RESUMO
OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.
OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Cesárea/efeitos adversos , Infecção Hospitalar/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Fatores de Risco , Cocos Gram-Positivos/isolamento & purificação , Enterococcus faecalis/isolamento & purificação , Ferida Cirúrgica/microbiologia , Abdome/cirurgia , Honduras , Hospitais Públicos/estatística & dados numéricos , Klebsiella pneumoniae/isolamento & purificação , Laparotomia/efeitos adversosRESUMO
ABSTRACT Objective: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients. Methods: This was a retrospective cohort study involving 173 adult patients submitted to "clean" craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections. Results: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n= 8), 8.49% (n= 9), and 9.43% (n= 10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n= 7), 14.92% (n= 10), and 14.92% (n= 10), respectively. Conclusion: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Infecção da Ferida Cirúrgica/epidemiologia , Craniotomia/efeitos adversos , Monitoramento Epidemiológico , Fatores de Tempo , Brasil/epidemiologia , Incidência , Estudos Retrospectivos , Fatores de Risco , Infecções Relacionadas à Prótese/epidemiologia , Hospitais UniversitáriosRESUMO
A infecção de sítio cirúrgico (ISC) é uma complicação que pode acometer o paciente, acarretando incremento da mortalidade e morbidade, bem como aumento dos custos em saúde. A videocirurgia surgiu como opção menos invasiva de acesso à cavidade abdominal, reduzindo as taxas de ISC, mas nem mesmo a modernização gerada pela cirurgia minimamente invasiva conseguiu extinguir esse tipo de infecção. O presente estudo teve como objetivo geral analisar a ocorrência e os fatores de risco de infecção de sítio cirúrgico, em pacientes submetidos à colecistectomia videolaparoscópica. Trata-se de estudo descritivo exploratório conduzido em hospital de pequeno porte, localizado no sudoeste de Minas Gerais. A amostra foi composta por 118 pacientes. Para a coleta de dados, elaborou-se instrumento, o qual foi submetido à validação de face e conteúdo por estudiosos da área de conhecimento de enfermagem perioperatória. A coleta dos dados foi realizada no período de março a novembro de 2016 e, em três momentos, a saber: perioperatório, retorno ambulatorial e busca ativa fonada. Os dados foram coletados pelo pesquisador e um auxiliar de pesquisa devidamente treinados. A ocorrência de ISC foi de 5,9% (n=7), sendo todos os casos diagnosticados como infecção incisional superficial. As variáveis investigadas relacionadas ao paciente foram sexo, faixa etária, Índice de Massa Corporal, presença de doença crônica e classificação ASA. As variáveis estudadas relacionadas ao procedimento anestésico-cirúrgico foram tempo total de internação, porte cirúrgico, tempo de anestesia e tempo de cirurgia. Os resultados não apresentaram diferença estatisticamente entre as variáveis de interesse e a presença de ISC. Todos os casos de ISC foram diagnosticados, após a alta hospitalar, desses, seis pacientes (86%) tiveram o diagnóstico no retorno ambulatorial, e um paciente (14%) foi diagnosticado durante a busca ativa fonada. A condução do estudo oferece subsídios para a compreensão da problemática, no âmbito nacional. Além disso, gerou evidências para a reflexão dos profissionais de saúde em relação à subnotificação desse tipo de infecção em cirurgia minimamente invasiva, reforçando a necessidade de implantação de programa de vigilância pós-alta, nos serviços de saúde
Surgical site infection (SSI) is a complication that can affect the patient, leading to an increase in mortality and morbidity, as well as an increase in health costs. Video surgery emerged as a less invasive option for access to the abdominal cavity, reducing SSI rates; however, not even the improvement generated by minimally invasive surgery was enough to eliminate this type of infection. This study aimed to analyze the occurrence and risk factors of surgical site infection in patients submitted to laparoscopic cholecystectomy. It is an exploratory-descriptive study conducted in a small hospital, located in the southwest of Minas Gerais. The sample consisted of 118 patients. An instrument was developed for data collection, which was submitted to face and content validation by experts in perioperative nursing. Data collection was performed from March to November 2016 and, in three stages: perioperative, outpatient return and active phone search. Data were collected by the researcher and a properly trained research assistant. The occurrence of SSI was 5.9% (n=7), being all cases diagnosed as superficial incisional infection. The studied variables related to the patient were gender, age, Body Mass Index, presence of chronic disease and ASA classification. The studied variables related to the anesthetic