Dissertations / Theses on the topic 'Surgical wound infections'
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Friberg, Örjan. "Local collagen-gentamicin for prevention of sternal wound infections /." Linköping : Univ, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7125.
Full textOpadotun, Olukemi. "Infection control practices for the prevention of surgical site infections in the operating room." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1017195.
Full textAncheril, Alphonsa. "Evaluation of a program implemented to reduce surgical wound infection in an acute care hospital in India : a clinical practice improvement project /." Electronic version, 2004. http://adt.lib.uts.edu.au/public/adt-NTSM20040913.150110/index.html.
Full textSingh, Baldev. "Prevalence of postoperative infection after orthognathic surgery." Thesis, Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23234635.
Full textTegnell, Anders. "The epidemiology and consequences of wound infections caused by coagulase negative staphylococci after thoracic surgery /." Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med742s.pdf.
Full textCurtis, Merrilyn. "Surgical site infections within the vascular surgical patient : identification of an appropriate index for risk stratification /." [St. Lucia, Qld], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18233.pdf.
Full textLai, Shuk-tin, and 黎淑鈿. "Evidence-based guidelines for chlorhexidine gluconate in preoperative skin preparation to reduce surgical site infection in patients undergoing general surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193047.
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Master of Nursing
Gomila, Grange Aina. "Current challenges in the prevention, management and outcomes of surgical site infections in elective colorectal surgery." Doctoral thesis, Universitat de Barcelona, 2018. http://hdl.handle.net/10803/665451.
Full textLes infeccions de localització quirúrgica (ILQ) són actualment les infeccions relacionades amb l’assistència sanitària més freqüents. Les taxes d’ILQ són especialment altes en cirurgia electiva colorectal. Aquest projecte analitza diferents aspectes de la prevenció, maneig i evolució de les ILQ, i en especial la d’òrgan-espai, en cirurgia electiva colorectal en 10 hospitals del programa VINCat. El primer estudi mostra les diferències entre les cirurgies de colon i recte en quant a prevalença d’ILQ, sent major en cirurgia de recte que de colon i en els factors de risc d’ILQ d’òrgan-espai. En el segon article s’analitzaren els factors de risc i la microbiologia de les SSI desenvolupades de forma precoç (7 dies) i tardana (del 8 al 30è dia) després de la cirurgia. Es van trobar diferents factors de risc per ILQ precoç i tardana, no obstant, no hi van haver diferències significatives en la microbiologia. La profilaxis antibiòtica oral (PAO) i la laparoscòpia van ser factors protectors comuns. El tercer estudi mostra la microbiologia més freqüent i la presència de multiresistència en bactèries Gram-negatives en les ILQs. També analitza el maneig antibiòtic i de control del focus de les ILQ d’òrgan-espai. El fracàs terapèutic de les ILQ d’òrgan-espai a 30 dies de la cirurgia va ser del 34.2%, i es va associar amb l’edat avançada, la laparoscòpia i la necessitat de reoperació. En el quart estudi es van analitzar els costos de salut (excés d'estada hospitalària i mortalitat als 30 dies de la cirurgia) del desenvolupament d’ILQ d’òrgan-espai mitjançant un model multiestat. Els pacients amb ILQ òrgan-espai van presentar una estada hospitalària i mortalitat significativament superior als pacients amb ILQ incisional o que no van desenvolupar ILQ. En el cinquè estudi es van analitzar els factors de risc, el maneig i pronòstic de les ILQ causades per Pseudomonas aeruginosa. Un 9.3% de les ILQ van tenir aïllament de P. aeruginosa. Aquests pacients tenien una classificació American Society of Anesthesiologists’ (ASA) més alta, un índex de National Nosocomial Infections Surveillance (NNIS) més alt, una major durada de la cirurgia, un tractament més llarg i major fracàs terapèutic (30.6% vs. 20.8%) que els pacients amb ILQ d’altres etiologies. Els factors associats de forma independent a ILQ per P. aeruginosa van ser un índex NNIS 1-2 i la no-administració de PAO.
Maruta, Anna. "Surveillance of surgical site infections following caesarean section at two central hospitals in Harare, Zimbabwe." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/98019.
Full textENGLISH ABSTRACT: Background Caesarean section deliveries are the most common procedures performed by obstetricians in Zimbabwe. Surgical site infections (SSI) following caesarean section delivery result in increased hospital stay, treatment, cost, hospital readmission rates and related maternal morbidity and mortality. There is no national surveillance system for SSIs in Zimbabwe, however, information is available on number of cases of post-operative wound infection after caesarean section, but the denominator and definition used is not consistent. The objective of this study were develop and strengthen the surveillance system in Zimbabwe, to establish a clinical-based system in a setting with limited microbiological access, to measure post-operative SSI after caesarean section and to describe the associated risk factors and to determine whether feedback of SSI data has any effect on the surgical site infection incidence rate. Methodology This was a before and after study with two rolling cohort periods conducted at two Central hospitals in Harare, Zimbabwe. An Infection Prevention and Control (IPC) intervention was conducted in-between. During the pre-intervention period, baseline demographic and clinical data were collected using a structured questionnaire, and during the post-intervention period the impact of the interventions was measured. Convenience sampling was employed. Results A total of 290 women consented to participate in the study in the pre intervention period, 86.9% (n= 252) completed the 30-days post-operative follow-up and the incidence rate of SSI was 29.0% (n=73, 95% CI:23.4-35.0) Interventions developed included: training in Infection Prevention and Control for health workers; implementation of a protocol for cleaning surgical instruments; dissemination of information on post-operative wound management for the women. After implementation of the intervention, 314 women were recruited for the post-intervention, 92.3%(n= 290) completed the 30-day follow-up and there was a significant (p<0.001) reduction in the incidence rate of SSIs to 12.1 % (n=35, 95% CI: 8.3 -15.8) during this period. Development of SSI after caesarean section was found to be significantly associated with emergency surgery (p<0.001), surgical wound class IV (p=0.001) and shaving at home (p<0.001) at both pre- intervention and post-intervention periods. Stellenbosch University https://scholar.sun.ac.za iii Conclusion This study shows that caesarean section can be performed with low incidence of SSI if appropriate interventions such as training in IPC, adequate cleaning of equipment and education in wound-care for the mother are adhered to. It also demonstrated a simple surveillance data collection tool can be used on a wide scale in resource limited countries to assist policy makers with monitoring and evaluation of SSI rates as well as assessment of risk factors.
AFRIKAANSE OPSOMMING: Agtergrond Keisersnitte is die mees algemene prosedure wat uitgevoer word deur obstetriese dokters in Zimbabwe. Chirurgiese wond infeksies wat op keisersnitte volg lei tot verlengde hospitaal verblyf, behandeling, koste, heropname koerse en verwante moederlike morbiditeit en mortaliteit. Alhoewel daar geen nasionale waaktoesig sisteem vir chirurgiese wondinfeksies is nie, is informasie beskikbaar vir ‘n aantal gevalle wat post-operatiewe wondinfeksie na ‘n keisersnit onwikkel het, maar die noemer en definisie word inkonsekwent gebruik. Die doel van hierdie studie was om die waaktoesig sisteem in Zimbabwe te ontwikkel en te versterk, om ‘n klinies-gebasseerde sisteem te vestig in ‘n opset met beprekte mikrobiologiese toegang, om postoperatiewe chirurgiese wond infeksies na keisersnitte te meet en om die geassosieerde risikofaktore te beskryf en om vas te stel of terugvoering van chirurgiese wondinfeksie data enige effek op die infeksiekoerse na keisersnitverlossings gehad het. Metodologie Hierdie was ‘n voor-en-na studie met twee kohort periodes uitgevoer by twee sentrale hospitale in Harare, Zimbabwe. ‘n Infeksievoorkoming en –beheer intervensie was tussenin uitgevoer. Tydens die pre-intervensie periode was basislyn demografiese en kliniese data ingesamel deur middel van ‘n gestruktureerde vraeboog, en gedurende die post-intervensie fase was die impak van die intervensies gemeet. Gerieflikheidsteekproefneming was geimplementeer. Resultate ‘n Totaal van 290 vroue het toestemming verleen om aan die studie deel te neem in die pre-intervensie periode, waarvan 86.9% (n=252) die 30 day post-operatiewe opvolg voltooi het en die insidensiekoers van chirurgiese wondinfeksies was 29.0% (n=73, 95% CI:23.4-35.0) Intervensies wat onwikkel was het ingesluit: opleiding in Infeksie Voorkoming en -Beheer vir gesondheidswerkers; die implementering van ‘n protokol om chirurgiese instrumente skoon te maak; disseminering van informasie oor post-operatiewe wondhantering vir vroue. Na die implimentering van die intervensie was 314 vroue gewerf in die post-intervensie fase, waarvan 92.3% (n=290) die 30 dae opvolg voltooi het. Daar was ‘n beduidende (p<0.001) verlaging in die insidensiekoers van chirurgiese wondinfeksies na 12.1% (n=35, 95% CI: 8.3-15.8) gedurende hierdie periode. Stellenbosch University https://scholar.sun.ac.za v Daar was bevind dat chirurgiese wondinfeksies beduidend geassosieer was met noodchirurgie (p<0.001), chirurgiese wondklassifikasie IV (p=0.001) en skeer van hare by die huis (p<0.001) by beide die pre-intervensie en post-intervensie periodes. Gevolgtrekking Hierdie studie wys dat keisersnitte uitgevoer kan word met ‘n lae insidensie van chirurgiese wondinfeksies indien toepaslike intervensies, soos opleiding in infeksievoorkoming en beheer, voldoende skoonmaak van toerusting en opvoeding in wondsorg vir die moeders. Dit het ook aangedui dat ‘n eenvoudige data-insameling instrument op ‘n wye basis gebruik kan word in beperkte-hulpbron lande om beleidmakers te help met monitering en evaluering van chirurgiese wondinfeksie koerse, asook die assessering van risikofaktore.
Braga, Jessyca Rodrigues. "Aspectos clínicos e epidemiológicos das infecções de sítio cirúrgico por micobactéria não tuberculosas no município de Goiânia-Goiás." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7257.
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Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq
Surgical Site Infection (SSI), besides being an indicator of the quality of care, is one of the main healthcare-associated infection (HAI). SSI caused by non-tuberculous mycobacteria (NTM) has become increasingly frequent, increasing the prevalence of SSI in clinical practice. OBJECTIVE: To analyze the epidemiological and clinical aspects of SSI by MNT in the city of Goiânia-Goiás. METHODS: Retrospective cross-sectional study, carried out from the Municipal Coordination of Infection Control and Patient Safety in Health Services (Comciss), of the Municipality of Goiânia - Goiás (Brazil). The population consisted of clinical cases of SSI by probable MNT notified to Comciss, by public and private health institutions of the city of Goiânia-Goiás, in the period from 2006 to 2015. Data were collected during the months of October to December 2015 and March 2016. The source of the data consisted of the notification/investigation forms of SSI cases by MNT stored in Comciss. The data were organized, processed and analyzed in SPSS software version 20.0 and estimated by means of simple frequency and measures of central tendency (average, fashion and median). Chi-square test or Fisher's exact test were used to assess the differences between proportions, and Odds Ratio to estimate the chance of positivity for each outcome. The level of significance was considered p <0.05. RESULTS: One hundred twenty two specimens were positive for MNT and 9 were negative. The average age of the patients was 38.15 years (SD: 13.8, min: 19 and max: 86 years). The female sex predominated in 77.1% of the cases. Comciss was the main responsible (67.1%) for the notifications. The private healthcare institutions accounted for 92.3% of the surgeries performed. Aesthetic surgeries were the most prevalent (51.9%), with mammoplasty being the most frequent. The conventional route stood out with 44.2%, compared to those made by video. The species M. abscessus and M. fortuitum prevailed. Orthopedic surgery (p = 0.002) and general surgery (p <0.001) presented a statistical association for M. abscessus infection. The use of prosthesis (p <0.001, OR 95%: 6.12) and plastic surgery (p <0.001; OR 95%: 5.90) showed statistical difference for M. fortuitum infection, but were not associated in regression. Signs / symptoms were present in 119 patients, including fever, secretion, abscess, nodules, hyperemia, among others. Clarithromycin was the most commonly used antimicrobial for the treatment of SSI by M. abscessus, and amikacin-associated clarithromycin was the most commonly used antimicrobial therapy for M. fortuitum. Resistance to 12 (80%) different antimicrobials was found for M. abscessus, and 15 (88.2%) for M. fortuitum. CONCLUSIONS: Females predominated, with mammoplasty being the main surgery. M. abscessus and M. fortuitum were the most prevalent species, being resistant to up to 15 (88,2%) antimicrobials. Being submitted to orthopedic and general surgery was a factor associated with ISC by M. abscessus.
