Prevenção de Infecção de Sítio Cirúrgico

Summary

This video provides an in-depth guide on preventing surgical site infections (SSIs), covering key classification types such as superficial, deep, and organ or cavity infections. It highlights essential pre-operative, intra-operative, and post-operative practices based on global and local guidelines. Emphasis is placed on proper hygiene, antibiotic prophylaxis, maintaining body temperature and oxygen levels during surgery, and post-operative care, including wound management and nutrition. These recommendations are crucial for ensuring patient safety and improving surgical outcomes, and are backed by research and best practice protocols.

Takeaways

• 😀 Superficial SSI involves infections of the skin and subcutaneous tissue, occurring within 30 days post-surgery.
• 😀 Deep SSI affects fascia and muscle, and can occur within 30 days or up to 90 days if an implant is used.
• 😀 Organ or cavity infections can occur up to 90 days post-surgery, or even up to 24 months if caused by rapid-growing mycobacteria.
• 😀 Preoperative measures like using antimicrobial soap or chlorhexidine for patient bathing help reduce microorganism presence on the skin.
• 😀 Mupirocin ointment is recommended for nasal carriers of *Staphylococcus aureus* to reduce infection risks.
• 😀 Antibiotic prophylaxis should be administered within 60–120 minutes before surgery, considering the antibiotic's half-life.
• 😀 Shaving the surgical site is not recommended as it may cause skin lesions and increase infection risk.
• 😀 Proper surgical site antisepsis is crucial, with the use of alcohol-based solutions like chlorhexidine or povidone-iodine.
• 😀 Maintaining normothermia, oxygenation (80%), and blood glucose control during surgery is vital for infection prevention.
• 😀 Postoperative care includes oxygenation for at least two hours, proper surgical dressing, and ensuring good nutritional support for wound healing.

Q & A

What are the three main classifications of surgical site infections (SSI)?

The three main classifications of SSIs are: 1) Superficial Incisional SSI, which affects the skin and subcutaneous tissue. 2) Deep Incisional SSI, which affects the fascia and muscle. 3) Organ or Space SSI, which involves internal organs or cavities.

What is the time frame for diagnosing a superficial incisional SSI post-surgery?

A superficial incisional SSI is typically diagnosed within the first 30 days post-surgery, considering the first day as the date the procedure was performed.

What are the key criteria for diagnosing a superficial incisional SSI?

Key criteria for diagnosing a superficial incisional SSI include pus drainage, a positive culture of secretion, deliberate wound reopening by the surgeon, or clinical symptoms such as pain, redness, or increased sensitivity in the area.

How long can a deep incisional SSI occur after surgery, and what factors influence this timeframe?

A deep incisional SSI can occur within 30 days post-surgery or up to 90 days if an implant is present. The infection may take longer to develop due to the presence of implants.

What are some common symptoms associated with a deep incisional SSI?

Common symptoms of a deep incisional SSI include fever (temperature of 38°C or higher), localized pain, abscess formation, and a positive culture or a clinical diagnosis by the surgeon.

What are the recommendations for preventing SSIs in the preoperative phase?

Preoperative recommendations for preventing SSIs include performing a preoperative bath with antimicrobial soap or chlorhexidine, de-colonizing nasal passages with mupirocin for staphylococcus aureus carriers, administering antibiotic prophylaxis 60-120 minutes before surgery, and ensuring proper nutritional support for the patient.

Why is it important to avoid shaving the surgical site before surgery?

Shaving the surgical site is discouraged because it can cause micro-injuries to the skin, creating entry points for bacteria. Instead, hair removal should be done with electric clippers if necessary.

What are the key elements of intraoperative infection prevention?

Intraoperative infection prevention includes using sterile techniques for skin preparation, maintaining proper hand hygiene, applying antiseptic solutions to the surgical site, controlling the patient's body temperature, ensuring adequate oxygenation, and managing surgical team hygiene.

How does oxygenation contribute to the prevention of SSIs during surgery?

Maintaining adequate oxygenation during surgery is crucial as it supports tissue perfusion, enhances immune function, and promotes proper gas exchange, which are essential for preventing infections.

What are some postoperative care recommendations for preventing SSIs?

Postoperative care recommendations include maintaining proper wound care using aseptic techniques, controlling blood glucose levels (especially in diabetic patients), ensuring continued oxygenation for at least 2 hours post-surgery, and supporting nutritional recovery to facilitate wound healing.