RESUMO
Se realizó un estudio descriptivo, de serie de casos, de 258 pacientes intervenidos de forma urgente o electiva durante el trienio 2012-2014 en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, quienes presentaron infecciones posoperatorias, con el propósito de identificar diferentes factores relacionados con el empleo de antibióticos ante esta complicación. Entre los resultados sobresalientes se obtuvo que la estancia hospitalaria se prolongara por más de 14 días en más de la mitad de los pacientes cuyas operaciones quirúrgicas fueron clasificadas como contaminadas o sucias, y que en el período preoperatorio se aplicaron antibióticos en 77,1 % de la serie, mientras en la fase posoperatoria se administraron en todos los infectados. Asimismo, los estudios microbiológicos mostraron positividad en 86,5 % y los microorganismos más comúnmente aislados fueron gramnegativos: Klebsiella, estafilococo patógeno, Escherichia coli y Acinetobacter. Pudo concluirse que la política del uso racional de antibióticos con fines profilácticos y terapéuticos, debe relacionarse con la circulación intrahospitalaria de gérmenes, de acuerdo con el mapa microbiológico y la resistencia de estos, para así implementar un protocolo estandarizado al respecto.
A descriptive, serial cases study, of 258 patients undergoing surgery in an emergent or elective way who presented postoperative infections was carried out during the triennium 2012-2014 in the General Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, with the purpose of identifying different factors related to the use of antibiotics in these cases. Among the outstanding results it was obtained that the hospitalization lasted more than 14 days in more than half of the patients whose surgical operations were classified as polluted or dirty, and that in the preoperatory period antibiotics were applied in 77.1 % of the series, while in the postoperative phase antibiotics were administered in all those infected. Also, the microbiological studies showed positivity in 86.5 % and the most common isolated microorganisms were gramnegative: Klebsiella, pathogen Staphylococcus, Escherichia coli and Acinetobacter. It was concluded that the politics of the rational use of antibiotics with preservatives and therapeutic ends, should be related to the intrahospital circulation of germs, according to the microbiological map and the resistance of these, so as to implement a standardized protocol in this respect.
Assuntos
Antibioticoprofilaxia , Hospitalização/estatística & dados numéricos , Antibacterianos , Infecção da Ferida CirúrgicaRESUMO
Se realizó un estudio descriptivo y transversal de 21 puérperas cesareadas, con infección del sitio quirúrgico, ingresadas en el Hospital Ginecoobstétrico Dra. "Nelia Irma Delfín Ripoll" de Palma Soriano, provincia de Santiago de Cuba, desde octubre de 2014 hasta igual mes de 2015, a fin de caracterizarles según variables seleccionadas. En la serie predominaron el grupo etario de 20-29 años, la anemia (66,6 %) y la obesidad (42,8 %) como principales factores de riesgo, la cirugía urgente limpia contaminada (76,1 %), así como el Staphylococcus aureus y la Escherichia coli como los gérmenes más aislados; asimismo, se utilizaron combinaciones de antibióticos de primera línea con resultados favorables en todas las pacientes. Se concluye que la presencia de factores de riesgo y la identificación de bacterias como agentes causales importantes, exige mantener una vigilancia epidemiológica permanente para disminuir la infección en estas pacientes.
A descriptive and cross-sectional study of 21 newly-delivered woman undergoing cesarean section, with infection of the surgical place, admitted to Dr. "Nelia Irma Delfín Ripoll" Ginecoobstetric Hospital in Palma Soriano, Santiago de Cuba, was carried out from October, 2014 to the same month in 2015, in order to characterize them according to selected variables. In the series the 20-29 age group, anemia (66.6%) and obesity (42.8%) prevailed as main risk factors, the polluted clean urgent surgery (76.1%), as well as the Staphylococcus aureus and the Escherichia coli as the isolated germs; also, combinations of first line antibiotics were used with favorable results in all the patients. It was concluded that the presence of risk factors and the identification of bacterias as important causal agents, demands maintaining a permanent epidemiologic surveillance to diminish the infection in these patients.
Assuntos
Infecção da Ferida Cirúrgica , Cesárea , Infecção Puerperal , Mesas Cirúrgicas , AntibacterianosRESUMO
A pesar de los avances de las técnicas quirúrgicas, anestésicas, microbiológicas, así como de la ingeniería genética y la biotecnología, las infecciones constituyen el enemigo invisible del paciente operado. La aparición de infección nosocomial en el periodo posoperatorio constituye una complicación frecuente que, independientemente de todas las medidas de prevención y control, aumenta la morbilidad y mortalidad posquirúrgicas; pues, además de comprometer los resultados de las intervenciones, favorecen la aparición de otras complicaciones, en ocasiones fatales, con repercusiones socioeconómicas muy desfavorables para el enfermo y las instituciones sanitarias. Por esas razones, la revisión sobre este tema nunca pierde actualidad, dado su origen multifactorial, diversidad de localizaciones y variedad de gérmenes que las provocan. Así, este artículo pretende contribuir a su prevención, diagnóstico precoz, tratamiento oportuno y adecuado, según las buenas prácticas médicas y quirúrgicas.