A Infecção de Sítio Cirúrgico (ISC), além de ser um indicador da qualidade da assistência, é uma das principais infecções relacionadas à assistência à saúde (IRAS). As ISC causadas pelas Micobactérias Não Tuberculosas (MNT) têm se tornado cada vez mais frequentes, aumentando a prevalência de ISC na prática clínica. OBJETIVO: Analisar os aspectos epidemiológicos e clínicos das ISC por MNT no município de Goiânia-Goiás. MÉTODO: Estudo retrospectivo do tipo transversal, realizado a partir do banco de dados da Coordenação Municipal de Controle de Infecção e Segurança do Paciente em Serviços de Saúde (Comciss) do Município de Goiânia – Goiás (Brasil). A população constituiu-se de casos clínicos de ISC por provável MNT notificados à Comciss por instituições de saúde pública e privadas do município de Goiânia-Goiás, no período de 2006 à 2015. Os dados foram coletados durante os meses de outubro a dezembro de 2015 e março de 2016. A fonte dos dados constituiu-se das fichas de notificação/investigação dos casos de ISC por MNT armazenadas na Comciss. Os dados foram organizados, processados e analisados no software SPSS versão 20.0 e estimados por meio de frequência simples e medidas de tendência central (média, moda e mediana). Teste de Qui- quadrado ou exato de Fischer foram utilizados para avaliar as diferenças entre proporções, e Odds Ratio para estimar a chance de positividade para cada desfecho. O nível de significância foi considerado p<0,05. RESULTADOS: Foram positivas 122 espécimes para MNT e 9 negativos. A média de idade dos pacientes foi 38,15 anos (DP: 13,8; min:19 e máx: 86 anos). Predominou o sexo feminino em 77,1% dos casos. A Comciss foi a principal responsável (67,1%) pelas notificações. As instituições de saúde da rede privada foram responsáveis por 92,3% das cirurgias realizadas. As cirurgias estéticas foram as mais prevalentes (51,9%), sendo a mamoplastia a mais frequente. A via convencional se sobressaiu, com 44,2% em relação às realizadas por vídeo. Predominaram as espécies M. abscessus e M. fortuitum. Cirurgia ortopédica (p=0,002) e cirurgia geral (p<0,001) apresentaram associação estatística para infecção pelo M. abscessus. O uso de prótese (p<0,001; OR 95%: 6,12) e cirurgia plástica (p<0,001; OR 95%: 5,90) mostraram diferença estatística para infecção por M. fortuitum, porém não apresentaram associação nos modelos de regressão. Cento de dezenove pacientes apresentaram sinais/sintomas, verificou-se febre, secreção, abscesso, nódulos, hiperemia, dentre outros. Claritromicina foi o antimicrobiano mais utilizado para tratamento de ISC por M. abscessus, e claritromicina associada à amicacina foi terapêutica antimicrobiana mais utilizada para M. fortuitum. Encontrou-se resistência a 12 (70,0%) diferentes antimicrobianos para M. abscessus, e a 15 (88,2%) para M. fortuitum. CONCLUSÕES: Predominou o sexo feminino, sendo a mamoplastia a principal cirurgia envolvida. M. abscessus e M. fortuitum foram as espécies mais prevalentes, sendo as mesmas resistentes à até 15 (88,2%) antimicrobianos. Ser submetido à cirurgia ortopédica e geral foi fator associado à ISC por M. abscessus.
Perdiz, Luciana Baria [UNIFESP]. "Avaliação das infecções de sítio cirúrgico e do trato urinário em pacientes submetidos a transplante simultâneo de rim-pâncreas." Universidade Federal de São Paulo (UNIFESP), 2008. http://repositorio.unifesp.br/handle/11600/24235.
Full textObjetivos: 0 estudo procurou determinar os fatores de risco associados a infeccao de sitio cirurgico e do trato urinario pos-transplante simultaneo de rim-pancreas. Foi tambem estudada a incidencia de infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes e os principais patogenos causadores destas infeccoes. Metodo: 0 estudo foi realizado no Hospital São Paulo, hospital terciario de ensino da Universidade Federal de São Paulo. 0 estudo utilizou uma coorte de pacientes que incluiu todos os pacientes que realizaram transplante simultaneo de rim-pancreas no periodo de 01 de dezembro de 2000 a 31 de dezembro de 2006 (119 receptores). Estes pacientes foram acompanhados atraves do prontuario, por um periodo de um mes pos-transplante, para desenvolvimento de infeccao de sitio cirurgico, e durante todo 0 periodo de internacao apos 0 transplante para 0 desenvolvimento de infeccao do trato urinario hospitalar. Os criterios usados para 0 diagnostico de infeccao hospitalar foram definidos pelo Centers for Disease Control and Prevention (CDC). E foram realizados dois estudos tipo caso-controle aninhado (do ingles Nested Case Control), onde foram avaliados os fatores de risco para infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes. A analise multivariada foi realizada pela tecnica de regressao logistica multipla, utilizando as variaveis com p≤ 0,05 na analise univariada. 0 metodo utilizado foi 0 Stepwise forward. Resultados: A mortalidade nos primeiros 30 dias apos 0 transplante foi 11,8%. A infeccao de sitio cirurgico ocorreu em 55 (46,2%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11 %). Ap6s a regressao logistica multivariada, as variaveis independentemente associadas a ISC foram: necrose tubular aguda (OR=4,4; IC95%= 1,77 - 10,99; p=0,001); fistula renal ou pancreatica pos-transplante (OR=7,25; IC95%= 1,35 - 38,99; p=0,02) e rejeicao do enxerto (OR=4,28; IC95%= 1,59 - 11,48; p=0,004). A infeccao do trato urinario ocorreu em 29 (24,4%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae 13 (43,5%), Acinetobacter baumannii 7 (23,5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%).Apos a regressao logistica multivariada, as variaveis independentemente associadas a ITU foram: tempo de hipertensao arterial (OR=1, 1; IC95%= 1,00 - 1,02; p=0,01); uso de alcool pelo doador (OR=7,49; IC95%= 1,01 - 55,66; p=0,04) e uso de drogas vasoativas no doador (OR=0,08; IC95%= 0,01 - 0,84; p=0,03) e, como fator protetor: diurese residual pre-transplante (OR=0,16; IC95%= 0,04 - 0,59; p=0,006). Conclusao: Nosso estudo demonstrou que variaveis relacionadas ao procedimento cirurgico estao mais relacionadas ao desenvolvimento de infeccao de sitio cirurgico e que variaveis relacionadas ao receptor e doador estao mais relacionadas ao surgimento de infeccao do trato urinario em pacientes submetidos a transplante simultaneo rim-pancreas. Nosso estudo e um dos primeiros a avaliar fatores de risco para essas duas importantes infeccoes nosocomiais nessa coorte de pacientes.
BV UNIFESP: Teses e dissertações
Do, Thi Thu Hien. "Development and validation of a surgical wound assessment tool for use in Vietnam." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/129791/9/Thi%20Thu%20Hien%20Do%20Thesis.pdf.
Full textPinkney, Thomas David. "Wound-edge protection devices to reduce surgical site infection." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7588/.
Full textWiippa, Beatrice, and Sadaf Azarnia. "Förebygger kirurgiska munskydd infektion hos patienten vid interventionell radiologi? : en litteraturöversikt." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-71783.
Full textIntroduction: One of the radiographer's responsibilities is to prevent the spread of healthcare-associated infections. In interventional radiology, this means working with aseptic technique. Surgical face mask protection has been the standard of surgery for a century, but in interventional radiology there are no national guidelines for its use, even though the sterile technique is the same. Aim: The aim of this study was to clarify whether surgical face masks prevent infection in patient in interventional radiology. Methodology: A literature review (Friberg, 2017) has been done to identify the current knowledge in the field. The study includes twelve quantitative articles collected through a systematic literature search in PubMed. After quality review the articles were analyzed and presented into two main categories. Result: Concerning postoperative wound infections, there is no strong evidence to prove that using surgical face masks prevents infections during surgery or coronary angiography. However, using such mask prevents the spread of bacteria to some extent. Conclusion: Research on oral protection is limited, making it difficult to draw any conclusions. A set of new tests are needed to identify the effect of using mask in today’s interventional radiology. Based on the results of the studies, it can be concluded that: generally, mouth protection within interventional radiology should not be mandatory. However, each radiology department need to consider the operating condition and status of the patient and decide if the personal should follow mouth protection process.
Persson, Mikael. "Wound ventilation : a new concept for prevention of complications in cardiac surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-626-X/.
Full textKohli, Michele. "A risk index for sternal surgical wound infection after cardiovascular surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0002/MQ40716.pdf.
Full textReilly, Jacqueline. "Surgical wound infection : addressing the risk factors within a change theory framework." Thesis, Glasgow Caledonian University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322215.
Full textMadeira, Maria Zélia de Araújo 1965. "Vigilância de infecção de sítio cirúrgico em pacientes egressas no ambulatório de ginecologia de um hospital de ensino." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312428.
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Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: INTRODUÇÃO: As Infecções do Sítio Cirúrgico (ISC), compreendendo de 14% a 16% das encontradas em pacientes hospitalizados, são classificadas em incisional superficial, incisional profunda ou de órgão/cavidade. Entre 12% e 84% dessas infecções são detectadas depois que o paciente deixa o hospital, daí a importância da realização da vigilância pós-alta hospitalar. OBJETIVOS: Implementar um serviço de vigilância pós-alta de ISC em mulheres que realizaram cirurgia ginecológica em um Hospital de Ensino em Teresina-PI; monitorizar a ocorrência de ISC e sua associação com fatores de risco; caracterizar o perfil sociodemográfico desse contingente; determinar a taxa de incidência de ISC no ambulatório de ginecologia por meio da vigilância; e identificar o perfil das ISC diagnosticadas após a alta hospitalar. MÉTODO: Estudo quantitativo e prospectivo, realizado no ambulatório de ginecologia do Hospital Getúlio Vargas, o qual é de ensino público, geral, de grande porte e de referência em saúde para o Estado do Piauí e demais regiões do Norte e Nordeste do Brasil. A população foi de 1.026 mulheres egressas do hospital de ensino, que realizaram cirurgia ginecológica, no período de junho de 2011 a março de 2013. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da UFPI, sob o CAAE: 0059. 045. 000.11. RESULTADOS: Utilizou-se a vigilância epidemiológica às ISC do tipo busca ativa, por 30 dias, no ambulatório de ginecologia, por meio de contato presencial e telefônico. A taxa de retorno das mulheres para o ambulatório foi de 86,6% e a incidência de ISC foi de 5,8%, destas, 71,7% foram classificadas como incisional superficial e 28,3% como incisional profunda. O tempo médio entre a cirurgia e o diagnóstico de ISC foi de 12,9 dias; a maior incidência se encontra na faixa etária de 25 a 44 anos (44,3%) de idade; procediam da capital 57,8% e, do interior do Estado, 42,2%; 63% são casadas, 61% tinham até o ensino fundamental; economicamente, 46,4% declararam renda familiar de 1 (um) salário mínimo. Os fatores de risco para o desenvolvimento de ISC foram: Tempo PO (dias), Neoplasia e Diabetes mellitus. CONCLUSÃO: Evidenciou-se o incremento da notificação de incidência de ISC, o que aponta para a importância do acompanhamento das mulheres sob vigilância pós-alta, utilizando uma estratégia sistematizada. Palavras chaves: Vigilância epidemiológica, Procedimentos Cirúrgicos em Ginecologia, Infecção de ferida operatória
Abstract: INTRODUCTION: The Surgical Site Infection (SSI) understanding 14% to 16% of those found in intern patients, and be assorted in superficial incisional SSI, deep incisional SSI, or organ or space SSI. Between 12% and 84% those infections are detected after the patient leaves hospital, hence the importance of post-discharge surveillance. OBJECTIVES: The post-discharge surveillance woman service implementation who underwent gynecological surgery in school hospital in Teresina - PI; monitor the occurrence of ISC and association with risk factors; characterizing the socio-demographic profile; appoint incidence rate (SSI) in gynecological ambulatory for surveillance method, and identify the profile of SSI misdiagnosed after discharge. METHODS: Prospective and quantitative study, accomplished in gynecological ambulatory in Getulio Vargas Hospital, which is for public education, and a large general hospital, and the health reference for the state of Piauí and further the North and Northeast regions of Brazil. The population was 1026 patient women which has undergone gynecological surgery in period from june 2011 to march 2013. The project was approved for the UFPI Research Ethics Committee, under the CAAE: 0059 045 000.11. RESULTS: It was used SSI epidemiologic surveillance, type active report for 30 days in gynecological ambulatory, by face or telephonic contact. Return rate of women to gynecological ambulatory was 86,6% and SSI incidence was 5,8%, those 71,1% was classed in superficial incisional and 28,3% deep incisional. The average time betwixt surgery and SSI diagnosis was 12,9 days; the highest incidence is in the age group 25-44 years (44.3%); came from the city (57,8%) e countryside of the State (42,2%), 63% married women, had basic education 61%, 46,4% declare having minimum wage. The risk factors to SSI development was: OP Time (days), neoplasm and Diabetes mellitus. CONCLUSION: Highlighted the increased incidence of SSI notification, pointing to the importance of accompanying the women in post-discharge surveillance, using a systematic strategy. Key words: Epidemiological surveillance, Gynecologic Surgical Procedures, Surgical wound infection
Mestrado
Ciencias Biomedicas
Doutora em Ciências Médicas
Burgatti, Juliane Cristina. "Revisão sistemática sobre o uso de aventais cirúrgicos, conforme o material de confecção, no controle da contaminação/infecção do sítio cirúrgico." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-27092007-140738/.
