Made available in DSpace on 2015-03-26T13:47:18Z (GMT). No. of bitstreams: 1 texto completo.pdf: 1129609 bytes, checksum: a3efeca5c3602073a6372b6303d99ce6 (MD5) Previous issue date: 2013-07-31 / Surgical site infection (SSI) has been indicated as the third cause of nosocomial infection. The present study aimed at determining the epidemiological profile of SSI and its association to the described risk factors. It is a transversal study done at the São João Batista Hospital at at Viçosa-MG and at the Surgery Service of the Small Animals Veterinary Hospital of the Universidade Federal de Viçosa-MG, from September 2012 to February 2013. SSI global rates were 0.7% at the human and 3.46% at the veterinary hospitals. At the veterinary hospital, SSI rates were not related to contamination potential, with clean procedures presenting the greater rates. As for the type of surgery, orthopedic ones are the most common in both hospital and also the ones presenting the greater SSI rates. The diagnosis of SSI occurred within 30 days after surgery, and data HVT-UFV demonstrated effectiveness studies developed in this hospital, indicating improvement in the prevention and control of SSI, but in both hospitals is not performed surveillance post-discharge of patients, and may infer that there was underreporting of SSI. Bacteria isolated from surgical wounds were multi-resistant and the obtained data indicated that no criteria of antibiotic prophylaxis existed, mainly for clean surgeries. This scenario shows that the action of a commission to control nosocomial infection are extremely relevant in order to guarantee reliable data so that the quality of service may be evaluated and thus, promoting a decrease the risk of in post-operative complications. / A infecção de sítio cirúrgico (ISC) tem sido apontada como a terceira causa mais comum de infecção nosocomial. Este estudo objetivou determinar o perfil epidemiológico das ISCs e sua associação aos fatores de risco descritos. Trata-se de um estudo transversal, realizado no Hospital São João Batista de Viçosa-MG e na Clínica Cirúrgica de Cães e Gatos do Hospital Veterinário da Universidade Federal de Viçosa- MG, no período de setembro de 2012 a fevereiro de 2013. As taxas globais de ISC foram de 0,7% no hospital humano e 3,46% no veterinário. No hospital veterinário, a taxa de ISC não mostrou relação com o potencial de contaminação, apresentando a maior taxa nos procedimentos classificados como limpos. Quanto ao tipo de cirurgia, as ortopédicas são as mais comuns em ambos os hospitais e também as que apresentam maior taxa de ISC. Foi observada diferença significativa nas cirurgias com duração superior a 40 minutos pelos testes não paramétricos de Wilcoxon e Mann-Whitney (p=0,041) no HVT-UFV. O diagnóstico das ISC ocorreu dentro dos 30 dias após a cirurgia, e dados do HVT-UFV demonstraram efetividade dos estudos desenvolvidos neste hospital, indicando melhora das medidas de prevenção e controle das ISC, porém em ambos os hospitais não é realizada a vigilância pós-alta dos pacientes, podendo inferir que houve subnotificação das ISC. As bactérias isoladas das feridas cirúrgicas foram multirresistentes e os dados levantados indicam que não houve critério quanto ao emprego da antibioticoprofilaxia, principalmente nas cirurgias limpas. Este cenário mostra que é de extrema relevância a atuação de uma comissão de controle de infecção hospitalar, a fim de garantir obtenção de dados fidedignos, para que se possa avaliar a qualidade do serviço prestado e assim promover a redução dos riscos de complicações pós-operatórias.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) são um problema de saúde pública de relevância global, e atingem com mais intensidade os países em desenvolvimento. No entanto, quase todas as informações disponíveis sobre incidência e preditores de IRAS procedem de estudos conduzidos em hospitais de ensino e/ou de grande porte. No Brasil, aproximadamente dois terços dos serviços hospitalares tem menos de 50 leitos, sendo classificados como hospitais de pequeno porte (HPP). Estes albergam intensa atividade cirúrgica e obstétrica, embora voltada a procedimentos de baixa complexidade. São portanto ambientes de risco para infecção do sítio cirúrgico (ISC). Nosso estudo foi delineado para abordar a incidência e os determinantes de ISC em pequenos hospitais. Analisamos uma coorte de pacientes submetidos a procedimentos cirúrgicos em três HPP localizados no interior do Estado de São Paulo. Cada cirurgia foi acompanhada presencialmente, sendo registrados dados dos pacientes e dos processos de trabalho. Ao mesmo tempo, foi aplicado checklist de indicadores de contaminação ambiental em centro cirúrgico. Os sujeitos da pesquisa foram acompanhados por um mês com ligações telefônicas para diagnóstico de infecção do sítio cirúrgico (ISC). Modelos de regressão logística foram aplicados para identificar, separadamente, preditores de ISC e a associação de tópicos do checklist com o risco infeccioso em cirurgias. Foi identificada uma incidência agregada de ISC de 8.1% nos hospitais do es... