Aims: To assesses the effectiveness of surgical handwashing (S-HW) in healthcare workers (HCWs) in terms of organic material and bacteria elimination by means of bioluminescence assays. Methods: 62-HCWs were subjected to bioluminescence analyses to determine adenosine triphosphate (ATP) and colony forming units (CFU) of Enterobacteriaceae (EB) and E. coli before and after S-HW. A checklist to evaluate adherence to hand hygiene (HH) protocol was implemented. Results: ATP before HH (510.9/RLU) was reduced after S-HW (54.6/RLU), evidencing a significant decrease (p=0.001). Regarding the bacteria, 26.6/CFU and 4/CFU for EB and E. coli were reported before S-HW, respectively. After S-HW, CFU decreased for EB (21.8/CFU) and E. coli (3.5/CFU) without showing a significant reduction (p=0.679). Low ATP did not evidence a direct relation with EB (p=0.082) and E. coli (p=0.680) reduction. Surgical instrument professionals (p=0.001), general surgeons (p=0.001), residents (p=0.017), orthopedists (p=0.029) and otolaryngologists (p=0.029) evidenced a reduction in ATP after S-HW. Factors such as S-HW direction, surgical soap, moments and time of S-HW implemented showed a statistically significant difference in reduction of ATP, but not in CFU. Conclusion: Although there was a reduction in elimination of ATP, there was no evidence of a decrease in bacteria. This finding not only allowed to identify potential errors in S-HW processes, but also permitted to generate strategies to improve HH to prevent healthcare-associated infections.
Las personas de la tercera edad con mellitus2 (enfermedad no transmisible), reto en la Agenda Global 2030, cuentan con una amplia desigualdad, abandono familiar y social. En Colombia hay 6,4 millones de pacientes diabéticos, y 92 % de ellos son adultos mayores donde el 25 % tuvieron buen control metabólico. Objetivo: determinar las características clínico-quirúrgicas para el manejo del pie diabético en el adulto mayor en una institución prestadora de salud de tercer nivel en Bogotá, Colombia. Metodología: cuantitativo, descriptivo, observacional de corte transversal. Población: adulto mayor con diagnóstico de diabetes mellitus tipo 2, con neuropatía diabética como complicación microvascular, con algún grado de pie diabético. Resultados: no hay asociación estadísticamente significativa entre las variables sociodemográficas (edad, género, tabaquismo, consumo de alcohol, bajo nivel socioeconómico, aislamiento social) y el sometimiento de los pacientes a cualquier tipo de tratamiento quirúrgico. En pacientes que tuvieron un mal control metabólico y mayores de 70 años, se presentó aumento del riesgo a sufrir amputación, como tratamiento quirúrgico. Conclusiones: el diagnóstico y tratamiento del pie diabético continúa siendo un reto para el sistema en salud; es importante que las instituciones de salud conformen grupos interdisciplinarios donde se incluyan el diagnóstico temprano y seguimiento de la patología, identificando los signos de insuficiencia vascular asociada a la diabetes, las deformidades de los artejos que puedan producir áreas de presión que favorezcan la aparición de úlceras. Este grupo será el encargado de promoción y prevención de los signos de alarma.
This article systematically evaluates the most used diagnostic measures for the management of diabetic foot in the elderly, the decision making in the surgical approach, the tertiary prevention of the disease and the microbiological behavior. The initial diagnostic study for musculoskeletal infections and alterations is conventional radiography (sensitivity 40-75%, specificity 60-90%), computed tomography is more useful in the approach to chronic infection, assessing bone abductions and deformities. Magnetic resonance (sensitivity 100%, specificity 40%) is useful to assess the formation of abscesses and bone compromises.Decision-making in the surgical approach is due to sensory, motor or mixed neuropathy; which predispose to ulcers, fractures, deformities and fissures of the skin; lesions that are overinfected and must be operated on. Infections in elderly people with diabetic foot show that Staphylococcus Aureus is the main pathogen causing osteomyelitis. Beta-hemolytic Streptococci / S. Aureus, in patients with cellulitis, without open cutaneous wound, except in repeated mono microbial cultures, immunosuppressed patients or ulcers that do not respond to treatments. The diagnosis and treatment of diabetic foot continues to be a challenge for the health system; it is important that health institutions form interdisciplinary groups aimed at improving patient conditions, who must perform timely, adequate treatment, with routine monitoring and follow-up; using diagnostic methods throughout the course of the disease in order to reduce the need for amputations of the extremities.Keywords: Therapeutic approach, Diabetic Foot, osteomyelitis.
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