Full textThe surgical gown, one of the main components of the antimicrobial barrier, is confectioned with woven and non-woven materials. The American Operating Room Nursing - AORN and The European Norm - EN 13795-3 recommend that the surgical gowns should provide an appropriate barrier against microorganisms, blood and other organic fluids (dry or wet). These recommendations, however, do not define, yet, what to consider an \"appropriate barrier\".. What has not been proved yet is if the use of non-woven materials influence, in an isolated way, both the contamination of an operation wound, and the occurrence of ISC. It was the objective of this present study to investigate if there is scientific evidence, by means of systematic revision, that founded the practice of use of gowns in surgery, according to its material of confections. Only basic studies of intervention that investigated the contamination and or surgical site infection with the use of surgical gowns reusable or single-use were considered in the systematic revision, which used as population people who underwent surgery, in real or simulated situations, in any period, without idiom limitation. To locate the studies, we used the PICO strategy: P (patients): surgical patients, I (intervention) = clothing/protective clothing, C (comparison) = single-use or reusable, O (outcome) = contamination or surgical wound infection. The search of studies was guided by the following electronic data bases: LILACS, PubMed/MEDLINE, EMBASE, COCHRANE, CINAHL, manual research in the magazine of Brazilian Society Operating Room Nursing (SOBECC) and references of included studies. The data analyses were shown in three phases: Phase 1: characterization of process of select studies; Phase 2: characterization of included studies; Phase 3: evaluation of the evidence found in the included studies, using two quality scales, being one this The Jadad and other Surgical Infection Control (EQCIC), adapted from Nobre and Bernardo. The sample of this systematic revision comprises 12 studies, being only one of them analyzed only gowns. The remainder investigated mainly the surgical fields together with the gowns. We can see thereby the difficulty in isolating the object of intervention from other countless factors that can influence outcomes, in studies of this nature. Two studies (E1, E2) found strong evidence of recommendation, concluding that there is no difference in terms of contamination and surgical wound infection between woven and non-woven gowns and drapes. Due to the absence of similar studies it is not possible to do some metanalysis. The isolated verification of surgical gowns needs more well controlled and delineated research. The contribution of this investigation to the implementation of practices based on evidences in showed relevant not only to answer specifically the question of research, but also to identify quality, gaps and flaws and recommend aspects to be considered in future research of this nature
Hofmann, Andreas Cristian. "Prospective study of risk factors for wound infection in a group of horses undergoing surgical procedures /." [S.l.] : [s.n.], 1997. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
Full textMoreira, Cristiane Menabo. "Eletrocauterio na cesarea = complicações na ferida cirurgica." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309038.
Full textDissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
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Resumo: Objetivo: Avaliar a efetividade e segurança do uso do eletrocautério para coagulação na da ferida operatória da cesárea. Métodos: Foi realizado um ensaio clínico piloto duplo cego controlado aleatorizado. Mulheres com indicação de cesárea, com até uma cesárea prévia, que fizeram pré-natal foram aleatorizadas na hora da cirurgia para uso ou não de eletrocautério para coagulação. As 224 voluntárias que participaram foram examinadas na alta hospitalar (3o dia) e pós-alta, no 7°.ao 10° dia e 30° ao 40° dia. Foram avaliados sinais infecciosos, hematoma, seroma e deiscência. A amostra foi calculada baseada em uma prevalência de infecção pós-alta de 14,4%, estimando-se um risco adicional de 15% para o grupo com uso de eletrocautério, totalizando 224 voluntárias. Os dados foram analizados por intenção de tratamento e a razão de risco foi calculada. Resultados: Os grupos foram similares quanto à demografia, paridade, consultas de pré-natal, índice de massa corporal e cesárea prévia. Durante a internação, apenas 2,8% das mulheres com uso de eletrocautério apresentaram complicações na ferida operatória. As taxas de complicações alcançaram 15,4% no grupo sem cautério, chegando a 23% no outro grupo, 7-10 dias pós-alta (RR=1,50 0,84-2,60). Foram observadas poucas complicações no 30° ao 40°dia e no grupo sem cautério (RR=1,15, 95% IC=0,61-2,16). A cesárea durou 105 e 100 minutos sem e com cautério, respectivamente (p=0,54). Não foi observada nenhuma arritmia cardíaca neonatal. Conclusão: O uso de cautério não se mostrou de maior risco para complicações na ferida operatória de cesárea, sendo necessários mais estudos que deem continuidade e ampliem os conhecimentos em procedimentos realizados em gestantes
Abstract: Purpose: To estimate the risk for wound complications when electrocautery is available for coagulation during cesarean section. Methods: A randomized controlled trial of using electrocautery for coagulation was performed among 224 women with none or one previous cesarean who had their pregnancy terminated with an abdominal delivery. Volunteers who accepted to participate were examined before discharge (3rd day), when the skin suture was removed (7-10 days), and 30-40 days after surgery. Infection signs, haematoma, seroma, and scar dehiscence were searched during visits. Sample size was calculated based on 14.4% prevalence of infection after discharge, estimating 15% added risk for the group using electrocautery, totalizing 224 volunteers. Unadjusted and adjusted prevalence risk (age, schooling, obesity, previous cesarean) were calculated. Results: Both groups were similar regarding demographics, parity, antenatal care, body mass index, and previous cesarean. During hospital stay, none among 96 women without electrocautery, and 2.8% of 97 women using electrocautery showed wound complications. The figures reached 15.4% and 23% respectively after 7-10 days (unadjusted RR = 1.50, 0.84-2.60). Few other complications were observed later, only among the non-intervention group (RR=1.15, 95% CI = 0.61-2.16). The lack of effect was maintained after adjusting for age, schooling, obesity, and previous cesarean (RR=1.47, 0.77-2.81). Surgical procedure lasted 105 and 100 minutes for both groups (p=0.54). No neonatal arrhythmia was observed. Conclusion: There is no evidence to recommend the use of electrocautery for coagulation during cesarean delivery. Wound complications were concentrated on post-discharge period for both groups
Mestrado
Tocoginecologia
Mestre em Tocoginecologia
Hedström, Marie-Louise, and Karlsson Agneta. "Munskydd på operation : grunder för varför det ska användas." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-19654.
Full textProgram: Fristående kurs
Gower, Sierra. "The Effect of Tight Glycemic Control on Surgical Site Infection Rates in Patients Undergoing Open Heart Surgery." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4325.
Full textMerriman, Joseph Alan. "Secreted Staphylococcus aureus virulence factors and their role in chronic wound development and persistence." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/1989.
Full textSwenne, Christine Leo. "Wound Infection Following Coronary Artery Bypass Graft Surgery : Risk Factors and the Experiences of Patients." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7168.
Full textVelozo, Bruna Cristina. "Avaliação da profilaxia antimicrobiana e infecção de sítio cirúrgico estudo de coorte /." Botucatu, 2017. http://hdl.handle.net/11449/150165.
Full textResumo: A infecção de sítio cirúrgico é a complicação mais frequente em pacientes cirúrgicos e sua incidência pode ser diminuída com a profilaxia antimicrobiana realizada adequadamente. Sua importância na prevenção dessa infecção tem se tornado um tema relevante e emergencial para uma assistência adequada e segura. Este estudo objetivou avaliar o uso adequado da profilaxia antimicrobiana e a ocorrência de infecção de sítio cirúrgico de acordo com protocolo da Comissão de Controle de Infecção Relacionada à Assistência à Saúde (CCIRAS). Trata-se de um estudo de coorte, prospectivo, com seguimento de trinta dias em hospital de ensino do interior de São Paulo, Brasil. Para elegibilidade da amostra foram selecionados pacientes acima de 18 anos submetidos a cirurgias de todas as especialidades cirúrgicas, sejam eletivas e de urgência/emergência, que receberam profilaxia antimicrobiana. A coleta de dados foi através de software desenvolvido para este fim que comparou a profilaxia antimicrobiana realizada com a preconização do protocolo instituicional, identificando os acertos e inadequações para cada item avaliado. A infecção de sítio cirúrgico foi avaliada pela CCIRAS do hospital, a qual realiza a vigilância dos pacientes pós-alta através de ligações telefônicas. A amostra constituiu de 415 pacientes com cirurgias principalmente eletivas. A conformidade com todos os quesitos avaliados da profilaxia antimicrobiana foi de 1,7%. Verificamos que a cada inadequação da profilaxia antimicrobiana ... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre
Torres, Lilian Machado. "Readmissão por infecção de sítio cirúrgico em um hospital público de Belo Horizonte (MG)." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-22072011-114317/.
Full textThe growing concern about infections related to health care led the World Health Organization to promote the creation of the World Alliance for Patient Safety, emphasizing basic actions to infection control. The reduction in the incidence of surgical site infection implies protection for patients, professionals and institutions favoring the assistance free of risks. Among the most frequent, surgical site infection should be understood as a qualifying element of care, and related data, the starting point for preventive and control measures. Hospitals have difficulties in achieving post-discharge surveillance, complex task given the trend of reduced hospital stay. Knowledge of the of readmission rates helps to improve reporting of post-discharge surveillance. An exploratory and descriptive study was conducted in order to describe the epidemiology of readmissions for surgical site infections in patients in a governmental hospital in Belo Horizonte (MG). We evaluated 98 medical records and the reports of the Hospital Infection Control Committee related to readmitted patients for this reason among january/2008 and december/2009. The results showed that one quarter of patients who developed surgical site infection in the hospital needed a new hospitalization. The mean age of subjects was 57.2 years; more than a half had diabetes mellitus, and a third, hypertension, however, the anesthetic risk for the majority was classified as low. The infections occurred more frequently in clean and potentially contaminated surgeries and the medical specialties with higher number of patients readmitted was orthopedic, with more than half of surgeries related to the correction of fractures, and general surgery, where the hernia and gallbladder surgery predominated. Half of the subjects received biomaterial in its proceedings. The surgical and hospitalization times did not differ from others studies in the literature. Virtually all patients received antibiotic prophylaxis for indications mentioned in the protocol. Early signs and symptoms appeared after an average of 33.2 days, and half of the patients were diagnosed within the first 30 days postoperatively. The classification of infections showed that half of the patients had infection of organs and cavities and 60% were required surgical interventions, in addition to antimicrobial treatment. Staphylococcus aureus predominated in orthopedic procedures and Escherichia coli in general surgery, both with multi-resistance profile below the results presented in other studies. The study concludes that the post-discharge surveillance and monitoring of readmission rates contribute to the scaling of the problem and define specific actions for its control.
Kraft, Carré Miquel Eduard. "Ús d’antibiòtics i antisèptics tòpics per a la prevenció de la infecció del lloc quirúrgic." Doctoral thesis, Universitat Autònoma de Barcelona, 2020. http://hdl.handle.net/10803/670591.
Full textLa infección del sitio quirúrgico (SSI) es una de las principales causas de infección asociadas a la salud y se relaciona con una elevada mortalidad, estancias hospitalarias prolongadas y un consumo elevado de recursos. Aún disponiendo de guías de práctica clínica tan importantes como las de la OMS, CDC, NICE, recientemente publicadas y actualizadas, la evidencia respecto a la utilización de antibióticos y/o antisépticos tópicos en el lugar de la incisión para la prevención de infección de la herida quirúrgica es limitada y las recomendaciones heterogéneas. Las guías clínicas referidas son, además, muy generalizadas, sin especificar el tipo de antibiótico que debe o no debe ser usado. El uso de antibióticos y/o antisépticos en el lugar de la incisión antes de su cierre primario para prevenir la SSI puede ser aplicado en diferentes áreas de la cirugía como situaciones urgentes o electivas, y en diferentes formatos de aplicación. Hasta nuestro conocimiento la utilidad de los antibióticos y/o antisépticos tópicos no han sido meta-analizada teniendo en cuenta todas estas diferentes perspectivas. Hipotetizamos que se pueden obtener más datos de los que disponemos en la actualidad para hacer recomendaciones más concretas referentes a las diferentes opciones del uso de antibióticos y/o antisépticos tópicos antes del cierre primario de la herida para prevenir la SSI. Con esta intención hemos realizado dos Meta-análisis recopilando todos los Ensayos clínicos correspondientes a éste asunto para determinar si el uso de antibióticos tópicos y si el uso de antisépticos tópicos reducen la infección de herida quirúrgica.
The Surgical Site Infection (SSI) is one of the principal causes of infection associated to the health and is related with a high mortality, prolonged hospital stay, and an elevated consumption of resources. Still having guides of clinical practice as important like the WHO, CDC, NICE guidelines, recently published and updated, the evidence with regard to the utilisation of antibiotics and/or antisèptics at the surgical incision site for the prevention of infection of the surgical wound is limited and the recommendations are heterogeneous. The guidelines are, besides, very generalised, without specifying the type of antibiotic to being used. The use of antibiotics and/or antisèptics at the surgical wound before its primary closure to prevent SSI can be applied at different areas of the surgery, like urgent or elective situations, and with different application forms. The utility of antibiotics and/or antiseptics have not been meta-analysed taking into account all these different perspectives we hypothesize that we can obtain more data of which we actually know and we'll be able to do more concrete recommendations in relation with the different options of use of antibiotics and/or antiseptics before the primary closure of the surgical wound to prevent SSI. With this intention we have realised two Meta-analysis including all available Randomized controlled trials of the subject to determine if the use of topical antibiotics and/or topical antiseptics reduce the SSI.