surgical procedure were total length of hospitalization, surgical procedure size, time of anesthesia and time of surgery. The results did not show statistically difference between the variables of interest and the presence of SSI. All cases of SSI were diagnosed after patient discharge, and among them, six patients (86%) were diagnosed during outpatient return, and one patient (14%) was diagnosed during the active phone search. This study offers subsidies for understanding the problem at national level. In addition, it generated evidence for the reflection of health professionals regarding the underreporting of this type of infection in minimally invasive surgery, reinforcing the need to implement a post-discharge surveillance program in health services
Assuntos
Humanos , Infecção da Ferida Cirúrgica , Fatores de Risco , Colecistectomia LaparoscópicaRESUMO
A infecção de sítio cirúrgico (ISC) é uma complicação que pode acometer o paciente, acarretando incremento da mortalidade e morbidade, bem como aumento dos custos em saúde. A videocirurgia surgiu como opção menos invasiva de acesso à cavidade abdominal, reduzindo as taxas de ISC, mas nem mesmo a modernização gerada pela cirurgia minimamente invasiva conseguiu extinguir esse tipo de infecção. O presente estudo teve como objetivo geral analisar a ocorrência e os fatores de risco de infecção de sítio cirúrgico, em pacientes submetidos à colecistectomia videolaparoscópica. Trata-se de estudo descritivo exploratório conduzido em hospital de pequeno porte, localizado no sudoeste de Minas Gerais. A amostra foi composta por 118 pacientes. Para a coleta de dados, elaborou-se instrumento, o qual foi submetido à validação de face e conteúdo por estudiosos da área de conhecimento de enfermagem perioperatória. A coleta dos dados foi realizada no período de março a novembro de 2016 e, em três momentos, a saber: perioperatório, retorno ambulatorial e busca ativa fonada. Os dados foram coletados pelo pesquisador e um auxiliar de pesquisa devidamente treinados. A ocorrência de ISC foi de 5,9% (n=7), sendo todos os casos diagnosticados como infecção incisional superficial. As variáveis investigadas relacionadas ao paciente foram sexo, faixa etária, Índice de Massa Corporal, presença de doença crônica e classificação ASA. As variáveis estudadas relacionadas ao procedimento anestésico-cirúrgico foram tempo total de internação, porte cirúrgico, tempo de anestesia e tempo de cirurgia. Os resultados não apresentaram diferença estatisticamente entre as variáveis de interesse e a presença de ISC. Todos os casos de ISC foram diagnosticados, após a alta hospitalar, desses, seis pacientes (86%) tiveram o diagnóstico no retorno ambulatorial, e um paciente (14%) foi diagnosticado durante a busca ativa fonada. A condução do estudo oferece subsídios para a compreensão da problemática, no âmbito nacional. Além disso, gerou evidências para a reflexão dos profissionais de saúde em relação à subnotificação desse tipo de infecção em cirurgia minimamente invasiva, reforçando a necessidade de implantação de programa de vigilância pós-alta, nos serviços de saúde
Surgical site infection (SSI) is a complication that can affect the patient, leading to an increase in mortality and morbidity, as well as an increase in health costs. Video surgery emerged as a less invasive option for access to the abdominal cavity, reducing SSI rates; however, not even the improvement generated by minimally invasive surgery was enough to eliminate this type of infection. This study aimed to analyze the occurrence and risk factors of surgical site infection in patients submitted to laparoscopic cholecystectomy. It is an exploratory-descriptive study conducted in a small hospital, located in the southwest of Minas Gerais. The sample consisted of 118 patients. An instrument was developed for data collection, which was submitted to face and content validation by experts in perioperative nursing. Data collection was performed from March to November 2016 and, in three stages: perioperative, outpatient return and active phone search. Data were collected by the researcher and a properly trained research assistant. The occurrence of SSI was 5.9% (n=7), being all cases diagnosed as superficial incisional infection. The studied variables related to the patient were gender, age, Body Mass Index, presence of chronic disease and ASA classification. The studied variables related to the anesthetic surgical procedure were total length of hospitalization, surgical procedure size, time of anesthesia and time of surgery. The results did not show statistically difference between the variables of interest and the presence of SSI. All cases of SSI were diagnosed after patient discharge, and among them, six patients (86%) were diagnosed during outpatient return, and one patient (14%) was diagnosed during the active phone search. This study offers subsidies for understanding the problem at national level. In addition, it generated evidence for the reflection of health professionals regarding the underreporting of this type of infection in minimally invasive surgery, reinforcing the need to implement a post-discharge surveillance program in health services
