Recomendaciones prácticas para la antisepsia de la piel del paciente antes de cirugía

Abstract

ResumenLa búsqueda de estrategias para la disminución de la infección de sitio operatorio (ISO) es una prioridad, dado el impacto que ésta tiene en los resultados de la atención de los pacientes. Recientemente ha tomado gran relevancia en la prevención de la ISO, la preparación prequirúrgica de la piel del paciente como uno de los factores clave, en los que se puede intervenir y disminuir el riesgo. En los últimos años han aparecido revisiones exhaustivas dedicadas no solo a la comparación de las soluciones antisépticas, y técnica de aplicación, también acerca de la importancia del baño pre operatorio, uso de cintas y compresas quirúrgicas impregnadas con antisépticos y el recorte de cabello preoperatorio. En esta publicación se describen los hallazgos más importantes relacionados con la preparación antiséptica de la piel del paciente y se propone un protocolo con recomendaciones prácticas para ser implementado en las instituciones del país. Se incluyen recomendaciones basadas en niveles de evidencia sobre el uso de las soluciones antisépticas (yodopovidona, clorhexidina, clorhexidina mas alcohol, entre otras) con énfasis en las ventajas y desventajas de cada una de ellas. Keywords: Preoperative care, disinfection, Anti-Infective agents, Surgical Wound Infection Practical recommendations for skin preparation of Surgical Site AbstractThe search for strategies for reduction of Surgical Site infection (SSI) is a priority, given the impact that infections have on the outcome of the patients. The preoperative patient skin antisepsis, has recently gained greater significance in the prevention of SSI, as one of the critical factors, which can be intervened and can reduce the risk of infection. In recent years, comprehensive investigations have been published not only dedicated to the comparison of antiseptic solutions, application techniques, but also about the importance of preoperative bathing, use of surgical tapes and dressings impregnated with antiseptics, and preoperative shaving. This review outlines the key findings related to the preoperative patient's skin antisepsis and offers a protocol with practical recommendations to be implemented in the institutions of our country. It provides evidence based recommendations about the use of antiseptic solutions (povidone iodine, chlorhexidine, chlorhexidine plus alcohol, etc.) with emphasis on the advantages and disadvantages of each one.Palabras clave: Cuidados preoperatorios, desinfección, antisépticos, infección del sitio quirúrgico. REVISIÓN DE TEMA6 Médico especialista en cirugía general, departamento de cirugía, Universidad del Rosario,

Nursing Care during the Perioperative within the Surgical Context

“…To suppress transient flora and inhibit resident flora, thus, eliminating one of the sources of surgical infection, This is achieved by bathing and asepsis of the surgical area. (23) The presurgical bath is done with antiseptic soap, focusing on contaminated areas, like the navel, perineum, inguinal folds, and armpits, the previous day or the day of the intervention, including washing the hair with shampoo. (23,24) If the procedure is in the head, two baths with 4% chlorhexidine are recommended.…”

“…(23) The presurgical bath is done with antiseptic soap, focusing on contaminated areas, like the navel, perineum, inguinal folds, and armpits, the previous day or the day of the intervention, including washing the hair with shampoo. (23,24) If the procedure is in the head, two baths with 4% chlorhexidine are recommended. (23) Hair removal from the operative area.…”

“…(23,24) If the procedure is in the head, two baths with 4% chlorhexidine are recommended. (23) Hair removal from the operative area. The current trend consists of making a very sparse trichotomy, avoiding lacerations because they are infectious foci.…”

“…Do not use adhesive bandages tape to remove the hair because it can cause microaggressions that permit colonization with bacteria; patients must be educated not to shave the surgical zone. (23) Preoperative fasting. If the patient requires special preparation, the specifications appear in the medical orders.…”

“…In preparing the skin, emphasis is placed on the most contaminated areas: navel, armpits, folds, subungual region, foreskin, and others. Preparation of clean and contaminated areas for the procedure is performed separately to avoid microorganisms in the incision site (23,24) , like when there are stomas. Remember that povidone iodine is inactivated by organic material.…”