Ribeiro, Julio Cesar. "Análise da ocorrência e dos fatores predisponentes de infecção de sítio cirúrgico em pacientes sumetidos a cirurgias ortopédicas." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-05112012-194139/.
Full textSurgical site infection is one of the main problems that can occur to patients in the perioperative period. This type of infection in orthopedic surgeries is a severe problem due to its morbidity and high costs. This quantitative, correlational, non- experimental and longitudinal study aimed to analyze the incidence and predisposing factors for surgical site infection in patients who underwent orthopedic surgery. The sample consisted of 93 patients who underwent clean and elective orthopedic surgeries. For data collection, an instrument was developed and submitted to face and content validation. Data collection occurred between October 2011 and March 2012, in a private philanthropic hospital in the city of Franca, state of São Paulo. Bivariate analysis (by means of odds ratios, confidence intervals, Chi-squared test with Yates correction, Student\'s t and Mann-Whitney tests), multiple regression and binary logistic regression were used for statistical analysis. Surgical site infection was detected in 16 patients who participated in the research, with an incidence of 17.2%. The variables investigated related to patients were age, Body Mass Index, ASA score and the presence of chronic diseases. Variables related to surgical anesthesia were the duration of anesthesia, duration of surgery, use of antibiotic prophylaxis and total length of hospitalization. The results showed statistically significant difference between the groups with and without infection, when testing association with surgical site infection, ASA score variables and total length of hospitalization. After adjustment of the binary logistic regression model, only the variable total length of hospitalization was statistically significant regarding the presence or not of infection. It is worth noting that 75% of infections were diagnosed after discharge from hospital, indicating the importance of epidemiological surveillance after discharge.
Paterson, Anne, and Therese Johansson. "Att förebygga gör skillnad : Sjuksköterskans åtgärder för att förebygga postoperativ sårinfektion." Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-3768.
Full textPostoperativ sårinfektion är en komplikation som var tionde patient drabbas av efter ett kirurgiskt ingrepp. Det medför inte bara lidande och förlängd vårdtid för patienten utan kan även vara direkt livshotande. Den förlängda vårdtiden medför dessutom kostnader för samhället, och resurser skulle kunna användas till annan vård. Syftet med litteraturstudien var att beskriva sådana omvårdnadsåtgärder som sjuksköterskan kan vidta för att förebygga postoperativa sårinfektioner. Evidensbaserade omvårdnadsåtgärder som, var för sig minskar risken för att patienten ska drabbas av en postoperativ sårinfektion, och tillsammans utgör grunden för en säker vård. Databassökning av vetenskapligt material inom området ligger till grund för resultatet. Genom aktuell forskning presenteras och lyfts olika omvårdnadsåtgärder som reducerar risken för patienten att drabbas av en postoperativ sårinfektion. Viktiga omvårdnadsåtgärder är: korrekt hårborttagning, bibehållen normotermi, dusch med desinfektion, glukoskontroll, administrering av antibiotikaprofylax och postoperativ sårvård. Ny forskning inom området efterfrågas för att kunna följa utvecklingen, eftersom den befintliga är publicerad för många år sedan. För att patienten ska kunna erbjudas en säker vård behövs kontinuerlig utbildning under sjuksköterskeutbildningen men även i den kliniska verksamheten. Regelbunden uppföljning och utvärdering bör också ske i den kliniska verksamheten för att omvårdnadsåtgärderna ska vara effektiva.
Postoperative surgical wound infection is a complication that every tenth patient suffering after a surgical procedure. The consequences are the suffering and prolonged length of stay for the patient and can also be directly fatal. The prolonged duration of treatment is a high cost in society and resources could be used for other care. The purpose of literature review was to describe nurse’s interventions, which can be taken to prevent postoperative surgical wound infections. Evidence-based care interventions which reduce the risk of the patients suffering a postoperative surgical wound infection and together they represent a safe care. The result is based on search in databases for scientific materials in the subject area. Through current research highlights interventions which reduce the risk of the patient suffering a postoperative wound infection. Essential nursing interventions which are identified as: Hair removal, warming, shower with disinfectant, glucose monitoring, administration of antibiotic prophylaxis and wound care. New research in this area is requested to follow the developments since the current research is getting old. If the care should be safe for patient there must be education in nursing training as well as in the clinical work. Continuous follow-up should also occur in the clinical work in order to get feedback if the nursing interventions are effective.
Guatura, Gabrielle Meriche Galvão Bento da Silva. "Vigilância pós-alta em infecção de sítio cirúrgico: criação e validação de um instrumento." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-05112018-115921/.
Full textIntroduction: Surgical site infection (SSI) represents the third cause of healthcare-associated infections, which affects patients in Europe and Brazil. Considering hospital discharges that are becoming more precocious and that most SSI will manifest themselves up to the seventh postoperative day, postdischarge surveillance is extremely necessary, since its failure to perform can lead to underreporting, making it difficult to prevention and control actions. There is a lack, until now, of tools that have been validated for the identification of potential cases of SSI during postdischarge surveillance. Objective: To create and validate an instrument for the postdischarge surveillance of potential SSI cases. Method: a psychometric study for the creation and validation of an instrument, using content, criterion and construct validation. Result: The instrument, after validating content with expert judges, presented coefficient of total content validity equal to 0.87. For the validation of criterion and construct the instrument was applied in a sample of 100 patients. Comparing the instrument to the physical examination by the health professional, Cronbachs Alpha was equal to 0.87; Cohen\'s Kappa was equal to 0.83; sensitivity equal to 76.4%; specificity of 100%; negative predictive values of 92.5%, and, positive predictive equal to 100%. The accuracy of the instrument was 94%. Conclusion: The proposed instrument was validated and constitutes a useful tool to detect possible cases of Surgical Site Infection in postdischarge surveillance.
Oliveira, Ramon Antônio. "Fatores de risco para infecção do sítio cirúrgico em transplante de fígado: coorte histórica." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-17052017-125931/.
Full textIntroduction: Surgical site infections (SSI) are one of the main liver transplantation complications with incidence varying between 10.4% to 23.6%. Recent literature review shows gaps between risk factors within this specific population. Objective: To analyze the incidence and the risk factors in the development of SSI among adults submitted to liver transplantation. Methods: Historical cohort done through records of adults submitted to liver transplant between 2009 and 2015 in a philanthropic hospital in the countryside of Sao Paulo state. The Research Ethics Committee of School of Nursing of University of Sao Paulo approved the project. Data was analyzed by central tendency and variability measures, Pearson X2-test, Fisher exact test, Mann Whitney test and Wilcoxon-Man Whitney test. After the bivariate analyzes, the variables were included in the Classification and Regression Tree model. Results: The records of 156 patients submitted to liver transplant were investigated, of which 26.9% developed SSI. Prolonged operative time (>487 minutes) associated with Body Mass Index differences between donator/receptor (>1.3kg/m2) increased the chance of SSI in approximately 5.5 times (OR 5,5; CI 95% 2,5 - 11,8); and in the first 96 postoperative hours capillary glycemia (>175 mg/dl) increased the chance of SSI in approximately three times (OR 2.97; CI 95% 1.43 6.17). The main microorganisms isolated in collection sites related to SSI were Staphylococcus sp., P. aeruginosa, Klebsiella sp., A. baumanii and C. albicans. Conclusion: There is high incidence of SSI among the studied population and the identified risk factors for this patients category are highly diverse from the ones indicated by scientific literature in other categories or surgical specialties.
Mantoani, Camila Cristina. "A transfusão sanguínea no perioperatório e a ocorrência da infecção de sítio cirúrgico." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-05112012-153811/.
Full textThe aim of this integrative literature review was to identify and analyze evidence from primary studies on the relation between blood transfusion and the occurrence of surgical site infection in adult patients submitted to elective surgery. The search was accomplished in April 2012 in the databases PUBMED/ MEDLINE, CINAHL, LILACS and the Cochrane Library and was limited to studies indexed in the last 10 years. For the electronic database search, combinations were used among the controlled descriptors blood transfusion, blood component transfusion, elective surgery and surgical site infection and the non-controlled descriptors blood infusion, elective surgical procedure, non-urgent surgery and surgical site infection, which resulted in the identification of 2195 references. Of these, 2112 were excluded due to the lack of relation with the theme, based on the reading of the title and abstract. Thus, 73 studies were eligible and were fully read, 50 of which were not selected. For five studies, the reason for exclusion was that they did not analyze the relation between the surgical site infection and the blood transfusion, two studies included individuals younger than 18 years of age, 33 studies considered urgency and emergency surgeries, four studies transfused plasma and platelets and six studies did not refer to surgical site infection. Among the 33 selected studies, 16 were repeated, so that 17 primary studies were selected and included in the sample, as they complied with the selection criteria for the review. To extract the data, a validated instrument was used. Data analysis was descriptive and presented in two thematic categories: patients who received a blood transfusion and presented surgical site infection as an infectious outcome; and patients with surgical site infection, for whom the blood transfusion was verified as an independent risk factor. The most frequently and significantly related clinical and surgical variables in the studies were: hemoglobin levels, intraoperative blood loss, amount of blood transfused, duration of surgery, ASA score, surgery classification and use of prophylactic antibiotics. And the highest incidence levels of surgical site infection were found in older women whose body mass index indicated obesity. One positive aspect to be highlighted is that the definition of surgical site infection used in the included primary studies was the same. A consensus is needed on what hemoglobin levels indicate blood transfusion and the implementation of nursing care in response to these patients\' actual needs, minimizing the risks and complications inherent in the anesthetic- surgical procedure, education for and surveillance after hospital discharge with a view to the early identification of surgical site infection in patients submitted to blood transfusion.
Emmesjö, Anna-Karin, and Sara Sjungargård. "Preoperativ huddesinfektion med klorhexidin-alkohol jämfört med jodbaserat medel med och utan alkohol vid ren och ren kontaminerad kirurgi : - En metaanalys." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-33420.
Full textCamargo, Tamara Carolina de. "Eficácia da esterilização a vapor de instrumental laparoscópico montado versus desmontado: um estudo experimental." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-20042007-140745/.
Full textThe video laparoscopy is a technological innovation that brought unquestionable advantages and, also, new challenges, like: the policies for the adequate reprocessing of the instruments and its permanent accessories. The steam sterilization of disassembled laparoscopic instruments is much safer, once that the thermal conduction is facilitated. However, laparoscopic instruments are quite complex articles; they are composed by many parts and the reassemblage in site at the moment of the surgery brings many inconveniences to the surgical team, like the possibility of the instruments malfunctioning or non functioning at all, or even damages to the instruments due to inadequate assembling. There is a strong belief among the Healthcare Professionals about the necessity of the direct contact of the steam with all the surface of the materials submitted to the steam sterilization, which is correct, however it doesn´t consider the latent heat assumption as well. The destruction of the microbiological material throughout the steam sterilization is essentially related to the latent heat, created by the vapor condensation when in contact with the instrument´s cold surface, promoting the thermal-coagulation of microbiological proteins. Many hospitals use the steam sterilization of previously mounted instruments, although there´s not any consistent scientific evidence about the efficiency of this practice. Once stated this point, this investigation´s aim was: evaluate the effectiveness of the steam sterilization process of the previously mounted, permanent laparoscopic instruments. It was an experimental laboratorial research, using a quantitative approach. Two models of permanent laparoscopic instruments of major complexity were chosen for the experiments: a trocar with a 5mm screw window valve, composed by five dismountable parts and a 5mm dissection clamp, composed by four dismountable parts. Each part of the instruments was considered as a sample unit on the microbiological analysis. This study it had the Assembled Group was: mounted laparoscopic instruments; the Disassembled Group was: disassembled laparoscopic instruments; the Microbiological Counting Group was: laparoscopic instruments submitted to the - challenge contamination - procedures, being directed straight to the test of microbiological counting. The inoculants material used for the challenge contamination consisted on the suspension of the Geobacillus stearothermophilus, in its spore form, plus defibrinated and sterilized sheep blood. All the instruments were contaminated, disassembled with the challenge inoculants material. The Assembled and Disassembled groups were submitted to the manual cleaning processes, enhanced by the automatic cleaning in an ultrasonic washer with retro-flux, rinsed in running and under pressure water. At last, a rinsing with distilled water was performed; the drying process was made with medicinal compressed air. Then, a sorting was performed to decide about the composition of the Assembled and Disassembled groups. The instruments were individually packed in surgical paper and submitted to the steam sterilization in a pre-vacuum sterilizer machine. After the sterilization, the instruments were evaluated according to sterilization effectiveness throughout the microbiological culture test´s results, using the straight inoculation method. In the Assembled Group the microorganism´s tests were recovered in three parts of one same clamp (3/48) and in three parts of the same trocar (3/60), in the Disassembled Group the test microorganism wasn´t recovered in any of the sample unities. The results, under the conditions of the experiment, refuted the hypothesis of safety in the usage of the steam sterilization in previously mounted used clamps and trocar in laparoscopy
Hinkson, Larry [Verfasser]. "The incidence of surgical site infection in Caesarean Sections with the use of a plastic sheath wound retractor compared to the traditional self-retaining metal retractor / Larry Hinkson." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1119803136/34.