Assuntos
Humanos , Cuidados Pós-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Risco , Colecistectomia LaparoscópicaRESUMO
The present study evaluated patients with diagnosis of surgical site infection (SSI) following cesarean section and their controls to determinate risk factors and impact of antibiotic prophylaxis on this condition. Methods: All cesareans performed from January 2009 to December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control patients were determined after inclusion of case patients. Medical records of case and control patients were reviewed and compared regarding sociodemographic and clinical characteristics. Results: Our study demonstrated an association following univariate analysis between post-cesarean SSI and number of internal vaginal examinations, time of membrane rupture, emergency cesarean and improper use of antibiotic prophylaxis. This same situation did not repeat itself in multivariate analysis with adjustment for risk factors, especially with regard to antibiotic prophylaxis, considering the emergency cesarean factor only. Conclusion: The authors of the present study not only question surgical antimicrobial prophylaxis use based on data presented here and in literature, but suggest that the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean section. Further research with greater number of patients and evaluated risk factors are fundamental for better understanding of the causes and evolution of surgical site infection after cesarean delivery. .
Assuntos
Adulto , Feminino , Humanos , Gravidez , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Cesárea/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
OBJETIVO: identificar factores de riesgo asociados a la endoftalmitis poscirugía de catarata. MÉTODOs: se realizó un estudio retrospectivo-observacional analítico de caso-control de enero de 2011 a diciembre de 2013. Se incluyeron pacientes operados de cirugía de catarata. La muestra quedó conformada por 33 casos que sufrieron endoftalmitis posquirúrgica y los controles por 65 pacientes. La información se obtuvo de las hojas de trazabilidad quirúrgica y de la planilla de casos infectados del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". RESULTADOS: el sexo masculino representó un riesgo mayor que el femenino (p= 0,014; OR= 2,91). La cirugía practicada en la estación de verano incrementó el riesgo de endoftalmitis (p= 0,000; OR= 9,91), así como un volumen quirúrgico mayor de 10 casos por posición (p= 0,000; OR = 27,8). La ruptura de cápsula posterior representó un riesgo mayor (p= 0,016; OR= 7,00). La técnica de Blumenthal resultó un riesgo mayor que la faco (p= 0,008; OR= 3,60). Otras variables como la edad, la diabetes mellitus y el tiempo quirúrgico, destacadas en otras series, no tuvieron significación estadística en este estudio. CONCLUSIONES: el sexo masculino, el clima elevado y la técnica de Blumental representan un mayor riesgo en la aparición de la endoftalmitis posquirúrgica.
OBJECTIVE: to identify the risk factors associated to endophthalmitis after cataract surgery. METHODS: case-control analytical observational and retrospective study conducted from January 2011 through December 2013, which included those patients operated on for cataract. The final sample was made up of 33 cases who suffered postsurgery endophthalmitis and 65 patients were included as controls. The information was collected from surgical traceability sheets and from the infected case forms at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. RESULTS: males were at greater risk for the disease than females (p= 0,014; OR= 2,91). The surgery performed at summer time increased the risk of suffering endophthalmitis (p= 0,000; OR= 9,91) as well as a surgical volume over 10 cases per surgical position (p= 0,000; OR= 27,8). The posterior capsule rupture was the major risk (p= 0,016; OR=7,00). Blumenthal technique resulted in greater risk for endophthalmitis than the phaco technique (p= 0,008; OR= 3,60). Other variables such as age, diabetes mellitus and surgical time, which were remarkable in other case series, had no statistical significance in this study. CONCLUSIONS: males, the high climate and the Blumenthal technique represent a greater risk in the apparition of the postsurgery endophthalmitis.
Assuntos
Humanos , Masculino , Idoso , Catarata/complicações , Extração de Catarata/normas , Endoftalmite/complicações , Fatores de Risco , Estudos de Casos e Controles , Estudos Retrospectivos , Estudo ObservacionalRESUMO
OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.