Analysis of surgical site infections in orthopedic patients in a hospital in Paraná

Authors

DOI:

https://doi.org/10.33448/rsd-v10i17.24868

Keywords:

Surgical site infection; Orthopedic surgery; Risk factors.

Abstract

Surgical site infections are found in 14-16% of hospitalized patients, and those related to orthopedic surgeries are considered severe. Therefore, the determination of risk factors is necessary to identify situations that predispose to the development of this infection. Aiming to list the risk factors related to surgical site infections at a university hospital in Paraná, in a retrospective cross-sectional descriptive study, 125 medical records of individuals who had undergone orthopedic surgery and developed postoperative infection were analyzed. Thus, it was possible to find a profile of patients more susceptible to developing this complication, in which, 41.0% of the patients were identified as healthy preoperatively, 61.6% of the surgeries were clean, 63.2% used orthopedic implant in their treatment and surgical treatment of closed fractures prevailed. The overall incidence of infection was 2.0% and the most prevalent microorganisms in the sample were Staphylococcus aureus, Enterobacter cloacae and Escherichia coli with 7.2% each. Comparing with the literature covered, differences are found in the prevalence of risk factors, due to the differences of each population. The identification of these risk factors is of utmost importance for the prevention of surgical site infections. Finally, new studies should still be carried out to validate the risk factors found.

References

ANVISA. (2011). Cirurgias com implantes/próteses: Critérios Nacionais de Infecções relacionadas a Assistência à Saúde. Agência Nacional de Vigilância Sanitária, 1- 27.

ANVISA. (2017). Critérios Diagnósticos de Infecção Relacionada à Assistência à Saúde. Série Segurança do Paciente e Qualidade em Serviços de Saúde, 1–89.

Carvalho, R. L. R. de, Campos, C. C., Franco, L. M. de C., Rocha, A. de M., & Ercole, F. F. (2017). Incidence and risk factors for surgical site infection in general surgeries. Revista Latino-Americana de Enfermagem, 25(2848), 1-8. https://doi.org/10.1590/1518-8345.1502.2848

Cunha, R. C. G. (2019). Incidência e fatores de risco para infecções de sítio cirúrgico ortopédicas com uso de prótese: coorte não concorrente (Tese de Mestrado, Universidade Federal de Minas Gerais, Belo Horizonte). https://repositorio.ufmg.br/handle/1843/30244

Engelman, B. (2016). Fatores de risco para infecção relacionada à assistência a saúde em adultos hospitalizados: uma revisão integrativa (Tese de Bacharelado, Universidade Federal do Rio Grande do Sul, Porto Alegre). https://lume.ufrgs.br/handle/10183/184413

Ercole, F. F., Chianca, T. C. M., Duarte, D., Starling, C. E. F., & Carneiro, M. (2011). Infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas: o índice de risco NNIS e predição de risco. Revista Latino-Americana de Enfermagem, 19(2), 269–276. https://doi.org/10.1590/S0104-11692011000200007

Ercole, F. F., Franco, L. M. C., Macieira, T. G. R., Wenceslau, L. C. C., de Resende, H. I. N., & Chianca, T. C. M. (2011). Risk of surgical site infection in patients undergoing orthopedic surgery. Revista Latino-Americana de Enfermagem, 19(6), 1362–1368. https://doi.org/10.1590/s0104-11692011000600012

Ferraz, E. M., Bandeira Ferraz, A. A., Torres D’Albuquerque Coelho, H. S., Pereira Viana, V., Lopes Sobral, S. M., Marques Maia Vasconcelos, M. das D., & Bacelar, T. S. (1995). Postdischarge surveillance for nosocomial wound infection: Does judicious monitoring find cases? American Journal of Infection Control, 23(5), 290–294. https://doi.org/10.1016/0196-6553(95)90059-4