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Healthcare associated infections (HAIs) are a worldwide threat, and affect more heavily developing countries. Still, almost all published information concerning incidence and predictors of HAIs come from studies conducted in big-sized and/or teaching hospitals. In Brazil, almost two thirds of hospital have less than 50 beds and are classified as small sized hospitals (SSH). Those hospitals harbor intense surgical and obstetrical activity, and therefore subjects at risk of surgical site infections (SSI). Our study was designed to address the incidence and determinants of SSI in SSH. We followed a cohort of patients submitted to surgeries in three SSH from inner São Paulo State, Brazil. Each surgical procedure was presentially followed, and a checklist of indicators of environmental contamination was applied. Patients were followed for 30 days in order to diagnose SSI. Logistic regression models were used to identify, in separate analysis, (a) predictors of SSI and (b) the statistical association of topics from the checklist to the risk of SSI. The overall incidence of SSI was 8.1%. Predictors identified in multivariable model were: a score in the Amercian Society of Anesthesiologists (ASA) physical status classification of 3 or more (OR=6.65, 95CI%=1.31-33.69, p=0.02), contaminated or dirty wound (OR=5.33, 95%CI=1.19-23.93, p=0.03), perioperatory hair removal (OR=4.60, 95%CI=1.03-20.55, p=0.04) and placement of drains (OR=3.97, 95%CI=1.02-15.46, p=0.04). Overall, hospitals per... (Complete abstract click electronic access below) / Mestre

A infecção de sítio cirúrgico (ISC) é uma complicação frequente que pode acometer o paciente submetido ao procedimento anestésico cirúrgico. A importância dessa problemática está no aumento da morbidade, mortalidade e dos custos hospitalares, e ainda, em relação ao paciente, pelo sofrimento emocional e físico, bem como o prolongamento do período de afastamento de suas atividades profissionais e do convívio social. A presente investigação teve como objetivo geral analisar a incidência de infecção de sítio cirúrgico em pacientes submetidos à neurocirurgia eletiva e limpa em hospital privado filantrópico, nível terciário, do interior do Estado de São Paulo. Para tal, realizou-se estudo com delineamento de pesquisa não experimental, tipo descritivo e prospectivo. A amostra foi composta por 85 sujeitos submetidos a neurocirurgias eletivas e limpas. Para a coleta de dados utilizou-se instrumento validado por estudioso da temática, esse procedimento ocorreu durante o acompanhamento do paciente no perioperatório (pré, intra e pós-operatório) e, após a alta, no trigésimo dia após o procedimento cirúrgico, sendo agendado o retorno do paciente na sala de curativos do hospital onde a pesquisa foi conduzida. A coleta de dados teve a duração de onze meses (junho de 2012 a abril de 2013). A indicência de ISC foi de 9,4%, resultado superior ao preconizado na literatura para o tipo de procedimento cirúrgico estudado (cirurgia limpa). As variáveis estudadas relacionadas ao paciente foram idade, classificação ASA, Índice de Massa Coporal e presença de doenças crônicas. As variáveis investigadas relacionadas ao procedimento anestésico cirúrgico foram duração da anestesia, duração da cirurgia, uso de antibioticoprofilaxia e tempo total de internação. Em relação ao momento do diagnóstico, dos oito pacientes com ISC, cinco (62,5%) tiveram o diagnóstico durante o período em que permaneceram internados; dois (25%) após a alta por ocasião de reinternação devido ISC e um (12,5%) no retorno agendado na sala de curativos. O estudo fornece subsídios para a reflexão dos profissionais de saúde sobre a incidência e os fatores predisponentes de ISC em neurocirurgia, os quais podem auxiliar na implementação de medidas de prevenção e controle para a problemática em razão dos efeitos deletérios acarretados no tocante aos custos e as repercussões familiares, sociais e financeiras ao paciente cirúrgico / The surgical site infection (SSI) is a common complication that can occur in patients undergoing the surgical anesthetic procedure. The importance of this problem is the increasing of morbidity, mortality and hospital costs, and also in relation to patients, the emotional and physical distress, as well as the extension of the period of absence from their professional and social life. This study aimed to analyze the incidence of surgical site infection in patients undergoing