Full textVelozo, Rodrigo Augusto Peres. "Aplicativo móvel para controle da profilaxia antimicrobiana de infecção de sítio cirúrgico." Botucatu, 2019. http://hdl.handle.net/11449/183190.
Full textResumo: A infecção de sítio cirúrgico é uma das complicações mais importantes e frequentes no cuidado do paciente, gerando grande ônus ao mesmo e à instituição. A profilaxia antimicrobiana é uma das principais ferramentas no combate à essas infecções, contudo, estudos apontam elevadas taxas de erros em seus processos, aumentando o risco de infecção de sítio cirúrgico e o prolongamento da internação e gastos hospitalares. Este estudo objetivou desenvolver e validar um aplicativo para auditoria e controle da profilaxia antimicrobiana em sítio cirúrgico para dispositivos móveis, baseando-se no protocolo adotado pela Comissão de Controle de Infecção Relacionada à Assistência à Saúde (CCIRAS) do Hospital das Clínicas de Botucatu e pesquisas recentes da instituição. O desenvolvimento do aplicativo foi realizado utilizando a ferramenta Xamarin, que permite o desenvolvimento de aplicativos de maneira multiplataforma. A validação foi realizada por meio de entrevistas com 10 especialistas de áreas que trabalham diretamente com profilaxia antimicrobiana, onde foram avaliados a usabilidade, apresentação e informações do modelo proposto. Nestas entrevistas, utilizou-se do Índice de Validação de Conteúdo (IVC) e Coeficiente de Kappa para avaliação da concordância entre os juízes, sendo definido como valores mínimos ideais de 0.75 e 0.61, respectivamente. A validação do sistema demonstrou excelentes resultados, onde os itens avaliados apresentaram uma boa classificação, com IVC igual ou superior a ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Surgical site infection is one of the most important and frequent complications in patient care, generating a great burden on the patient and the institution. Antimicrobial prophylaxis is one of the main tools for the prevention of these infections; however, studies indicates that there are high error rates in this process, which can increase the risk of surgical site infection, prolong hospitalization time and increases hospital expenses. This study aimed to develop and validate a mobile application to audit and control antimicrobial prophylaxis in surgical site process, based on the protocol adopted by the Infection Control Committee related to Health Care (ICCHC) of the Hospital das Clínicas de Botucatu, and recent researches at the institution. The development of the system was carried out using the Xamarin development platform, which allow the development of multiplatform applications. The validation process was conducted with interviews from 10 experts that works directly in areas related to antimicrobial prophylaxis, evaluating the usability, presentation and information of the proposed model. In those interviews, the Content Validity Index (CVI) and Kappa Coefficient were used to evaluate the concordance between the judges, having defined as ideal minimum values of 0.75 and 0.61, respectively. The system’s validation showed excellent results, where all the evaluated items received a good classification, with a CVI equal to or higher than 0.90 and Kappa Coefficient equ... (Complete abstract click electronic access below)
Mestre
Borges, Elsie Storch. "Instrumento para controle e prevenção de infecção de sítio cirúrgico em neurocirurgia." Universidade Federal Fluminense, 2016. https://app.uff.br/riuff/handle/1/3063.
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Mestrado Profissional em Enfermagem Assistencial
Estudo metodológico com abordagem quantitativa, com o objetivo de elaborar instrumento de checagem fundamentado no levantamento das ações para avaliação e acompanhamento dos pacientes submetidos à neurocirurgia, com vistas ao controle das Infecções do Sítio Cirúrgico (ISC), entendendo que o seu preenchimento se constitui em ação de vigilância realizada pelos profissionais da Comissão de Controle de Infecção Hospitalar (CCIH). Para tanto, este instrumento foi construído e validado de conforme cinco etapas metodológicas: 1- Levantamento bibliográfico; 2- Construção da primeira versão do instrumento com base na literatura; 3- Coleta de dados com a validação de conteúdo por juízes-especialistas; 4-Análise e discussão da validação realizada pelos juízes-especialistas; 5- Produção da versão final do instrumento. Na primeira etapa foi realizado levantamento bibliográfico por meio de revisão integrativa, com busca nas bases de dados LILACS, CINAHAL, PUBMED, LILACS e portal CAPES. Foram selecionados 23 artigos. Desta busca emergiram três categorias as quais deram origem à primeira versão do instrumento de checagem que foi subdividido em: ações pré operatória, intra operatória e pós operatória, com 24 itens a serem checados quanto à sua adequação. Para a etapa de validação, foram selecionados juízes especialistas com atuação no pré, intra ou pós operatório de neurocirurgia entre enfermeiros e médicos, cada profissional avaliando as questões pertinentes à sua prática. Para obtenção do consenso dos especialistas, foi utilizado um questionário com Escala do tipo Likert de quatro pontos, numeradas de 1 a 4, onde 1 corresponde à menor concordância, e 4, à maior concordância. Utilizou-se a análise com o cálculo de Índice de Validade de Conteúdo (IVC), onde foi encontrado 0,96. O instrumento demonstrou validade de conteúdo na opinião de especialistas. Conclui-se que este instrumento poderá facilitar os processos de trabalho dos profissionais da CCIH, possibilitando a vigilância de potenciais riscos ao paciente submetido à neurocirurgia
Methodological study with quantitative approach, with the aim of drawing up a reasoned check instrument in the assessment of actions for evaluation and follow-up of patients undergoing neurosurgery, with views to the control of surgical site infections (ISC), understand that your filling is performed by professional surveillance action of hospital infection control Committee (CCIH). For both, this instrument has been built and validated as five methodological steps: 1-bibliographic survey; 2-construction of the first version of the instrument based on literature; 3-data collection with content validation by judges-experts; 4-analysis and discussion of the validation performed by the judges-experts; 5-production of the final version of the instrument. In the first phase was carried out bibliographical through integrative review, with search in the databases LILACS, CINAHAL, PUBMED, LILACS and portal CAPES. 23 articles were selected. This search three categories emerged which gave rise to the first version of the instrument that was subdivided into checking: pre-operative actions, intra operative and post operative, with 24 items to be checked for appropriateness. For the validation step, judges were selected experts with expertise in pre, intra or post-operative neurosurgery between nurses and doctors, each professional assessing the issues pertinent to your practice. For obtaining the consensus of experts, it was used a questionnaire with Likert type scale of four points, numbered from 1 to 4, where 1 corresponds to the lowest agreement, and 4, the larger agreement. Analysis was used to calculate content Validity index (CVI), where he was found 0.96. The instrument demonstrated content validity in the opinion of experts. It is concluded that this instrument may facilitate work processes of the CCIH professionals, enabling the monitoring of potential risks to the patient submitted to Neurosurgery
Schmitt, Cristiane. "Características e iniciativas institucionais que aprimoram as práticas de uso de antibioticoprofilaxia cirúrgica." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-20072015-155313/.
Full textIntroduction: healthcare-related adverse events are associated with increased morbidity and mortality and the Healthcare-associated Infections (HAI) account for 15% to 25% of these events. There is a shortage of new antimicrobials, increase in resistant strains and high consumption of these drugs. Adherence to surgical antibiotic prophylaxis guidelines is poor and there is little data on the subject in Brazil. Objective: to recognize the characteristics and institutional initiatives to improve antibiotic prophylaxis practices in neurosurgery. Specific objectives: identify adherence; verify the association of adherence with characteristics of patients, surgeries, hospitals, Hospital Infection Control Team (ICT) and processes related to prevention of Surgical Site Infection (SSI) and use of antibiotic prophylaxis; recognize the perception of anesthesiologists and neurosurgeons on institutional guidelines. Method: Cross-sectional observational study, carried out with a population consisting of hospitals, medical records of neurosurgical patients, ICT professionals, anesthesiologists and neurosurgeons. The sample of hospitals, anesthesiologists and neurosurgeons was used for convenience and the number of records for each hospital was calculated based on 40% of overall adherence. Results: Among the nine assessed hospitals, six are private, seven are large and five achieved quality certification in 2010. The mean time of Hospital Infection Control Committee (HICC) was 21.9 years and of ICT was 19.4 years. The mean weekly hours of ICT professionals per hospital bed and per critical bed was 0.7 and 3.8, respectively. Eight hospitals disclosed SSI rates, seven stratified by surgical specialty. Six hospitals created the antibiotic prophylaxis guidelines with the surgeons approval; the recommendations were fully disseminated in four and the rate of adherence was monitored and disclosed. The 1,011 neurosurgeries (craniotomy, arthrodesis, laminectomy and other surgeries), were performed predominantly in male patients with a mean age of 49.6 years. A total of 38 procedures were excluded from the analysis due to lack of records. Overall adherence was 10.0%; the highest rates were observed in Hospitals 3 (28.9%), 1 (18.2%) and 8 (16.4%), being <5% in the others. Overall adherence was zero in Hospital 9. The administration route was appropriate in 100% of the neurosurgeries, dose was appropriate in 90.6%, indication in 90.0% and time of onset in 77.1%. There was a lower adherence regarding duration (26.1%), in 62.2% of cases, longer than recommended. There was a statistically significant association between hours of ICT professional / ICU bed (p = 0.048), dissemination of surgical antibiotic prophylaxis use guidelines (p 0.035), adherence monitoring (p 0.024), disclosing of results (p 0.015) and the period of the day when the surgery occurred (CI = 1.7 to 6.6). A total of 43 professionals from six hospitals were interviewed. More than 80% knew about and agreed with the institutional guidelines and more than 50% reported they always followed them; 37.0% of anesthesiologists and 50.0% of surgeons believed that the guidelines were almost always followed by other professionals. One surgeon reported he never followed and believed that other professionals never followed the guidelines. The main observations of the respondents were lack of discipline in the operating room and lack of dissemination of antibiotic prophylaxis use guidelines. It was suggested to the ICT to carry out training, make the guidelines broadly available, monitor and promote adherence to them. Conclusion: The number of ICT professionals/critical bed, dissemination of guidelines, monitoring and disclosing of results are associated with higher adherence regarding antibiotic prophylaxis use; period of surgery, dose (IC 1,72-6,65) and initial time (IC 1,12-3,01) and surgery type, initial time (IC 1,24-4,25) and duration (IC 1,09-2,59). The identified inadequacies seem more related to microbial resistance than with SSI. The ICT had structure as required by law, but had shortcomings regarding the process of guideline implementation, monitoring and dissemination of results. It is of the utmost importance to promote better approach to ICT, especially with the individuals involved in the surgical process as well as the search for innovative solutions, as the conventional methods of intervention are not yielding the expected results.
Goveia, Vania Regina. "Avaliação da eficácia da esterização de furadeiras elétricas domésticas utilizadas em cirurgias ortopédicas." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-23012008-110937/.
Full textElectric drills have been used to perform orthopedic surgeries in Brazilian hospitals for almost more than 50 years. This electric equipment is heat-sensitive and it is not appropriate to use in surgical procedures. Until now the efficacy of sterilization of this item had been not evaluated as a potential risk for the occurrence of surgical site infection or infection related to orthopedic prosthesis. The objectives of this study were to evaluate the bioburden of the used electric drills and to evaluate the sterility of the new electric drills contaminated artificially. It is an experimental and randomized study performed in the research laboratory of the Nursing School of the São Paulo University. The study was performed in two phases following rigorous aseptic techniques to control the variables. In the first phase fifteen electric drills were taken in the operating room of the university hospital and included in the study using aleatory and blind methods. Cultures were performed from the air produced by the drill engine and the aliquots of 10µL of the rinsed water from the internal and external surface of the electric drill. One electric drill was included as a positive control and was contaminated with Serratia marcescens. A membrane filter with porous of 0,45 µm were cultured after had been exposed to the rinsed water from the internal and external surface of the clean electric drill. In the second phase were analyzed twenty two electric drills and three orthopedic drilling machines. Sixteen electric drills were included in the experimental group, six were the positive control group and three orthopedic drilling machines in the negative control group. All the equipments previously cleaned and sterilized were submitted to the contamination with Bacillus atrophaeus. The electric drills included in the positive control group were analyzed after exposed to the contaminant and the electric drills of the experimental group and orthopedic drills included in the negative control group were submitted to clean and ethylene oxide sterilization before to start the analysis. The air produced by the drill engine and the membrane filter after exposed to the rinsed water of the internal and external surface of the electric drill were cultured. It was performed Gram microscopy and Wirtz-Conklin to Gram positive bacilli. The results showed low bioburden in the electric drills in two episodes. So, 1 cfu/electric drill was found in one episode of the air culture and 9 cfu/electric drill in one episode of culture of the aliquot. The positive control with Serratia marcescens demonstrated the sensibility of the method in samples with high concentration of contaminants. The method of membrane filtration showed sensible to detect low bioburden of the electric drills. So it is elected for the sterility test. The positive controls showed the growth of the contaminant microrganism demonstrating the adherence to the material surface. The negative controls did not show growth. Two of the sixteen electric drills included in the experimental group showed each one growth of 1cfu of the initial contaminant of the air and the membrane cultures respectively. So the efficiency of the sterilization process was 99,99999881% and the probability of find survivor was 1,19 x 10-8. In these conditions the study demonstrates that the efficacy of the ethylene oxide sterilization was proved
Cardoso, Del Monte Meire Celeste. "Vigilancia pos-alta em cesareas : incidencia e fatores associados a infecção do sitio cirurgico." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313654.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Objetivo: Identificar a taxa de incidência de infecção do sítio cirúrgico (ISC) e fatores associados ao aparecimento desta infecção, em pacientes submetidas à cesárea em um hospital público, de ensino e terciário, através da vigilância pósalta. Sujeitos e Métodos: Foram admitidas no estudo 204 mulheres que realizaram cesárea no Centro de Atenção Integral à Saúde da mulher no período de maio de 2008 a março de 2009 e que possuíam telefone para contato. A pesquisadora abordava as mulheres durante sua internação e preenchia uma ficha para registrar os fatores associados às infecções pós-cesárea. Após a alta hospitalar, a pesquisadora ligava para essas mulheres 15 e 30 dias após a cirurgia, preenchendo um questionário para obter dados relativos à infecção pós-operatória. A análise estatística foi feita com o programa SAS versão 9.02, usando-se os testes qui-quadrado e exato de Fisher para variáveis categóricas e Mann-Whitney para variáveis numéricas. Um modelo de regressão logística para riscos de COX (RR), com critério de seleção de variáveis stepwise, foi utilizado para identificar os fatores associados a ISC. O RR e seu intervalo de confiança foram calculados e p<0,05 foi considerado significativo. Resultados: A amostra final foi de 187 mulheres. Dessa amostra 44 apresentaram uma ISC, correspondendo a uma taxa de 23,5%. Em 42 mulheres (95%) a ISC manifestou-se após a alta, sendo que em 39 delas (93%) a ISC manifestou-se dentro dos primeiros 15 dias. Na análise bivariada foram observadas como significantes para ISC as variáveis: número de consultas pré-natal = 7 e hipertensão arterial. Na análise multivariada foi observada significância apenas para hipertensão arterial. Conclusão: A vigilância pós-alta é fundamental para não subestimar as ISC em cesáreas, e neste estudo um acompanhamento de 15 dias pós-alta foi suficiente para detectar o aparecimento dessas infecções. A hipertensão arterial foi associada à ISC.
