Avaliação da profilaxia antimicrobiana e infecção de sítio cirúrgico: estudo de coorte
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Data
2017-02-23
Autores
Velozo, Bruna Cristina [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
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 no intraoperatório a razão de chance de infecção de sítio cirúrgico aumentou 60% e para o seguimento até o pós-operatório a mesma foi de 39%. A incidência de pacientes diagnosticados com infecção de sítio cirúrgico foi 3,6% ainda na internação e 5,8% após a alta, demonstrando significância de maior tempo de internação para pacientes com essa infecção, assim como desfecho de óbito para os que permaneceram internados. Nosso estudo corrobora a outros brasileiros e de países em desenvolvimento na avaliação geral da profilaxia antimicrobiana, porém a infecção de sítio cirúrgico é ainda uma preocupação na Europa e EUA, sendo a segunda maior infecção associada à assistência à saúde. A inadequação mais evidente foi ausência de repique ou não realização do mesmo, em que alguns estudos também retrataram como dificuldade de cumprimento em suas auditorias. A avaliação da profilaxia antimicrobiana é imprescindível na detecção de inconformidades com protocolos. Nosso estudo demonstrou a inferência das inadequações da profilaxia e fatores associados ao desfecho de infecção de sítio cirúrgico e também permitiu elucidar como ocorre essa prática de forma global em hospital de ensino de grande porte. É necessário realizar feedback às especialidades cirúrgicas a fim de que que haja maior aderência ao protocolo instituicional com vistas à qualidade da assistência ao paciente e diminuição da incidência dessa infecção.
The surgical site infection is the most common complication in surgical patients and its incidence can decrease with an adequate surgical antibiotic prophylaxis. Its importance to prevent that infection has become a relevant and emergency theme for an adequate and safe care. This study aimed to assess the adequate use of surgical antibiotic prophylaxis and the occurrence of surgical site infection according to the protocol of the Health Care-Related Infection Control Committee (CCIRAS). This is a cohort, prospective study, with a 30-day follow-up at a teaching hospital in the interior of São Paulo, Brazil. For eligibility of the sample, there was selection of patients over 18 years old who underwent surgeries of all surgical specialties, whether elective or urgency/emergency, who received surgical antibiotic prophylaxis. The data collection occurred through a software developed for this purpose that compared the performed surgical antibiotic prophylaxis with the recommendation of the institutional protocol, identifying the correctness and inadequacies for each evaluated item. CCIRAS of the hospital assessed the surgical site infection, which performs the surveillance of the patients after the discharge through phone calls. The sample consisted of 415 patients with mainly elective surgeries. The compliance with all evaluated items of the intraoperative surgical antibiotic prophylaxis was 1.7%. We verified that every inadequacy of the intraoperative surgical antibiotic prophylaxis increased 60% the odds ratio of the surgical site infection and, in the post-operatory, it was 39%. The incidence of patients diagnosed with surgical site infection was 3.6%, still during hospitalization, and 5.8% after discharge, which demonstrates the significance of a higher hospitalization time for patients with that infection, as well as the death outcome for those who remained hospitalized. Our study corroborates other Brazilian ones, and from other developing countries, in the general assessment of the surgical antibiotic prophylaxis. However, the surgical site infection is still a concern in Europe and in the USA, being the second greatest infection related to health care. The most evident inadequacy was the lack of reapplication, or its non-use, which some studies also described as a difficulty for non-accomplishment in their auditing. Assessing the surgical antibiotic prophylaxis is essential to detect non-compliances with protocols. Our study showed the inference of inadequacies of the prophylaxis and the factors associated to the outcome of surgical site infection, and allowed elucidating how that practice generally occurs at a large-sized teaching hospital. It is necessary to perform feedback to surgical specialties so that there is greater adherence to the institutional protocol, aiming at the quality of the care to the patient and decreasing the incidence of that infection.
The surgical site infection is the most common complication in surgical patients and its incidence can decrease with an adequate surgical antibiotic prophylaxis. Its importance to prevent that infection has become a relevant and emergency theme for an adequate and safe care. This study aimed to assess the adequate use of surgical antibiotic prophylaxis and the occurrence of surgical site infection according to the protocol of the Health Care-Related Infection Control Committee (CCIRAS). This is a cohort, prospective study, with a 30-day follow-up at a teaching hospital in the interior of São Paulo, Brazil. For eligibility of the sample, there was selection of patients over 18 years old who underwent surgeries of all surgical specialties, whether elective or urgency/emergency, who received surgical antibiotic prophylaxis. The data collection occurred through a software developed for this purpose that compared the performed surgical antibiotic prophylaxis with the recommendation of the institutional protocol, identifying the correctness and inadequacies for each evaluated item. CCIRAS of the hospital assessed the surgical site infection, which performs the surveillance of the patients after the discharge through phone calls. The sample consisted of 415 patients with mainly elective surgeries. The compliance with all evaluated items of the intraoperative surgical antibiotic prophylaxis was 1.7%. We verified that every inadequacy of the intraoperative surgical antibiotic prophylaxis increased 60% the odds ratio of the surgical site infection and, in the post-operatory, it was 39%. The incidence of patients diagnosed with surgical site infection was 3.6%, still during hospitalization, and 5.8% after discharge, which demonstrates the significance of a higher hospitalization time for patients with that infection, as well as the death outcome for those who remained hospitalized. Our study corroborates other Brazilian ones, and from other developing countries, in the general assessment of the surgical antibiotic prophylaxis. However, the surgical site infection is still a concern in Europe and in the USA, being the second greatest infection related to health care. The most evident inadequacy was the lack of reapplication, or its non-use, which some studies also described as a difficulty for non-accomplishment in their auditing. Assessing the surgical antibiotic prophylaxis is essential to detect non-compliances with protocols. Our study showed the inference of inadequacies of the prophylaxis and the factors associated to the outcome of surgical site infection, and allowed elucidating how that practice generally occurs at a large-sized teaching hospital. It is necessary to perform feedback to surgical specialties so that there is greater adherence to the institutional protocol, aiming at the quality of the care to the patient and decreasing the incidence of that infection.
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Palavras-chave
Infecção da ferida operatória, Antibioticoprofilaxia, Procedimentos cirúrgicos operatórios, Surgical wound infection, Antibiotic prophylaxis, Operatory surgical procedures