clean elective neurosurgery in a private philanthropic hospital, tertiary level, in the state of São Paulo. For this, a descriptive and prospective study with non-experimental research design was performed. The sample consisted of 85 subjects undergoing clean elective neurosurgery. For data collection, an instrument validated by an expert was used; this procedure occurred during the follow up of the patient in the perioperative period (pre, intra and post- operative) and, after discharge, in the thirtieth day after the surgical procedure. The patient\'s return was scheduled in the dressing room of the hospital where the research was conducted. Data collection lasted eleven months (from June 2012 to April 2013). The incidence of SSI was of 9.4%, and this result was higher than that recommended in the literature for the type of surgical procedure studied (clean surgery). The studied variables related to the patient were age, ASA score, body mass index and chronic diseases. The studied variables related to surgical anesthesia were duration of anesthesia, duration of surgery, use of antibiotic and total hospitalization time. Regarding the time of diagnosis, from the eight patients with SSI, five (62.5%) were diagnosed during the period in which they were hospitalized, two (25%) after discharge at the time of readmission due to SSI, and one (12, 5%) in the return scheduled at the wound dressing. The study provides support for reflection of health professionals on the incidence and predisposing factors for SSI in neurosurgery, which can assist in the implementation of prevention and control measures for the problem because of the deleterious effects due to costs and social, financial and family repercussions to the surgical patient

Les infections du site opératoire (ISO) sont classées au 3ème rang des infections associées aux soins les plus fréquentes en France. Des approches épidémiologiques " classiques " de prévention ont permis une réduction des taux d'ISO d'environ 50% en 20 ans. Malgré ces progrès, les taux d'incidence et le nombre brut d'ISO restent notables en France. De nouveaux outils permettraient d'améliorer la compréhension et la prévention des ISO. Lors d'une approche clinique de la prévention des ISO, nous avons évalué l'efficacité d'éponges de collagène imprégnées de gentamicine pour la prévention des ISO chez des patients à haut risque bénéficiant d'un pontage aorto-coronarien avec double artères mammaires internes. Des Dans un second temps, une approche, épidémiologique, avait pour objectif d'étudier l'accord des hygiénistes et des chirurgiens impliqués dans la surveillance des ISO de 10 pays Européens dans le diagnostic des ISO. La finalité était d'évaluer l'intérêt de la publication des taux d'ISO dans un objectif de benchmarking. La dernière approche était comportementale. Nous avons tout d'abord réalisé une revue systématique de la littérature afin d'évaluer l'état actuel des connaissances concernant l'impact des comportements des équipes opératoires sur la survenue d'ISO ou sur des marqueurs du risque infectieux. Enfin, nous avons présenté le protocole d'une étude en cours de réalisation sur l'évaluation des déplacements des personnels durant 63 interventions de chirurgie cardiaque et orthopédique, enregistrés de manière objective et continue par l'intermédiaire d'un système automatique de capture de mouvement. Ces données seront corrélées à des marqueurs du risque infectieux. / Surgical site infection (SSI) constitutes the third most frequent healthcare associated infection in France. “Classic” epidemiological approaches have already allowed to decrease SSI rate of approximately 50% in 20 years. Despite these improvements, the incidence rate and the crude number of SSI stay important in France. New tools may improve the understanding and the prevention of SSI. In first, through a clinical approach of the SSI prevention, we have evaluated the efficacy of a gentamicin-impregnated collagen sponge reduce sternal wound infections in high-risk cardiac surgery patients. Secondly, an epidemiological approach had the objective to assess the agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe and evaluate the interest of the public reporting of SSI rate in a view of benchmarking. Finally, a behavioural approach has begun by a systematic descriptive review of the literature to evaluate the current evidence regarding the influence of staff behaviours on the infectious risk in operating room. Then, we have presented the protocol of a study in progress on the assessment of movements in the operating room during 63 procedures of cardiac and orthopaedic surgery, recorded with an objective and continuous manner using a motion capture system. These data will be correlated to surrogates of the infectious risk.

