Risco das infecções cirúrgicas segundo o potencial de contaminação das feridas operatórias

Abstract

Surgical infection is an important issue since it relates to morbidity, mortality and it may be also used to assess the quality of the assistance provided by hospitals and health professionals. In order to improve rates of surgical site infection (SSI) and reduce its incidence, it is usual practice to compare present and past rates, data from differentinstitutions and from different surgeons. Levels of infections can be therefore assessed by institution and, if necessary, control measures may be established. So far, this procedure has been done by means of either risk stratification by potential for contamination (developed in 1964) or the risk scores developed by the American CDC such as the SENICand NNIS models. For each patient, variables associated with increased risk of infection such as potential for wound contamination, assessment of the severity of the patients conditions by an anesthetist and duration of surgery are recorded so that a reliable comparison between infection rates is achieved. The primary objective of this study is toevaluate risk stratification for surgical site infection according to the potential for surgical wound contamination proposed by the National Academy of Sciences and the National Research Council in 1964, and adjusted to current healthcare assistance services by Cruse and Foord. In addition, this study aims to identify SSI incidence on these strata and use it as a reference point in future research, as well as to contrast our findings with the results of previous studies with the view to enhancing effectiveness of infection prevention and control and hence reduce SSI. A multi-center study was carried out on privately insured 1 patients and patients who were operated in private sector hospitals. A total of 249,457surgical procedures were collected between January/1993 and July/2006 by the Hospital Infection Control Services of the participating institutions. All patients were monitored for SSI while in hospital and up to 30 days after release. A total of 6,641 SSI cases were reported, which represent 2.7% of the patients. Most SSI infections were diagnosed after the patient left hospital (68.6%). SSI occurred in 2.4% of clean surgeries, 2.6% ofpotentially contaminated, 4.9% of contaminated and in 8.2% of infected surgeries. A correlation between potential for wound contamination and SSI was also observed since wounds with higher level of contamination displayed higher risk of SSI.