In spite of the advances of the surgical, anesthetic and microbiologic techniques, as well as of the genetic engineering and the biotechnology, infections constitute the invisible enemy of the operated patient. The occurrence of nosocomial infection in the postoperative period constitutes a frequent complication which, independently from all the prevention and control measures, increases the postsurgical morbidity and mortality, as besides compromising the results of the interventions, they favor the appearance of other complications, occasionally fatal, with very unfavorable socioeconomic repercussions for the sick person and the health institutions. For these reasons, the review on this topic never loses updating, given its multifactor origin, diversity of localizations and variety of germs provoking them. Thus, this work seeks to contribute to its prevention, early diagnosis, opportune and appropriate treatment, according to the good medical and surgical practices.
Assuntos
Período Pós-Operatório , Infecção Hospitalar , Infecções , AntibacterianosRESUMO
A prática da utilização de máscaras cirúrgicas durante a realização dos procedimentos cirúrgicos, como uma medida de prevenção da infecção do sítio cirúrgico (ISC), vem sendo questionada nos últimos tempos. Com o intuito de produzir evidências científicas, foi desenvolvida a presente investigação, com delineamento experimental, controlado, que teve como objetivo avaliar a eficácia da barreira microbiana das máscaras cirúrgicas descartáveis (Eficácia de Filtração Bacteriana - BFE- de 95%), segundo o seu tempo de utilização (1 hora, 2 horas, 4 horas e 6 horas). Os dados foram coletados em uma sala de operação de uma unidade de centro cirúrgico de um hospital privado do município de São Paulo cuja estrutura física atende às recomendações atuais propostas pelo Ministério da Saúde (RDC-50 - MS/2002). Para os experimentos, constituíram-se 2 grupos denominados controle e experimental. O primeiro sem utilização de máscaras cirúrgicas e o segundo com elas. A fim de reproduzir as conversações que normalmente ocorrem entre a equipe cirúrgica durante o ato operatório, uma variável que interfere no período de validade das máscaras cirúrgicas descartáveis, manteve-se o controle de palavras emitidas pelos colaboradores da coleta de dados, nos dois grupos, em todos os tempos estudados. Para controlar a influência do ambiente, foram mantidas placas de Petri no ambiente de sala de operações, próximas à entrada do ar condicionado. Realizou-se a contagem das Unidades Formadoras de Colônia (UFC) das unidades de análise das simulações em ambos os grupos, nos intervalos de tempo pré-estabelecidos (1, 2, 4 e 6 horas), por meio das placas de Petri com meio de cultura (Agar Triptona Soja -ATS) dispostas sobre a mesa cirúrgica. Foram identificados os microrganismos mais freqüentes encontrados nas simulações. Os dados foram submetidos à análise estatística e os resultados mostraram que a utilização da máscara cirúrgica diminuiu ) diminuiu (coeficiente de regressão = -20,10) a média de UFC das placas da mesa cirúrgica que simulou o campo operatório, em todos os tempos testados. Verificou-se que a sua utilização além de 2 horas aumentou a contaminação das placas da mesa cirúrgica. Nas análises estatísticas foram consideradas as interferências da contaminação ambiental e constatou-se que existiu uma correlação positiva alta (coeficiente de correlação = 0,886) entre as médias de UFC da mesa cirúrgica e do ambiente, estatisticamente significante (P< 0,001). Concluiu-se que as máscaras cirúrgicas descartáveis (BFE 95%) demonstraram constituir barreiras microbianas eficazes em todos os tempos estudados, diminuindo sua eficácia de filtração após 2 horas de sua utilização
The practice of the use of surgical masks during surgical procedures as a preventive measure against Infection of the Surgical Site (ISS) has been questioned lately. With the aim of producing scientific evidence, the present investigation was developed - with an experimental controlled basis - in order to evaluate the effectiveness of microbial barriers of disposable surgical masks (Bacterial Filtration Effectiveness - BFE - 95%) in relation to their usage time (one, two, four and six hours). Data were collected inside an operating room of the operation theatre unit of a private hospital in the city of São Paulo, whose physical structure meets the recommendations currently proposed by the Health Ministry (RDC - 50 - MS/2002). Two groups were formed for the carrying out of these experiments, respectively denominated control group and experimental group: in the first group no surgical masks were used; in the second surgical masks were used. In order to reproduce conversations that usually take place among the surgical team members during surgeries - a variable which interferes in the validity period of disposable surgical masks - control was kept of words uttered by those collaborating in the gathering of the data, in the two groups, for all the times studied. In order to control the influence of the environment, Petri dishes were maintained in the operating room environment, close to the air conditioning inlets. A count was taken of the Colony Forming Units (CFU) of the units of simulation analysis in both groups, at pre-established time intervals (1,2,4 and 6 hours), through Petri dishes with culture medium (Agar Trypton Soybean - ATS) placed on the surgical table. Identification was made of the most frequent micro organisms found in the simulations; these data were submitted to statistical analysis and the results demonstrated that the use of surgical masks decreased (regression coefficient = -20,10) the the average count of CFU in the Petri dishes placed on the surgical table which simulated the surgical field in all of the times tested. It was verified that their use beyond 2 hours increased contamination of the dishes placed on the surgical table. In the statistical analyses, the interferences of milieu contamination were considered and it was found that there was a high positive correlation (correlation coefficient = 0,886) between the average count of CFU in the surgical table and in the environment, which was statistically significant (P<0,001). The final conclusion was that disposable surgical masks (BFE 95%) proved to be effective microbial barriers in all of the times studied. Their BFE decreased after two hours of use