Staphylococcus aureus is a gram-positive opportunistic pathogen responsible for more deaths every year than HIV/AIDS. Its formidable repertoire of virulence factors, ubiquitous nature, and ability to acquire antibiotic resistance quickly allow S. aureus to colonize and persist in nearly any body site if given the opportunity. S. aureus is the leading cause of many common and severe skin diseases, i.e. atopic dermatitis and surgical site infections, which can result in significant morbidity and mortality due to lack of available treatments and chronic non-healing nature of each infection. The human body is capable of producing many antimicrobial factors, such as defensins in the epidermis, in conjunction with providing a seamless barrier to many environmental threats, i.e. the skin, yet when given the opportunity, S. aureus can overtake these innate defenses, colonize, and cause disease. Despite S. aureus being a prominent organism in skin infections, little has been done to identify critical factors of S. aureus to cause skin infections. This document demonstrates the capacity of specific S. aureus virulence factors, superantigens and cytotoxins, to alter re-epithelialization and wound healing, as indicated by altered keratinocyte migration and proliferation. In an attempt to harness natural occurring host defenses, we have also identified and generated novel antimicrobial peptides capable of ablating toxin production independent of bacterial growth inhibition. Evidence presented should convince the reader that S. aureus exotoxin production is critical in perpetuating chronic wounds through local keratinocyte interaction. This suggests targeting production of these toxins to prevent cell toxicity and inflammatory responses, could allow the host to repair damaged tissue effectively.

No description available.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13166号 / 論医博第2153号 / 新制||医||1029(附属図書館) / (主査)教授 一山 智, 教授 松原 和夫, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: Postoperativa sårinfektioner är infektioner som uppträder i sårområdet inom 30 dagar efter ett kirurgiskt ingrepp. Infektioner i postoperativa sår är en av de vanligaste vårdrelaterade infektionerna. När mikroorganismer hamnar i såret startar en inflammationsprocess och skapar en infektion i såret. Postoperativa sårinfektioner innebär ett stort lidande för patienten, dessvärre minskar inte postoperativa sårinfektioner i önskad takt. Syfte: Att belysa hur sjuksköterskan kan arbeta med förebyggande omvårdnadsinsatser i relation till postoperativa sårinfektioner. Metod: Studien genomfördes som en allmän litteraturstudie baserat på tio resultatartiklar av kvalitativ, kvantitativ och mixad metod. Resultatartiklarna analyserades och sammanfattades till tre kategorier och fem underkategorier. Resultat: Resultatet belyser följande omvårdnadsinsatser: (1) Att följa riktlinjer, (2) Att implementera åtgärdspaket och (3) Att involvera patienten. Sjuksköterskans följsamhet till riktlinjer påverkades av barriärer och facilitatorer. Åtgärdspaket var en effektiv omvårdnadsinsats. En involverad patient kunde bidra positivt till det förebyggande arbetet. Konklusion: Det finns ett behov av förbättringsarbete och vidare forskning kring hur sjuksköterskan kan arbeta med förebyggande omvårdnadsinsatser i relation till postoperativa sårinfektioner. / Background: Surgical site infections (SSI) are infections that occur within 30 days after surgery. SSIs are one of the most common health care- associated infection. When microorganisms end up in the wound an inflammatory process starts and creates an infection in the wound. SSIs lead to suffering in patients, unfortunately the incidence of SSIs is not decreasing in a desired rate. Aim: To highlight how nurses can work with preventative nursing interventions in relation to surgical site infections. Method: The study was conducted as a general literature study based on the result from ten articles with qualitative, quantitative and mixed methods. The results from the articles were analyzed and summarized into three categories and five subcategories. Results: The result highlights the following nursing interventions: (1) to follow clinical practice guidelines, (2) to implement care bundles and (3) to involve patients. Nurses’ compliance to guidelines was affected by barriers and facilitators. The care bundle implementation was a successful nursing intervention. Involving the patient could contribute to nurse’s preventative work against surgical site infections. Conclusion: There is a need for further quality improvement and research to how nurse’s work with preventative nursing interventions in relation to SSIs.

No description available.

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH 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.