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      Análise dos fatores de risco relacionados à incidência de infecção do sítio cirúrgico em gastrocirurgias Translated title: Análisis de los factores de riesgo relacionados a la incidencia de infección del sitio quirúrgico en gastrocirugías Translated title: Analysis of risk factors related to the incidence of site infections in gastrosurgeries

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          Abstract

          A infecção hospitalar é considerada um problema grave, crescendo tanto em incidência quanto em complexidade, gerando diversos tipos de implicações sociais e econômicas. A presente investigação teve como objetivo identificar a incidência de infecção do sítio cirúrgico (ISC) e os fatores de risco de pacientes submetidos a cirurgias eletivas, na especialidade de Gastroenterologia, realizadas em um hospital público do interior paulista. Os dados foram coletados por meio de estudo retrospectivo de prontuários médicos, no período compreendido entre janeiro a dezembro de 1999. Em 134 casos estudados, detectamos a ocorrência de infecção do sítio cirúrgico em 18 situações (13,4%), ocorrendo 9 casos (50%) do tipo considerado infecção incisional superficial, 8 (44.4%) infecção incisional profunda e 1 (5.5%) infecção de órgão/espaço. Em relação aos fatores de risco presentes nos casos de ISC detectados, os que atingiram porcentagem maior ou igual a 50% foram: idade acima de 50 anos, presença de neoplasias, duração da cirurgia maior que duas horas e tricotomia inadequada.

          Translated abstract

          La infección hospitalaria es considerada un problema grave, creciendo tanto en incidencia como en complejidad, generando diversos tipos de implicaciones sociales y económicas. La presente investigación tuvo como objetivo identificar la incidencia de infección del sitio quirúrgico en pacientes sometidos a cirugias electivas, en la especialidad de Gastroenterología, realizadas en un hospital público del interior del estado de São Paulo. Los datos fueron recoleccionados por medio de un estudio retrospectivo de los archivos medicos, en el periodo entre enero y diciembre de 1999. En 134 casos estudiados, detectamos la ocurrencia de infección del sitio quirúrgico en 18 situaciones (13.4%), ocurriendo 9 casos (50%) del tipo considerado infección incisional superficial, 8 (44.4%) infección incisional profunda y 1 (5.5%) infección de órgano/espacio. Con relación a los factores de riesgo presentes en los casos de ISC detectados, los que alcanzaron percentaje mayor or igual a 50% fueron: edad acima de 50 años, presencia de neoplasias, duración de la cirugía mayor que dos horas y tricotomía inadecuada.

          Translated abstract

          Nosocomial infection is regarded as a serious problem whose incidence and complexity has been increasing, thus generating various types of social and economic implications. This investigation aimed at assessing the incidence of surgical site infection and risk factors in patients submitted to elective surgeries in the specialty of gastroenterology performed in a public hospital in the interior of São Paulo State. Data were collected by means of a retrospective study of medical records from January to December 1999. Of the 134 cases under study, the occurrence of surgery site infection was detected in 18 situations (13.4%). Nine cases (50%) were considered to be superficial incisional infections, 8 (44.4%) were deep incisional infections and 1 (5.5%) was an organ/space infection. With respect to the risk factors, the ones with percentage higher or equal to 50% were: age above 50 years, the presence of neoplasia, surgeries that last more than two hours and inadequate trichotomy.

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          Guideline for Prevention of Surgical Site Infection, 1999

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            Glucose control lowers the risk of wound infection in diabetics after open heart operations.

