Evaluation of a preventive surgical site infection bundle in colorectal surgery.

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P=.03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P=.04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P=.001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery.

Evaluación de un paquete de medidas para la prevención de la infección de localización quirúrgica en cirugía colorrectal / Evaluation of a preventive surgical site infection bundle in colorectal surgery

OBJETIVO: Evaluar la efectividad de un protocolo para la prevención de la infección de localización quirúrgica (ILQ) en cirugía colorrectal. PACIENTES Y MÉTODOS: Evaluación de 2 cohortes de pacientes intervenidos de colon y recto en un hospital público de tercer nivel: una cohorte histórica (2008-2011) y otra prospectiva (posterior a la implementación del programa en 2012). Las principales medidas establecidas fueron: adecuación de la profilaxis antimicrobiana prequirúrgica, mantenimiento de la normotermia del paciente en el quirófano y adecuación del cambio de guante durante la intervención. Se determinó la comparabilidad de ambas cohortes mediante un análisis bivariable de la edad, sexo, factores e índices de riesgo (índice NNIS, índice ASA, tiempos quirúrgicos, transfusión periquirúrgica, diagnóstico, diabetes, insuficiencia renal). RESULTADOS: Se evaluó a 342 pacientes (256 intervenidos de colon y 86 de recto), distribuidos en 2 cohortes: periodo previo (218) y periodo postimplementación del programa (124). La incidencia acumulada de ILQ de la primera cohorte fue del 27,5% (IC 95% = 21,6-33,4), y de la cohorte postintervención 16,9% (IC 95% = 10,3-23,5; p = 0,03). La mortalidad postoperatoria fue del 9,2% (IC 95% = 5,4-13) en la primera cohorte y del 3,2% (IC 95% = 0,1-6,3) en la cohorte postintervención (p = 0,04). La administración inadecuada de la profilaxis disminuyó del 37,4% (IC 95% = 30,4-44,6) al 18,9% (IC 95% = 11,9-26,1; p = 0,001). CONCLUSIONES: Tras la implementación de un protocolo para la prevención de la infección quirúrgica en cirugía colorrectal se verifica una disminución significativa de la frecuencia de ILQ, de la mortalidad posquirúrgica y de la profilaxis antimicrobiana inadecuada

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P = .03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P = .04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P = .001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery

[A hand hygiene education program. Comparison between handwashing and the use of alcohol solutions]. / Programa de formación sobre la higiene de las manos. Estudio comparativo aleatorizado del lavado higiénico y el uso de soluciones alcohólicas.

OBJECTIVE: To analyze the results of a hand hygiene education program in nursing staff, and to compare the efficacy of handwashing with and without the application of alcohol solutions. METHOD: A hand hygiene educational program was applied in nursing professionals through theoretical and practical workshops. The workshops were evaluated through a student satisfaction survey. During the training period, a prospective randomized study was performed and the students were divided into 3 groups. The results of routine handwashing, handwashing after the training period, and the application of alcohol solutions were compared. A hand culture was taken from all participants before and after each intervention and the reduction in the number of colony-forming units (CFU) was evaluated. In a fourth group, artificial contamination was performed and the effectiveness of routine handwashing was analyzed by detection of residual contamination with ultraviolet light. RESULTS: Seventy-three workshops were imparted, with 792 students (462 nurses, 26 midwives and 304 nursing auxiliaries). Overall evaluation of the course was 8.3/10 and the trainers' score was 9/10. The mean reduction in CFU was 100.7 in the routine handwashing group, 100.3 in the group performing handwashing according to the protocol, and 118.2 in the alcohol solution group (p = 0.026). CONCLUSIONS: The hand hygiene training program was well regarded by the nursing staff. The reduction in bacterial count was greater when alcohol solutions were used than in other forms of handwashing.