Medidas de prevenção de infecção para cirurgia cardíaca: estudo de implementação
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Data
2024-11-04
Autores
Barbieri, Bruna Moraes
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Universidade Federal do Espírito Santo
Resumo
Introduction: Surgical site infections are among the three most frequent types of infection in hospitalized patients, and are particularly worrying in cardiovascular surgeries with sternotomy, due to the risk of deep infections that increase mortality, making it essential to take a managerial look at the processes related to this adverse event. This study is carried out within the research line Organization and evaluation of health care systems. This study is one of the outcomes supported by funding from the CAPES/COFEN Cooperation Agreement, under Call for Proposals No. 08/2021. Objectives: To develop and implement a manual for the prevention and control of surgical site infections in the intraoperative period of cardiovascular surgery. Method: This is participatory research with a quantitative and qualitative approach, based on the theoretical framework of implementation science, carried out in the operating room of a university hospital in the state of Espírito Santo. The nursing and medical teams involved in intraoperative cardiovascular surgery took part in the study. The research followed five activities using the Plan-Do-Check-Act cycle: situational diagnosis, creation of a working group to draw up the manual, awareness-raising workshop, post implementation audit with assessment of barriers and facilitators, and planning of sustainability actions. Results and Products: Four new technical products were developed to meet an institutional need; a manual on measures to prevent and control surgical site infections during cardiac surgery, an infographic on antibiotic prophylaxis in cardiovascular surgery, and two scientific articles. To this end, a group was set up made up of employees responsible for caring for cardiac patients and a representative of the institution's infection control committee, which generated discussions based on scientific evidence, resulting in innovative technical products. After implementing the manual, some improvements were observed in the audit, such as: the rate of SSI in cardiovascular surgeries with sternotomy fell from 17.55% to 10.77%; adequacy in the indication of prophylactic antibiotics increased from 74.47% to 85.90%; and adherence to recording the time of administration of the antimicrobial and the surgical incision reached compliance in 42.2% of cases. There was also a significant increase in the collection of intraoperative blood glucose, from 28.72% to 87.5%. The recording of the validity of surgical instruments rose from 54.79% to 82.8%, with low rates of proof of sterilization through integrators being maintained. In addition, 95% compliance with preoperative cleaning of the operating room was recorded, a result similar to the adequacy of surgical gowns. Antisepsis of the patient's skin showed compliance in 97% of cases. Surgical instruments were considered adequate in 94% of the observations, and the procedure for cleaning instruments during surgery took place in 97% of the cases. There was 19% of misinformation about sterile dressing techniques. Conclusion: The Manual was published by the institution’s Quality sector and incorporated into the institution's work processes, favoring changes in practice, as well as maintaining evidence-based care. This research is relevant due to its potential to be extended nationally, as it systematically describes an innovative method with the steps and resources needed to implement good practices for the control and prevention of surgical wound infection.
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Infecção da ferida cirúrgica , Cirurgia cardíaca , Controle de infecções , Enfermagem perioperatória , Ciência da implementação , Surgical wound infection , Cardiac surgery , Infection control , Perioperative nursing , Implementation of science