Abstract: Objective: To identify the rate of surgical site infections (SSI) and factors associated with their occurrence by performing postdischarge surveillance of patients following Cesarean section at a public university teaching hospital. Subjects and Methods: A total of 204 women, who had undergone Cesarean section at the Center for Women's Integrated Healthcare (CAISM) between May 2008 and March 2009 and who were able to be contacted by telephone, were admitted to the study. The women were approached during hospitalization and a form was completed on factors associated with post-Cesarean section infections. Following discharge from hospital, the women were contacted by telephone 15 and 30 days after surgery to complete a questionnaire on the presence of postoperative infection. Statistical analyses were performed using the SAS statistical software program, version 9.02. The chi-square test and Fisher's exact test were used to analyze categorical variables and the Mann Whitney test for numerical variables. Cox proportional hazards regression model with stepwise variable selection was applied to determine the relative risks (RR) and respective confidence intervals of factors associated with SSI. Significance was established at p<0.05. Results: The final sample consisted of 187 women. SSI was detected in 44 cases (23.5%). In 42/44 women (95%), SSI appeared following discharge from hospital, becoming evident within the first 15 days following surgery in 39/44 cases (93%). Bivariate analysis indicated the following variables as being significantly associated with SSI: number of prenatal visits =7 and hypertension; however, only hypertension remained significant in the multivariate analysis. Conclusion: Postdischarge surveillance is essential for ensuring accurate estimates of post-Cesarean section SSI; nevertheless, the present findings suggest that a 15-day post discharge follow up is sufficient to detect these infections. Hypertension was associated with SSI.
Universidade Estadual de Campi
Ciencias Biomedicas
Mestre em Tocoginecologia
Sola, Angela Figueiredo [UNIFESP]. "Avaliação de pacientes submetidos à craniotomia: incidência, evolução e fatores de risco para infecção de sítio cirúrgico." Universidade Federal de São Paulo (UNIFESP), 2010. http://repositorio.unifesp.br/handle/11600/9066.
Full textIntrodução: A infecção de sítio cirúrgico é uma das mais temidas complicações de uma cirurgia. A incidência de infecção de sítio cirúrgico em neurocirurgia é baixa, mas as conseqüências podem ser desastrosas devido à morbidade e a mortalidade. Poucos estudos nacionais têm abordado este problema. Objetivo: Determinar a incidência de infecção de sítio cirúrgico e analisar os fatores de risco para o desenvolvimento dessas infecções em pacientes submetidos à craniotomia. Analisar o impacto dessas infecções na mortalidade e no tempo de internação. Casuística e Método: Estudo tipo coorte retrospectivo, realizado no Hospital Terciário Público em Diadema - São Paulo. Foram incluídos no estudo todos os pacientes submetidos a craniotomia consecutivas no período de 01 de janeiro de 2006 a 31 de dezembro de 2007. Todos os diagnósticos de infecção seguiram a definição do Centers for Disease Control and Prevention (CDC). As infecções de sítio cirúrgico foram classificadas como: superficiais, profundas ou órgão e espaços. Resultados: Foram realizadas 352 craniotomias. A idade média dos pacientes foi de 46,24 anos. Os diagnósticos de entrada mais freqüentes foram: traumas cranioencefálicos 101 (28,7%); hematomas subdurais 61 (17,3%) e neoplasias 54 (15,3%). No período do estudo ocorreram 46 (13,1%) infecções de sítio cirúrgico, sendo 23 (50%) infecções de sítio cirúrgico superficial e 23 (50%) infecções de sítio cirúrgico de órgão e espaços. O tempo médio de internação dos pacientes com infecção foi de 58,26 dias (3 a 187 dias) em comparação aos pacientes que não apresentaram infecção o tempo médio de internação foi de 16,07 dias (zero a 122 dias). Avaliando os agentes etiológicos encontramos predomínio de bactérias Gramnegativas 34 (72,4%), destaque para Acinetobacter baumannii 11 (37,9%) e Klebsiella pneumoniae 5 (17,2%). Após a análise multivariada, os fatores independentemente relacionados à incidência de infecções foram: necessidade de re-operação (OR=13,22; IC95%=5,61-31,16; p<0,0001) e a presença de derivação ventricular externa (OR=5,61; IC95%=2,21 -14,22; p<0,0001). A mortalidade nos pacientes com infecção de sítio cirúrgico de órgão e espaços foi de 78,3%. Conclusões: Em nosso estudo encontramos uma taxa elevada de infecção de sítio cirúrgico, principalmente causada por bactérias Gram-negativas. A utilização de derivação ventricular externa e a re-operação foram os principais fatores de risco encontrados. Encontramos relação com aumento de mortalidade nos pacientes que desenvolveram infecção de sítio cirúrgico de órgão e espaços e a ocorrência de infecção de sítio cirúrgico teve um impacto importante no aumento do tempo de internação dos pacientes.
Introduction: Surgical site infection is one of the most feared complications of a procedure. The incidence of surgical site infection in neurosurgery is low, but consequences can be dire in terms of both morbidity and mortality. Few studies on the national level have assessed this issue. Objective: Determinate the incidence of surgical site infections and analyze the risk factors of the development of these infections on patients submitted to craniotomy. Examine the impact of these infections in mortality rates and length of stay in hospitalization. Casuistry and Methodology: Retrospective cohort type study, done on Hospital Estadual de Diadema (Diadema State Hospital). All patients submitted to craniotomy between January 1st 2006 and December 31st 2007 were included in the study. All diagnostics of infection were compliant to the definitions of the Centers for Disease Control and Prevention (CDC). The surgical site infections were classified as superficial, deep or organ space. Results: 352 craniotomies were conducted. The average age was 46.24 years. Admittance diagnosis most prominent were cranioencephalic trauma 101 (28.7%), subdural hematoma 61 (17.3%) and neoplasm 54 (15.3%). In the time span were observed 46 (13.1%) surgical site infections. Length of stay of patients that suffered infections was on average 58.26 days (3 and 187 days), against 16.07 days (0 and 122 days) for patients that showed no sign of infections. We found a predominance of Gram-negative bacteria 34 (72.4%), with prominence of Acinetobacter baumannii 11 (37.9%) and Klebsiella pneumoniae 5 (17.2%). After multi-valued analysis, the factors independently related to the incidence of infections were necessity of surgery repetition (OR=13,22; IC95%=5,61-31,16; p<0,0001) and external ventricular derivation presence (OR=5,61; IC95%=2,21 -14,22; p<0,0001). In the sample, 78.3% of patients with organ space surgical site infections expired. Conclusions: In our study we found a high rate of surgical site infections, mostly Gram-negative bacteria. The use of external ventricular derivation and surgery repetition were the main risk factors. We found a relation between the rise of mortality and patients suffering organ space surgical site infections, and the occurrence of surgical site infection had a significant impact in patient length of stay increase.
TEDE
BV UNIFESP: Teses e dissertações
Arnstigen, Sara, and Christer Axelsson. "Vårdpersonals syn på hygieniska preoperativa förberedelser : En kvalitativ intervjustudie." Thesis, Mid Sweden University, Department of Health Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-477.
Full textAbstrakt
Bakgrund: Länge har man varit medveten om vikten av god hygien och dess inverkan på
smittspridning. Det mest effektiva sättet att minska postoperativa sårinfektioner (SSI) är att arbeta
förebyggande och att ha en god hygien. Frekvensen av SSI ökar, och som en del av den förebyggande
vården ingår den preoperativa förberedelsen. Att inte ha kunskap och stöd till att utföra en sådan
åtgärd korrekt är en stor brist och kan leda till att patienter drabbas av SSI och därmed ett ökat
postoperativt lidande.
Syfte: Studiens syfte var att beskriva vårdpersonalens syn på betydelsen av hygienisk preoperativ
förberedelse hos ortopedpatienter.
Metod: Studien genomfördes på ett länssjukhus i mellersta norrland under våren 2008, där alla
ortopedavdelningar på sjukhuset deltog. En kvalitativ intervjumetod användes med manifest
innehållsanalys av materialet.
Resultat: All personal som ingått i studien anser att den hygieniska preoperativa förberedelsen är av
stor vikt. Trots faktorer som stress, personalbrist och hög arbetsbelastning kände personalen att de
ville vara noggrann i sitt arbete och göra det bästa för patienten, även genomföra en bra förberedelse
innan operation. Den största orsaken till att de frångick de skrivna rutinerna var att patienterna hade
ont, samt vid akuta situationer då det var svårt att planera sitt arbete.
Diskussion: Trots att personalen visste om förberedelsens betydelse för frekvensen av SSI och att de
tyckte att riktlinjerna inte förändrats på många år, valde de medvetet att vissa gånger frångå de rutiner
som finns och de tog inget eget ansvar för att hålla sig uppdaterad kring ny forskning.
Abstract
Background: Long has one been aware about the importance of good hygiene and its effect on
infection control. The most effective way to decrease surgical site infections (SSI) is to work
preventive and to have a good hygiene. The frequency of SSI increases and as a part of the preventive
care the hygienic preoperative preparation is included. To not have knowledge and aids to carrying out
such a measure correct is a big deficiency and can lead to patients being hit of SSI and with that
increased postoperative suffering
Aim: The study's aim was to describe the care personnel's view on the importance of hygiene
preoperative preparation at orthopaedic patients.
Method: The study was implemented on a county hospital in the north central part of Sweden during
the spring of 2008, where all orthopaedic departments on the hospital participated. A qualitative
interview method was used with a manifest content analysis of the material.
Results: All personnel as been included in the study were unanimous that hygienic preoperative
preparation was of big importance. Despite factors like stress, lack of personnel and high workload,
they wanted to be accurate in their work and do what’s best for the patient. That also implemented a
good preparation before operation. The major reason to not follow the guidelines where that the
patients was in acute pain, and in emergency situations when it were impossible to plan its work.
Discussion: Despite the knowledge about the importance of preparation for the frequency of SSI and
they thought that the guideline not been changed on many years, they sometimes deliberately chose
not to follow the guideline. The nurses took no responsibility in order to keep updated around new
research.
Vilas-Boas, Vanessa Aparecida 1981. "Carga microbiana dos trocartes de laparoscopia ginecológica, possíveis fontes de contaminação e repercussão clínica." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/283894.