            Elevated blood glucose levels in the postoperative period are associated with an increased risk of deep wound infection in diabetic individuals undergoing open heart operations at Providence St. Vincent Hospital. Of 8,910 patients who underwent cardiac operations between 1987 and 1993, 1,585 (18%) were diabetic. The rate of deep sternal wound infections in diabetic patients was 1.7%, versus 0.4% for nondiabetics. Nine hundred ninety patients had their operation before implementation of the protocol and 595 after implementation. Charts of all diabetic patients were reviewed. Mean blood glucose levels were calculated from documented results of finger-stick glucometer testing. Thirty-three diabetic patients suffered 35 deep wound infections: 27 sternal (1.7%) and eight at the donor site (0.5%). Infected diabetic patients had a higher mean blood glucose level through the first 2 postoperative days than noninfected patients (208 +/- 7.1 versus 190 +/- 0.8 mg/dL; p < 0.003) and had a greater body mass index (31.5 +/- 1.4 versus 28.6 +/- 0.1 kg/m2; p < 0.05). Multivariable logistic regression showed that mean blood glucose level for the first 2 days (p = 0.002), obesity (p < 0.002), and use of the internal mammary artery (p < 0.02) were all independent predictors of deep wound infection. Institution of a protocol of postoperative continuous intravenous insulin to maintain blood glucose level less than 200 mg/dL was begun in September 1991. This protocol resulted in a decrease in blood glucose levels for the first 2 postoperative days and a concomitant decrease in the proportion of patients with deep wound infections, from 2.4% (24/990) to 1.5% (9/595) (p < 0.02). The incidence of deep wound infection in diabetic patients was reduced after implementation of a protocol to maintain mean blood glucose level less than 200 mg/dL in the immediate postoperative period.
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              Surgical site infections at the National Cancer Institute in Mexico: a case-control study.

              To quantify the surgical infection rate and to identify risk factors associated with surgical site infection. We conducted a case-control study of all surgical patients between January 1, 1993, and June 30, 1994. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. A 130-bed tertiary-care teaching hospital for adult patients with cancer. The study followed 3372 surgeries. Three hundred thirteen patients had a surgical site infection (rate per 100 surgeries: 9. 30). The risk factors associated with surgical site infection were diabetes mellitus (OR = 2.5, 95% confidence interval [CI] = 1.27-4. 91), obesity (OR = 1.76, 95% CI = 1.14-2.7), presence of surgical drains for >5 and /=16 days (OR = 2.14, 95% CI = 1. 0-4.6). The bacteria most frequently isolated were Escherichia coli 38 (21.8% of the total of microorganisms found), Pseudomonas sp 22 (12.6%), Staphylococcus aureus 16 (9.2%), and coagulase-negative Staphylococcus 25 (13.6%). The coexistence of other nosocomial infections was greater among the cases (OR = 1.8, 95% CI = 1.1-3.1) than in the control group. The surgical site infection rate in our hospital is slightly higher than the rates reported for general hospitals. The risk factors associated with surgical site infection are similar to those previously reported. Diabetes mellitus, obesity, and prolonged presence of a surgical drain increased the risk of infection.
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                Author and article information

                Journal
                reeusp
                Revista da Escola de Enfermagem da USP
                Rev. esc. enferm. USP
                Universidade de São Paulo, Escola de Enfermagem (São Paulo, SP, Brazil )
                0080-6234
                1980-220X
                March 2003
                : 37
                : 1
                : 81-89
                Affiliations
                [01] orgnameUSP orgdiv1EERP orgdiv2Departamento de Enfermagem Geral e Especializada
                [02] orgnameSecretaria de Educação Superior orgdiv1Programa Especial de Treinamento
                [03] orgnameUSP orgdiv1EERP orgdiv2Departamento de Enfermagem Geral e Especializada crisgal@ 123456eerp.usp.br
                [04] orgnameUSP orgdiv1EERP orgdiv2Especialista em Laboratório
                Article
                S0080-62342003000100010 S0080-6234(03)03700110
                8d3336c8-0574-451c-a522-3b65449af894

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 March 2003
                : 19 March 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 9
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                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Artigos Originais

                Factores de riesgo,Infección hospitalaria,Surgery,Risk factors,Cross infection,Cirurgia,Fatores de risco,Infecção hospitalar,Cirugía

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