Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

Abstract

Objective: Evaluate pre-and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections. Method: A prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais. Results: 18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7%) had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on 27.7% of patients in the operating room, with the use of blades in 80% of the cases. Antibiotic prophylaxis was administered to 81.8% of patients up to 60 minutes prior to surgical incision. An average of nine professionals were present during surgery and the surgery room door remained open in 94.4% of the procedures. Conclusion: Partial adhesion to the recommended measures was identified, reaffirming a need for greater attention to these critical steps/ actions in order to prevent surgical site infection. DESCRIPTORSSurgical Wound Infection; Operating Rooms; General Surgery; Gloves, Surgical; Infection Control; Perioperative Nursing. Evaluation of adherence to measures for the prevention of surgical site infections by the surgical teamAvaliação da adesão às medidas para a prevenção de infecções do sítio cirúrgico pela equipe cirúrgica Evaluación de la adhesión a las medidas para la prevención de infecciones del sitio quirúrgico por el equipo quirúrgico

Determinants of surgeons’ adherence to preventive intraoperative measures of surgical site infection in Gaza Strip hospitals: a multi-centre cross-sectional study

“…In contrast to the current study, double gloving was significantly associated with longer duration of operation in a study in Brazil, possibly due to the greater risk of glove perforation with longer duration of operations [15]. It is expected that the need for change of or double gloving in this study is underestimated.…”

“…The WHO guidelines [8] aim to achieve this, but several studies have shown that adherence is not optimal [33][34][35]. In comparison to a Brazilian study [15], this study found a higher rate of administering surgical antibiotic prophylaxis (96.0% vs 77.6%), which was comparable to an Italian study [16] (96.0% vs 96.8%). The effectivity of surgical antibiotic prophylaxis may depend on the type of surgery performed [36], and as a result, if a surgeon is aware of this, the adherence to SSI prevention guidelines might be expected to be improved.…”

“…Both, the observed staff and the data collectors, were blinded to the true research question (are patient-and procedure-related factors associated with the application of intra-operative SSI preventive measures by surgical staff?). As shown in previous studies, keeping the staff unaware of observations is intended to limit the "Hawthorne Effect", when clinicians adjust their practice because they know that they are being observed [14,15]. The data collectors were also blinded to minimize the ascertainment bias that can happen because of their knowledge about SSI risk factors.…”

“…However, it remains unclear why the adherence to SSI preventive measures generally improved over the months of the study. Surgeons and data collectors were blinded to the purpose of the observations in order to reduce potential bias from the Hawthorne effect, when clinicians 'improve' their practice, because they are conscious of being observed [14,15]. However, it cannot be excluded, that surgeons 'learned' to improve adherence to SSI preventive measures over time.…”

Incidência de infecção de sítio cirúrgico em hospital dia: coorte de 74.213 pacientes monitorados

“…Muitos fatores contribuem para o risco dessas infecções, tais como os relacionados ao paciente e à equipe, mas, essencialmente, da possibilidade de contaminação da ferida cirúrgica durante o procedimento operatório, período trans-operatório e, portanto, quanto maior a contaminação microbiana nesse período, maior a chance de infecção por conta da introdução de microrganismos na cavidade cirúrgica aberta e manipulada 6,7 .…”