Full textTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
Made available in DSpace on 2018-08-25T22:17:35Z (GMT). No. of bitstreams: 1 Vilas-Boas_VanessaAparecida_D.pdf: 3742241 bytes, checksum: 6d49ce98c3aba54d7cae1f702dacd78d (MD5) Previous issue date: 2014
Resumo: Introdução: Instrumentos cirúrgicos utilizados em cirurgias minimamente invasivas podem oferecer risco de infecção cruzada. Identificar sua fonte de contaminação contribui para prevenção de infecção e prestação do cuidado com qualidade e segurança. Contudo, a infecção de sítio cirúrgico é complexa, multifatorial e pode ser subnotificada se não houver programa de vigilância pós-alta efetivo. Objetivos: avaliar a relação entre carga microbiana de trocartes e microbiota da paciente, bem como a ocorrência de infecção de sítio cirúrgico após laparoscopia ginecológica; validar um instrumento de vigilância pós-alta por contato telefônico para cirurgias vídeo-assistidas. Método: estudo realizado em hospital público especializado em saúde da mulher. Fase I - estudo longitudinal prospectivo, 2011-2012, no qual amostras da microbiota da paciente foram coletadas no dia da internação por esfregaço com zaragatoa nas regiões da pele, ponto de McBurney esquerdo, cicatriz umbilical e fundo de saco vaginal. Após laparoscopia, trocartes foram coletados com técnica asséptica, obtendo-se o lavado microbiológico por adição de água destilada estéril e agitação, filtrados por membrana. As amostras foram incubadas para análise microbiológica. Após alta hospitalar, realizou-se vigilância por retorno ambulatorial e por contato telefônico. Realizada análise descritiva dos dados e aplicação dos testes de concordância de Kappa e Mc Nemar com nível de significância de 5%. Fase II - desenvolvida em duas etapas, a primeira 2011-2012, estudo metodológico com elaboração do instrumento de vigilância pós-alta por contato telefônico, para investigação de sinais e sintomas de infecção de sítio cirúrgico, seguida pela validação por peritos. O instrumento foi avaliado por cinco peritos quanto à pertinência, clareza e abrangência do conteúdo. A validação foi feita analisando-se a porcentagem de concordância entre peritos, sendo válidas as questões que obtiveram 80% de concordância. A segunda etapa, 2013, estudo transversal com aplicação do instrumento validado a pacientes submetidas aos procedimentos de histeroscopia e/ou laparoscopia ginecológica. Os dados foram analisados por estatística descritiva. Resultados: Fase I - a amostra foi composta por 24 pacientes, 68 esfregaços e 52 trocartes. Nos esfregaços encontrou-se predomínio de microbiota de pele Gram-positiva, mas também foram isoladas Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, dentre outros. Trocartes de 5 mm apresentaram crescimento bacteriano em 33,3% dos casos, com carga microbiana de 0-6 UFC. Trocartes de 10 mm apresentaram crescimento em 29,2%, com carga microbiana de 0-366 UFC. Observou-se grau de concordância pobre na comparação entre trocartes e microbiota da paciente (Kappa= 0,05; p= 0,08), exceto para Staphylococcus spp (p< 0,0001) e Corynebacterium spp (p= 0,0002). Não houve infecção decorrente da laparoscopia. Fase II - houve discordância entre peritos na primeira avaliação, o instrumento foi reformulado obtendo-se concordância na segunda avaliação. A amostra foi composta por 68 pacientes, sendo o contato telefônico possível em 86,36% dos casos. Queixas de dor abdominal, sangramento e edema incisional foram mais frequentes. Nenhuma apresentou infecção. Conclusão: Este estudo encontrou baixa contaminação nos trocartes, com a maioria das bactérias pertencentes à microbiota de pele da paciente sugerindo ser esta, sua principal fonte de contaminação. O questionário de vigilância pós-alta para cirurgias vídeo-assistidas foi validado, aplicado e encontra-se disponível para utilização
Abstract: Background: Surgical instruments used in minimally invasive surgery may offer risk of cross infection. Identify its source of contamination contributes to infection prevention and provision of quality and safety care. However, surgical site infection is complex, multifactorial and may be underreported if there is no post-discharge surveillance effective program. Aim: To evaluate the relationship between microbial load of trocars and patient flora as well as the occurrence of surgical site infection after gynecological laparoscopy; validate an instrument of post-discharge surveillance by telephone for video-assisted surgery. Method: study developed in public hospital specializing in women's health. Phase I - longitudinal prospective study, 2011-2012, in which the patient flora samples were collected with swabs the skin regions, left McBurney's point, umbilicus and vaginal fornix, on day of the admission. After the laparoscopy, trocars were collected using sterile technique, obtaining microbiological wash by addition of sterile distilled water and stirring, filtered through the membrane. The samples were incubated for microbiological analysis. After discharge, patients were followed up by outpatient and telephone call. Descriptive statistics, Kappa coefficient and McNemar¿s test were applied with significance level of 5%. Phase II - two stages, the first 2011-2012, methodological study with development of the post-discharge surveillance instrument for investigation of signs and symptoms of surgical site infection by telephone, addied with validation by experts. The instrument was evaluated by five experts on the relevance, clarity and completeness of contents. The validation was performed by analyzing the percentage of agreement among experts being considered valid the questions that have obtained 80% agreement. The second stage, in 2013, was a cross-sectional study with application of validated instrument to patients undergoing to hysteroscopy or gynecological laparoscopy. Data were analyzed using descriptive statistics. Results: Phase I - The sample consisted of 24 patients, 68 swabs and 52 trocars. In smears by swab there was a predominance of Gram-positive skin flora, but were also isolated Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, among others. The 5 mm trocars presented bacterial growth in 33.3% of cases with microbial load of 0-6 CFU. The 10 mm trocars presented bacterial growth in 29.2% with microbial load of 0-366 CFU. Noted poor agreement degree when comparing trocars and patient flora (Kappa= 0.05, p= 0.08), except for Staphylococcus spp (p<0.0001), and Corynebacterium spp (p= 0.0002). There was no infection resulting from laparoscopy. Phase II - there was disagreement among experts in the first evaluation, the instrument was redesigned obtaining agreement in the second evaluation. The sample consisted of 68 patients being telephone call possible in 86.36% of cases. Complaints of abdominal pain, bleeding and incisional edema were more frequent. No patient had infection. Conclusion: This study found low contamination in trocars, with most of the bacteria belonging to patient skin flora, their main source of contamination. The instrument of post-discharge surveillance for video-assisted surgery has been validated, implemented and is available for use
Doutorado
Enfermagem e Trabalho
Doutora em Ciências da Saúde
Torres, Lilian Machado. "Readmissão por infecção do sítio cirúrgico ortopédico: um enfoque fenomenológico." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-10052017-094147/.
Full textIntroduction: When people develop a surgical site infection, including the orthopedic site, it can be observed that some receive treatment and care in the home environment, not requiring re-hospitalization. In the case of readmission due to infectious process, treatment can be conservative through caring for the surgical wound and antimicrobial use, or it can require one or more surgical interventions. Health professionals should know the meanings and the experience of readmissions as a consequence of infections associated with surgical procedures. It is this reflection about past reports stories that when verbalized reveal unique and exclusive experiences. The questions leading to the investigation were: How does it feel to be readmitted for an orthopedic surgical site infection?; How is readmission due to an orthopedic post-operative infection understood in the personal, family life and work context?; What personal and social repercussions from orthopedic infection readmission can be perceived by the individual? Objective: To understand the experience of individuals readmitted due to orthopedic surgical site infection. Method: A qualitative research based on the Existential Phenomenology of Martin Heidegger. 11 individuals readmitted due to orthopedic surgical site infection in a public hospital in Belo Horizonte, Minas Gerais, who met inclusion and exclusion criteria participated in this study. Their statements were obtained through interviews between March 2014 and April 2015, from the following guiding question: How is it for you to be readmitted due to an orthopedic surgical site infection? Results: The testimonies that were collected and analyzed in the light of the Existential Phenomenology unveiled a specific readmitted-being-there feeling from orthopedic post-operative infection. They felt afraid and insecure regarding the unknown; expressed frustration because something that they did not expect would happen was happening; and the passing of time was perceived that did correspond to the amount of days or weeks in which they were present, but, instead, a feeling of being absent from being in their daily lives. At that point, a feeling of neglect was perceived, with health communication characterizing this neglect, making them feel like they have not been welcomed, nor had their story, their existence, heard. Therefore, understanding the impaired social relationships, which sometimes affected the disruption. Becoming attached to God was a comfort strategy of proximity to a divine being who could ward off the treatments that were coming: complications, sequelae and death. Conclusions: The results of this study indicate the need to deepen the knowledge of the dimensions involving care with a view to develop skills from the subjectivity of the experiences lived in the health-illness process. For this, understanding is essential, and reflection enables understanding, whereupon the simple ability to listen leads to qualified listening, where attitudes are possible and the health professional develops the ability to care for its true meaning; the care that transcends know-how and tries to achieve sensitive know-how.
Predrag, Rašović. "Značaj intraoperativnog mehaničkog ispiranja u prevenciji kontaminacije kalema kod rekonstrukcije prednje ukrštene veze kolena." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=101529&source=NDLTD&language=en.
Full textIntraoperative contamination of autograft during anterior cruciate ligament reconstruction still remains a topic for debate among orthopaedic surgeons mainly concerning the need and the way of its treatment. Graft contamination arises after pathogen settlement from the surrounding air, from skin and mucoses of patient and staff, as well as not enough sterilized instruments. Pathogens found in graft contamination are the same ones who are causes of septic arthritis, which is the most common complication in arthroscopic surgery in general. Consequences of septic arthritis usually leave a huge impact on patient’s mental and physical status. In modern surgery, it is mandatory to prevent potential auto-graft contamination by irrigation (during anterior cruciate ligament reconstruction in knee). Most commonly used agents for intraoperative auto-graft irrigation are variety of antiseptic and antibiotic solutions. Even though intraoperative irrigation with saline solution presents one of the most commonly used procedures during different surgical interventions in general, little is said in literature about its usage in auto-graft contamination. The aim of this study was to show that decontamination of auto-graft during anterior cruciate ligament reconstruction of the knee can be successfully done by mechanical irrigation with saline (0,9%) solution and also to define a precise quantity of saline for complete decontamination. Furthermore, effects of different factors in surroundings were inspected. The study consisted of two parts: experimental and clinical. Experimental part was conducted at the Department for clinical bacteriology, at Microbiology Centre at the Institute for public health of Vojvodina. It consisted in making the experimental model with in vitro conditions similar to or as the same as in the operating theatre. Experimental model was made of 50 preparated and sterilized pig tendons of deep finger flexors, which are similar dimensions as human anterior cruciate ligament of the knee. Then, the tendons were contaminated with previously defined concentration of most common cause of contamination which is coagulase negative staphylococcus (ATCC 12228 Staphylococcus epidermidis). Contaminated tendons were mechanicaly irrigated with 500ml, 1000ml and 1500ml saline solution. After each irrigation a swab was taken and put in blood agar to grow. Following 24h of incubation, bacterial colonies were counted. Results of experimental model show that 1500ml of saline solution is required for decontamination of tendon. Results of experimental model were used in clinical part of the study which was conducted at the Clinic for orthopaedic surgery and traumatology in Clinical Centre of Vojvodina. It comprised of 200 patients, who were 15-50 years old. Patients were divided in two equal groups: tested and control group. In control group mechanical irrigation of auto-graft was done prior to its implementation with 500ml saline solution, while in tested group 1500ml of saline was used for irrigation. Results of clinical part of the study show that intraoperative irrigation with 1500ml of saline solution is enough for complete decontamination of auto-graft. Furthermore, degree of auto-graft contamination rises with prolonged exposure time on surrounding air, with incrised number of people in the operating theatre and also with number and sequence of operations during the day. Intraoperative mechanical irrigation proved to be a sufficient method that can be used in intraoperative autograft decontamination during anterior cruciate ligament reconstruction. The results of this study can be applied to other aspects of the surgery and could be used and further clinicalstudies.
Veiga, Filho Joel [UNIFESP]. "Tempo de permanência do curativo após mamoplastia redutora: influência na colonização, na infecção da ferida operatória e na opinião das pacientes." Universidade Federal de São Paulo (UNIFESP), 2010. http://repositorio.unifesp.br/handle/11600/10107.
Full textIntrodução: o cuidado com a ferida operatória é controverso na literatura, com recomendações diversas, desde não se colocar curativo, mantê-lo por 24 a 48h, ou mantê-lo até a retirada das suturas. Objetivo: Avaliar a influência do tempo de permanência do curativo após mamoplastia redutora na colonização cutânea, na infecção da ferida operatória e na opinião das pacientes. Métodos: 70 pacientes com indicação para mamoplastia redutora foram distribuídas aleatoriamente em dois grupos. No grupo PO1 o curativo foi retirado no 1o dia pós-operatório e no grupo PO6 o curativo foi retirado no 6º dia pós-operatório. A colonização cutânea foi verificada por meio de culturas de coletas em momentos padronizados. A avaliação da ferida operatória quanto à infecção seguiu os critérios definidos pelo Centers for Disease Control and Prevention (CDC). A opinião das pacientes quanto ao curativo foi verificada no 13º dia pós- operatório. Resultados: no 6º dia pós-operatório houve um maior número de unidades formadoras de colônias, no grupo PO1. Nove pacientes (12,9%) apresentaram infecção, sete no grupo PO1 (20%) e duas no grupo PO6 (6%). Das pacientes do grupo PO1, 66% prefeririam manter o curativo por um dia e do grupo PO6, 83% prefeririam manter o curativo por seis dias. Conclusões: a colonização no 6º dia pós-operatório foi maior no grupo PO1. Não houve diferença entre os grupos quanto à ocorrência de infecção da ferida operatória. As pacientes demonstraram preferência e acharam mais seguro a permanência do curativo até o sexto dia pós-operatório.