Fontes, A. M. de S. (2010). Efetividade de intervenções na adequação da profilaxia antimicrobiana da infecção do sítio cirúrgico em um hospital universitário do Brasil (Tese de Mestrado, Universidade Federal de Uberlândia, Uberlândia). https://repositorio.ufu.br/handle/123456789/12690?locale=pt_BR

Franco, L. M. de C., Ercole, F. F., & Mattia, A. De. (2015). Infecção cirúrgica em pacientes submetidos a cirurgia ortopédica com implante. Revista Sobecc, 20(3), 163–170. https://doi.org/10.5327/z1414-4425201500030007

Gebrim, C. F. L., Rodrigues, J. G., Queiroz, M. N. R., Barreto, R. A. S. S., & Palos, M. A. P. (2014). Antimicrobial prophylaxis analysis for prevention of surgical site infection in a Brazil centre-west hospital. Ciencia y Enfermeria, 20(2), 103–115. https://doi.org/10.4067/s0717-95532014000200011

Gonçalves, M. L. M., Silva, M. J. S. da, & Torres, R. M. (2014). Antibioticoprofilaxia e tratamento de infecção do sítio cirúrgico na artroplastia de quadril. Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 5(3), 18–22. http://rbfhss.saude.ws/revista/arquivos/2014050302000588BR.pdf

Greene, L. R. (2012). Guide to the elimination of orthopedic surgery surgical site infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. American Journal of Infection Control, 40(4), 384–386. https://doi.org/10.1016/j.ajic.2011.05.011

Hochman, B., Nahas, F. X., Filho, R. S. de O., & Ferreira, L. M. (2005). Desenhos de pesquisa. Acta Cirúrgica Brasileira, 20(2), 2–9. https://doi.org/10.1037/met0000082

Kirkland, K. B., Briggs, J. P., Trivette, S. L., Wilkinson, W. E., & Sexton, D. J. (1999). The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs. Infection Control & Hospital Epidemiology, 20(11), 725–730. https://doi.org/10.1086/501572

Le, J., Dong, Z., Liang, J., Zhang, K., Li, Y., Cheng, M., & Zhao, Z. (2020). Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors. International Wound Journal, 17(1), 206–213. https://doi.org/10.1111/iwj.13258

Lima, Ana Lucia Lei Munhoz, & de Oliveira, P. R. D. (2010). Update on Infections in Articular Prosthesis. Revista Brasileira de Ortopedia (English Edition), 45(6), 520–523. https://doi.org/10.1016/s2255-4971(15)30296-2

Lima, Ana Lúcia Lei Munhoz, Zumiotti, A. V., Uip, D. E., & Silva, J. dos S. (2004). Fatores preditivos de infecção em pacientes com fraturas expostas nos membros inferiores. Acta Ortopédica Brasileira, 12(1), 32–39. https://doi.org/10.1590/s1413-78522004000100005

Maksimović, J., Marković-denić, L., & Bumbaširević, M. (2008). Surgical Site Infections in Orthopedic Patients: Prospective Cohort Study. Croat Med J. 49, 58–65. https://doi.org/10.3325/cmj.2008.1.58

Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & William, R. (1999). Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. AJIC, 27(2), 97–134. https://pubmed.ncbi.nlm.nih.gov/10196487/

Medina-Cuadros, M., Sillero-Arenas, M., Martínez-Gallego, G., & Delgado-Rodríguez, M. (1996). Surgical wound infections diagnosed after discharge from hospital: Epidemiologic differences with in-hospital infections. American Journal of Infection Control, 24(6), 421–428. https://doi.org/10.1016/S0196-6553(96)90035-8

Mendes, E. C., Carvalho, M. de C., Carvalho, R. B., Ferraz, C. A., Souza, D. M. S. T., & Schnaider, T. B. (2020). Técnicas de antissepsia em procedimentos cirúrgicos ortopédicos: Um estudo comparativo. Revista Brasileira de Ortopedia. 55(2), 56-62. https://doi.org/10.1055/s-0039-3400520

