Indicadores de processo para a prevenção da infecção do sítio cirúrgico em um hospital universitário do centro-oeste brasileiro
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2013-03-26
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Universidade Federal de Goiás
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INTRODUCTION: Evidence shows that out of every ten people in the world, one has
been the victim of medical errors or preventable adverse events. These statistics are
further evidence that of the 234 million patients undergoing surgeries, seven million
suffer postoperative complications, increasing mortality rates by around 0.4 to 10%.
A surgical site infection is considered the second highest incidence of major impact
to the morbidity and mortality of patients, and may cause irreparable physical and
emotional harm, as well as increase the cost of therapy for institutions. This reality
drove the Safe Surgery Saves Lives program, which is the second Global Challenge
for the World Alliance for Patient Safety program, launched by the World Health
Organization in 2004. Studies organized by the National Health Surveillance Agency
of Brazil, derived from these campaigns, cataloged nine process indicators to prevent
these infections, which were the subject of this investigation.
OBJECTIVE: To examine the process indicators for the prevention of surgical site
infection in the perioperative period in patients undergoing clean surgery in a
teaching hospital in central-western Brazil. METHODS: Retrospective analytical
cohort study, conducted in 700 records of patients aged 18 years or older undergoing
clean surgical procedures from January 2008 to December 2010. We used a
structured form, previously evaluated according to national guidelines. Data were
entered into SPSS version 15 for Windows. The analysis was descriptive and
multivariate, and used chi-square tests, Fisher, and odds ratio (OR) as measures of
association for variables with p <0.10. Statistically significant associations with p
<0.05 were considered. RESULTS: Regarding the socio-demographic profile of the
patients, 57.1% were female, aged between 18 and 101 years, 39.3% had
comorbidities, 74.5% with ASA ≤ II. Regarding surgical specialty, 29.9% were
orthopedic and 19.9% were vascular. Nonconforming indicators were found in
64.6%. Aspects such as the time of preoperative hospitalization, the method used for
hair removal, the duration of antimicrobial prophylaxis, glycemic control in diabetics,
as well as the thermal controls and inspection records of the surgical cases were not
considered appropriate. The predictors for surgical site infection in the univariate
analysis were male gender, carriers of chronic disease, alcoholism and smoking,
infections already present on admission, a length of preoperative hospital stay of
greater than 5 days, ASA ≥ III, shaving and antimicrobial prophylaxis; the
independent factors were: being a carrier of a chronic disease, infections already
present on admission and shaving with a razor blade. The estimated rate of infection
was 10%. The surgical specialty with the highest rate of infection was vascular, with
25.9%. The methicillin-resistant Staphylococcus aureus was the most evident
causative agent. CONCLUSION: We conclude that the service partially meets the
process indicators for the prevention of surgical site infection in the perioperative
period of clean surgeries, incongruent with the principles of the Safe Surgery Saves
Lives program.
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GEBRIM, Cyanéa Ferreira Lima. Indicadores de processo para a prevenção da infecção do sítio cirúrgico em um hospital universitário do centro-oeste brasileiro. 2013. 170 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2013.