Background: There is controversy in the literature regarding the treatment of surgical wounds, which includes different approaches to wound management, such as “not to dress the wound” to “leave the dressing in place for 24-48 hours” or “until sutures are removed”. Objective: To evaluate the effect of the length of time the dressings were left in place after reduction mammaplasty on skin colonization, surgical site infection, and patient opinion. Methods: Seventy patients undergoing reduction mammaplasty were randomly divided into two groups: group PO1 (dressing was removed on the first postoperative day) and group PO6 (dressing was removed on the sixth postoperative day). Skin colonization was detected by culture of samples collected at predefined time points. Surgical site infections were classified according to the guidelines of the Centers for Disease Control and Prevention (CDC). Patient satisfaction was assessed on postoperative day 13. Results: A larger number of colony-forming units were measured in group PO1 on postoperative day 6. Nine (12.9%) patients had surgical site infection (seven from group PO1, and two from group PO2). In group PO1, 66% of the patients chose to keep the dressing for one day, while 83% of the patients in group PO6 chose to keep the dressing for six days. Conclusions: Higher colonization levels were observed in group PO1 on the sixth postoperative day. There was no difference in surgical site infection between groups. Most of the patients chose to keep the dressing in place for six days postoperatively, and felt it was safer.
TEDE
BV UNIFESP: Teses e dissertações
Carvalho, Thialla Andrade. "Riscos e complicações associadas à Infecção do Sitio Cirúrgico : um estudo de coorte." Universidade Federal de Sergipe, 2016. https://ri.ufs.br/handle/riufs/4985.
Full textPurpose: to identify the occurrence of cross infection, the associated risks and its correlation with hospital stay and mortality in patients attended at a teaching hospital located in the northeastern region of Brazil. Methods: prospective cohort study, with information collected in medical records and kept on adverse event surveillance forms during the year 2015. The data were entered and analyzed in Epi-Info7 software. The variables studied were related to patients, procedures and outcomes. Results: A total of 752 adverse events surveillance forms were evaluated, with an overall incidence of 4,52% for Surgical Site Infection (SSI). A statistically significant association was found in the univariate analysis of SSI and the variables studied: contaminated surgeries, surgeries without laparoscopic techniques, patients with severe systemic alteration, patients with functional limitation, Nosocomial Infections Surveillance (NNIS) Risk Index (IRIC) ≥1 and in procedures that did not use Microbial prophylaxis in accordance to standardized Hospital Infection Control Service (HICS). The independent association with SSI was observed for NNIS and non-specified intra-abdominal surgery elsewhere. It was also demonstrated a significant association between the diagnosis of SSI and increased mortality and hospital stay.Conclusion: This study demonstrates the significant impact of risk factors for the occurrence of SSI and allows the establishment of strategies that improve the quality of patient care and safety.
Objetivo: Identificar a ocorrência de Infecção do Sítio Cirúrgico (ISC), os riscos associados e a sua correlação com permanência e mortalidade hospitalar em pacientes atendidos em um hospital de ensino localizado na região nordeste do Brasil. Método: estudo de coorte prospectivo, com coleta de informações contidas em prontuários e registradas em formulários de vigilância de eventos adversos durante o ano de 2015. Esses dados foram digitados e analisados em software Epi-Info7. As variáveis estudadas foram relacionadas aos pacientes, aos procedimentos e aos desfechos. Resultados: Foram avaliadas 752 fichas de vigilância de eventos adversos com uma incidência global de 4,52% de ISC. Foi encontrada uma associação estatisticamente significativa na análise univariada entre ISC e as variáveis: cirurgias contaminadas, cirurgias que não utilizaram técnicas videolaparoscópicas, pacientes com alteração sistêmica grave e com limitação funcional, Índice de Risco Cirúrgico (IRIC) ≥1 e nos procedimentos que não usaram a profilaxia microbiana conforme padronização do Serviço de Controle de Infecção Relacionadas à Assistência (SCIRA) da instituição. A associação independente com a ISC foi observada para IRIC e para cirurgia intra-abdominal não especificada em outro local (IAB). Demonstrou-se ainda, associação significativa entre o diagnóstico de ISC e o aumento da mortalidade e da permanência hospitalar. Conclusão: Este estudo demonstra o significativo impacto dos fatores de risco para ocorrência de ISC e permite o estabelecimento de estratégias que melhorem a qualidade da assistência e a segurança do paciente.
Oliveira, Priscila Rosalba Domingos de. "Incidência e fatores associados à ocorrência de infecção de sítio cirúrgico nas fraturas diafisárias do fêmur e da tíbia tratadas com haste intramedular: estudo prospectivo." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-23102018-092906/.
Full textBACKGROUND: Diaphyseal fractures of femur and tibia are prominent due to its high incidence and high economic and social impact. Intramedullary nailing (IN) is the surgical procedure of choice. Surgical site infection (SSI) related to this procedure is considered a difficult to treat complication. OBJECTIVES: Determine the incidence of SSI after IM in femoral and tibial diaphyseal fractures and evaluate possible risk factors. METHODS: Prospective observational cohort study. SSI was defined according to CDC-NHSN criteria. Incidence of SSI was calculated as the ratio between the number of patients with SSI and total number of patients. Analysis of potential risk factors included patients-related factors (age, gender, body mass index, active foci of infection, immunosuppressive conditions, ASA score, alcohol or illicit drug abuse, smoking, polytrauma, etiology of fracture, type of fracture if closed or open, classification of fracture according to Müller AO, Tcherne classification for closed fractures, to Gustilo-Anderson classification for open fractures, previous surgical manipulation, use of blood products); environmental and surgical-related factors (surgical wound classification, duration of surgery, hair removal, intraoperative contamination, antimicrobial use, presence of drains, hypothermia or hypoxia in the perioperative period, type of IN used, reaming, need for muscle or skin flap repair, use of negative pressure therapy) and microbiotarelated factors (S. aureus and A. baumannii colonization). RESULTS: 221 patients were included and completed the 12-month follow-up period. Incidence of SSI was 11.8%. In the initial analysis by unadjusted logistic regression, following factors were associated SSI: trauma etiology related to car and bicycle accidents, Müller AO classification of the fracture morphology groups 2 or 3, previous use of external fixator, surgeries with larger length of time, presence of drains, use of negative pressure therapy and need for muscle or skin flap repair. In the multiple logistic regression-adjusted analysis, previous use of external fixator and need for muscle or skin flap repair remained associated with SSI. CONCLUSIONS: Incidence of SSI associated with IN for femoral and tibial diaphyseal fractures was 11.8%. Previous use of external fixators and need for muscle or skin flap repair were factors associated with occurrence of infection
Silva, Lúcia Marta Giunta da [UNIFESP]. "Avaliação da estrutura e processo assistencial de enfermagem na prevenção e controle da infecção de sítio cirúrgico em pacientes submetidas à cirurgia oncológica de mama." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/9017.
Full textIntrodução: Altas taxas de infecção podem refletir a qualidade de um serviço de saúde. Considerando-se que as taxas de infecção de sítio cirúrgico (ISC) encontradas em estudos prévios no local do presente estudo variaram de 14,1% a 22%, questionou-se se a estrutura e o processo assistencial de enfermagem estariam influenciando estas taxas. Uma vez obtida esta resposta, outra indagação relacionou-se à capacidade de um programa educativo de gerar a construção de propostas ou projetos de mudanças por parte dos seus participantes, a partir e uma dinâmica que prime pela interatividade. Objetivo: Avaliar a estrutura e processo assistencial de enfermagem e um programa educativo para os enfermeiros, com o uso de estratégias educacionais interativas, para a prevenção e controle de ISC. Método: Estudo de intervenção, aprovado pelo Comitê de Ética em Pesquisa da UNIFESP sob o número 1486/07, desenvolvido em duas etapas. A primeira consistiu de um estudo observacional e de análise documental, realizado por meio de auditorias de estrutura e processo, na Unidade de Ginecologia e Setor de Oncomastologia do Hospital São Paulo (HSP), entre agosto de 2007 e março de 2008. Esta fase do estudo foi descrita no primeiro artigo que compõe o corpo desta tese. A segunda, de abordagem quali-quantitativa, foi realizada no período de outubro de 2008 a setembro de 2009 e compreende a estruturação, desenvolvimento e avaliação do projeto educacional em ambiente virtual voltado para as enfermeiras dos setores acima mencionados, para controle de ISC, baseado no Modelo Skopos e organizado a partir dos recursos do ambiente Moodle. O conjunto de dados desta etapa foi descrito nos três artigos subsequentes que compõem a tese. Resultados: A avaliação da estrutura e processo assistencial de enfermagem evidenciou que os documentos normativos estavam em consonância com o preconizado na literatura, porém, a estrutura física e os processos assistenciais dos locais pesquisados apresentavam limitações importantes com impacto negativo para o desenvolvimento dos processos assistenciais adequados à prevenção de ISC. No que se refere à estruturação e utilização de um ambiente virtual de aprendizagem na educação continuada em enfermagem, o Moodle mostrou-se valioso para estruturação de um programa educativo de enfermagem, que buscou distanciar-se do modelo de comunicação unilateral e hierárquico. A avaliação do alcance dos objetivos e da adequação dos conteúdos propostos pelo referido programa, por parte das quatro enfermeiras que participaram do processo, mostrou que as mesmas têm clareza dos benefícios e dos principais fatores limitantes atrelados aos programas educativos. E, ainda, embora novas estratégias pedagógicas, particularmente interativas, sejam bem-vindas, as profissionais preferiram os encontros presenciais para verbalização e organização das reflexões. Finalmente, a aplicação das ferramentas HFMEA® e diagrama de Ishikawa possibilitou a análise de quatro processos assistenciais de enfermagem e seus modos de falha: 1) Agendar cirurgia via Setor de Oncomastologia; 2) Fluxo de Admissão e Alta de Paciente Cirúrgico na Unidade de Internação de Ginecologia; 3) Realização de Procedimentos Cirúrgicos Ambulatoriais; 4) Retorno Ambulatorial de Pacientes Cirúrgicos. Possibilitou, ainda, a elaboração de ações de melhoria que foram iniciadas a partir das discussões realizadas no programa. Conclusões: Os resultados do estudo evidenciaram a necessidade de revisão do processo assistencial de enfermagem e adequação da estrutura, a fim de que os padrões de prevenção e controle da ISC fossem atendidos. Em relação ao programa educativo, a experiência de uso de tecnologia educacional na instituição em questão mostrou-se factível e propiciou a reflexão conjunta sobre a situação-problema vivenciada, bem como a proposta de ações para sua solução. Porém, como todo processo inovador, há uma trajetória a ser construída para que os enfermeiros habituados ao estilo expositivo, presencial e focado em objetos previamente determinados, sejam capazes de se beneficiarem de estratégias interativas, colaborativas e baseadas em projetos.
Introduction: High rates of infection can reflect low health service quality. The fact that previous studies performed at the same location of the present study found surgical site infection rates (SSI) ranging from 14.1% to 22% raised questions about the possibility of the nursing care structure and process to affect those rates. After obtaining this first answer, another question emerged, concerning the capacity of an inservice training program be able to encourage the participants, by means of an interactive dynamics, to develop proposals or projects from making changes. Objectives: To evaluate nursing care structure and process in preventing and managing SSI; and evaluate an inservice training program for nurses involved in the context of the identified problems, using interactive educational strategies aiming at the prevention and control of this complication. Method: This intervention study was approved by the UNIFESP Research Ethics Committee under register 1486/07, and was developed in two stages. The first stage consisted of and observation and analysis study, performed by means of inspections of the structure and process at the Gynecology Oncomastology Units at Hospital São Paulo (HSP), between August 2007 and March 2008. This stage was described in the first article that composes this dissertation. The second stage used a quali-quantitative approach and was performed from October 2008 to September 2009. It consisted of the structure, development, and evaluation of the educational project in a virtual environment for the Training Program at Work for nurses of the referred hospital units, in SSI control, based on the Skopos Model, and organized based on the resources of the Moodle environment. The data regarding this stage was described in the three subsequent articles that comprise the dissertation. Results: The evaluation of the nursing care structure and process showed that the normative document were in agreement with the literature; however, the physical structure and the nursing care processes of the studied locations presented important limitations, which had a negative impact on the development of adequate health care processes to prevent SSI. In terms of the structure and use of a virtual learning environment in continuing nursing education, Moodle showed to be valuable in structuring a nursing training program, which sought to stand apart from a unilateral and hierarchical communication model. The evaluation of goal achievement and content adequacy of the referred program was performed by four nurses who participated in the process. The nurses found that the program presents clear benefits and the main limiting factors associated with inservice training. In addition, although new educational strategies, particularly if interactive, are welcome, the professionals preferred in-person meetings. Finally, using the HFMEA® and the Ishikawa diagram permitted to analyze four nursing care processes and their forms of failure: 1) scheduling a surgery through the Oncomastology Unit; 2) Surgery Patient Admission and Discharge Flow at the Gynecology Hospitalization Unit; 3) Performing Outpatient Surgical Procedures; 4) Outpatient Return Appointments for Surgery Patients. In addition, it was possible to make a list of improvement actions that were initiated based on the discussions held during the training program. Conclusions: The study results evidenced the need to review the nursing care process and to make the structure adequate with a view to meet the standards for SSI prevention and control. As for the inservice training program, the experience of using educational technology at the referred institution was feasible and provided the chance for group analyses about the problematic situation, as well as the proposal of actions for its solution. However, just as any innovative process, there is a pathway to be constructed so that nurses, who are used to training programs that are expositive, performed on-site and focused on previously determined objectives become capable of benefiting from interactive, collaborative, and project-based strategies.
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