Tércio Souto Bacelar

Postdischarge surveillance for nosocomial wound infection: Does judicious monitoring find cases?

From 1988 through 1992, we conducted a prospective study of postdischarge surgical wound infection surveillance in our institution. A total of 6604 patients were seen after discharge in a centralized outpatient clinic, supervised by the infection control commission. Wounds were inspected, stitches were removed, and dressings were changed. This care was followed by referral of patients to the appropriate specialized surgical clinic. Postdischarge patient return rates for the period studied ranged from 68.4% to 91.2%. Wound infection detection in the outpatient clinic ranged from 32.2% (20 patients in 1991) to 50% (44 patients in 1990) for general surgical procedures and 52.9% (18 patients in 1990) to 91.4% (32 patients in 1992) for cesarean sections. Most surgical wound infections (87.6%, 127 patients) were diagnosed between the first and fourteenth postoperative days. We conclude that centralized postdischarge surveillance, as practiced in our institution, has enhanced the retrieval of wound infection data. At present, there is no universally accepted strategy for monitoring postdischarge surgical wound infection; however, we must take a rigorous approach to detect patients at risk for infection in our continuous attempt to improve the quality of surgical and postoperative care.

Wound infection rates in clean surgery: a potentially misleading risk classification.

OBJECTIVES To evaluate the incidence of wound infection in inguinal hernioplasties, incisional hernioplasties, splenectomies, and splenectomies performed in patients with hepatosplenic schistosomiasis, and to examine the relationship of surgical wound infection to antibiotic use, patient age, length of stay in the hospital prior to surgery, and the duration of the operation. DESIGN Retrospective surveillance study. RESULTS One thousand five hundred forty-two clean operations were analyzed. Comparing response (wound infection) and explanatory variables (age, length of hospital stay, duration of surgery, antibiotics, and surgery type), we found that age, use of antibiotics, and type of surgery were statistically significant, while length of hospital stay and duration of surgery were not significant. CONCLUSIONS From these results, we can predict that the probability of wound infection in surgical patients considering these significant variables is lower for patients ages 14 to 30 years and higher for patients ages 31 to 60 years and lower for patients with prophylactic antibiotic use (up to 72 hours of use) and higher for patients with prolonged use (more than 72 hours); and lower for patients undergoing inguinal heria, followed in ascending order by nonschistosomotic patients undergoing splenectomy in schistosomotic patients.

Controle de infecção em cirurgia geral: resultado de um estudo prospectivo de 23 anos e 42.274 cirurgias

BACKGROUND: The aim of this study was evaluate a methodology during 23 years in a public hospital used infection for control of surgeries. METHODS: A total of 42,274 surgeries in the General Surgery Division of the Clinics Hospital of the Pernambuco Federal University (January of 1977 until December 1999) were evaluated. The data were acquired through a active search system by the infection control nurse and an epidemiological search during the postoperative period, in the outpatient clinic that centralized all surgical patients after discharge. The infection control committee concentrated its action in the prevention emphasizing precise diagnosis of infections cases; corporal cleaning, control of associated infection, minimal preoperative period, care with the shaving; rigorous asepsia and antisepsia; adequate surgical technique; notification of the infection control results and the infection/surgeon/anesthetist rates; and a rigorous antimicrobial control. RESULTS: Wound infection rate dropped from 15-20% to the actual rate of 7.7%. Urinary infection was reduced from 18.2% to 0.4%, and the respiratory infection from 22.9% to 2.7%. The mortality related to infection was reduced from 2.8% to 0.9% and the rate of wound infection in clean surgeries from 12.8% to 3.4%. In the outpatient surgeries (27,580) the wound infection was 0.4% and the global mortality was 0.007%. CONCLUSION: The authors demonstrated that infection control is not made by expensive investments and equipaments, or computadorized ambient. Infection control is made, in our view, by political decision, manpower and motivation to control the infection control problem.

Tratamento cirúrgico da hipertensão portal esquistossomótica no hc/ufpe: análise de 131 casos

BACKGROUND: At the Clinical Hospital of the Federal University of Pernambuco the surgical treatment of hepatosplenic shistosomiasis has been done with splenectomy + left gastric vein ligature (LGVL) + devascularization of the great curvature of the stomach + postoperative endoscopic sclerosis. If the patient has gastric fundus variceals, the gastric fundus was open and the variceals sutured. The objective of this paper was to evaluate the surgical treatment proposal regarding the re-bleeding rate, mortality and laboratorials changes. METHOD: During the period between 1992 and April 1998, 131 procedures in the General Surgery Division of the Clinical Hospital. The patients were asked to return to the Hospital and underwent a clinical/laboratorial analysis. The mean follow-up was 30 months. RESULTS: The re-bleeding rate was 14,4% (16/111) and the mortality rate 5,4% (6/111). In 8 cases of re-bleeding the exteriorization was in form of melena and in 8 as hematemesis. In 3 cases the mortality was resulted of a linfoma, a hepatocarcinoma and a cardiac stroke. In two patients the death was resulted from the immediate postoperative period (sepsis and intravascular disseminated coagulation). The other death was during the late postoperative period as a result of a re-bleeding episode. Nine patients (13,2%) evaluated with portal vein thrombosis and in two a superior mesenteric vein thrombosis was identified. Hematological and biochemical datas was also analyzed. CONCLUSIONS: The authors concluded that the surgical treatment of the hepatosplenic shistosomiasis with splenectomy + LGVL + devascularization of the great curvature of the stomach + postoperative endoscopic sclerosis is a safe procedure and with results comparable with the literature, and a advantage to maintain the liver functionality. The LGVL and the direct suture of the gastric fundus variceals gave a more effective action on the esophagus-gastric variceals and a possible lower rates of portal vein thrombosis.

Avaliação da atividade mioelétrica do trato gastrointestinal em cães: avaliação de um sistema de fixação de eletrodos na parede abdominal

OBJECTIVE: The use of intra-abdominal electrodes in the study of gastrointestinal electrical wave is an important instrument of the gastrointestinal mioelectric activity. However, the dislocations of the electrodes in non-anaesthetized animals due to diaphragmatic muscle movements, gastrointestinal movements and mainly due to the animals habits, especially in dogs. The study has the objective to demonstrate a procedure that stabilize the system using simple resources an irrelevant cost. METHODS: The authors demonstrate under diagrams and picture a fixed system to fix the electrical electrodes through the animal skin using bottoms. RESULTS: The system was used in 5 animals. Each animal had 3 bipolar electrodes. During the study it was not identified any electrode migration. The animals was kept resting until the complete recovery of the postoperative ileus. CONCLUSION: The procedure proposed is efficient, simple, and easy to be made and allow an acquisition of the mioelectric activity, in dogs not anaesthetized, for long periods.