-8httxs Registrado em ClinicalTrials.gov: NCT03813693

Resumen Objetivo Comparar el uso de toallas impregnadas con gluconato de clorhexidina 2 % y gluconato de clorhexidina 2 % líquida en la preparación preoperatoria para prevenir casos de infección del sitio quirúrgico en pacientes sometidos a cirugías electivas potencialmente contaminadas. Métodos Ensayo clínico aleatorizado, piloto paralelo, simple ciego, compuesto por 48 pacientes sometidos a cirugías electivas potencialmente contaminadas que fueron designados aleatoriamente al grupo experimental (n=25, toallas impregnadas con gluconato de clorhexidina 2 %) y al grupo de control (n=23, baño preoperatorio con gluconato de clorhexidina líquida 2 %). El criterio principal de valoración fue la infección del sitio quirúrgico dentro de los 30 días posteriores a la cirugía. Se instruyó a los pacientes a usar los productos la noche anterior y a la mañana del día de la cirugía y recibieron instrucciones orales y escritas sobre su uso. Se utilizaron las pruebas de Wilcoxon-Mann-Whitney, test-T para dos muestras, χ2 de Pearson y pruebas exactas de Fisher, riesgo relativo (RR) e intervalo de confianza de 95 %. El nivel de significación para todas las variables fue establecido en α = 5 %. Resultados Ocho (16,7 %) de los 48 pacientes analizados presentaron infección del sitio quirúrgico. No hubo diferencias estadísticamente significativas entre los grupos respecto a la incidencia de infección del sitio quirúrgico (RR: 0,92; IC 95 %: 0,25-3,25; p=0,898). No obstante, no hubo casos de infección del sitio quirúrgico incisional superficial en el grupo experimental. Conclusión El uso de toallas impregnadas con gluconato de clorhexidina 2 % en la preparación preoperatoria de la piel no presentó diferencia estadísticamente significativa en la prevención de infecciones del sitio quirúrgico en comparación con el uso del baño preoperatorio con gluconato de clorhexidina 2 % líquida.

Abstract Objective To compare the use of 2% chlorhexidine gluconate-impregnated cloth and 2% liquid chlorhexidine gluconate in the preoperative skin preparation to prevent the occurrence of surgical site infections in patients undergoing clean-contaminated elective surgeries. Methods Parallel, single-blind, pilot study of the randomized clinical trial (RCT), composed by forty-eight patients underwent clean-contaminated elective surgeries were randomly assigned to the intervention group (n=25, 2% chlorhexidine gluconate-impregnated cloth) and the control group (n=23, pre-operative bathing with 2% liquid chlorhexidine gluconate). The primary outcome was surgical site infection within 30 days after surgery. The patients were instructed to use the products at the night before and at the morning of surgery and received verbal and written instruction on their use. The tests Wilcoxon-Mann-Whitney, Two Sample t-test, Pearson X2 and Fisher's exact tests, risk relative (RR) and 95% confidence interval (CI) were used. The level of significance for all variables was set at α = 5%. Results 48 patients analyzed, eight (16.7%) developed a surgical site infection. There were no statistically significant differences between the groups regarding the incidence of surgical site infection (RR: 0.92; 95% CI: 0.25-3.25; p=0.898), however there were not cases of superficial incisional surgical site infection in the intervention group. Conclusion The use of 2% chlorhexidine gluconate-impregnated cloth for preoperative skin preparation did not reveal a statistically significant difference in the prevention of surgical site infection compared to the use of pre-operative bathing with 2% liquid chlorhexidine gluconate. Brazilian clinical trial registry: RBR-8httxs Registered at ClinicalTrials.gov: NCT03813693

Patient participation in surgical site infection prevention: perceptions of nurses, physicians and patients / Participación del paciente en la prevención de la infección del sitio quirúrgico: percepciones de enfermeras, médicos y pacientes / Participação do paciente na prevenção de infecção do sítio cirúrgico: percepções de enfermeiros, médicos e pacientes

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.