Miranda, A. R. de A. (2017). Aspectos Epidemiológicos Das Infecções De Sítio Cirúrgico Em Cirurgias Ortopédicas Com Implante Em Um Hospital De Reabilitação (Tese de Mestrado, Universidade Federal de Minas Gerais, Belo Horizonte). https://pesquisa.bvsalud.org/portal/resource/pt/biblio-983351

Moon, G. H., Cho, J.-W., Kim, B. S., Yeo, D. H., & Oh, J.-K. (2019). Analysis of Risk Factors for Infection in Orthopedic Trauma Patients. J Trauma Inj, 32(1), 40–46. https://doi.org/10.20408/jti.2018.023

Nascimento, D. A. do, & Corradi, J. G. (2019). Infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas em um hospital estadual da região norte do Espírito Santo (Tese de Bacharelado, Faculdade Vale do Cricaré, São Mateus). https://repositorio.ivc.br/handle/123456789/328

Oliveira, A. C., & Carvalho, D. V. (2004). Postdischarge surveillance: The impact on surgical site infection incidence in a Brazilian university hospital. American Journal of Infection Control, 32(6), 358–361. https://doi.org/10.1016/j.ajic.2004.02.009

Oliveira, P. R., Carvalho, V. C., Felix, C. da S., Paula, A. P. de, Santos-Silva, J., & Lima, A. L. L. M. (2016). Infecção de sítio cirúrgico após fixação de fraturas fechadas e expostas – Incidência e perfil microbiológico. Revista Brasileira de Ortopedia, 51(4), 396–399. https://doi.org/10.1016/j.rbo.2015.09.010

Onyekwelu, I., Yakkanti, R., Protzer, L., Pinkston, C. M., Tucker, C., & Seligson, D. (2017). Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient. Journal of the American Academy of Orthopaedic Surgeons, 1(3), 1-10. https://doi.org/10.5435/jaaosglobal-d-17-00022

Ortega, G., Rhee, D. S., Papandria, D. J., Yang, J., Ibrahim, A. M., Shore, A. D., Makary, M. A., & Abdullah, F. (2012). An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. Journal of Surgical Research, 174(1), 33–38. https://doi.org/10.1016/j.jss.2011.05.056

Ren, M., Liang, W., Wu, Z., Zhao, H., & Wang, J. (2019). Risk factors of surgical site infection in geriatric orthopedic surgery: A retrospective multicenter cohort study. Geriatrics and Gerontology International, 19(3), 213–217. https://doi.org/10.1111/ggi.13590

Ribeiro, J. C., Dos Santos, C. B., Bellusse, G. C., Da Fonseca Rezende, V., & Galvão, C. M. (2013). Occurrence and risk factors for surgical site infection in orthopedic surgery. ACTA Paulista de Enfermagem, 26(4), 353–359. https://doi.org/10.1590/s0103-21002013000400009

Roth, J. A., Juchler, F., Dangel, M., Eckstein, F. S., Battegay, M., & Widmer, A. F. (2019). Frequent door openings during cardiac surgery are associated with increased risk for surgical site infection: A prospective observational study. Clinical Infectious Diseases, 69(2), 290–294. https://doi.org/10.1093/cid/ciy879

Vieira, D. A. R., Cristianismo, R. S., Campos, F. F., Costa, M. C. P. da, & Lucas, T. C. (2021). Infecção de sítio cirúrgico em osteossíntese de fêmur: incidência e fatores associados. Cogit. Enferm. 26(76087). https://doi.org/10.5380/ce.v26i0.76087

Published

27/12/2021

How to Cite

LONGO, L. B.; LEMOS, A. de S.; VELLOSA, J. C. R.; MONTES, E. G. Analysis of surgical site infections in orthopedic patients in a hospital in Paraná. Research, Society and Development, [S. l.], v. 10, n. 17, p. e235101724868, 2021. DOI: 10.33448/rsd-v10i17.24868. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/24868. Acesso em: 25 may. 2022.

Issue

Section

Health Sciences