Efetividade de intervenções na adequação da profilaxia antimicrobiana da infecção do sítio cirúrgico em um hospital universitário do Brasil

Abstract

The surgical site infection is one of the main healthcare-associated infections (HAIs), the main surgical complication and the use of antimicrobials is part of a set measures used in order to reduce this infection. There are well-conducted studies with general recommendations and specific standards for each type of surgery on surgical prophylaxis with antimicrobial. However, the inappropriate use of antimicrobials remains one of the major errors in medication administration in hospitals and prescription for far too long persists as one of the major flaws in the prophylaxis of surgical site infection (SSI). The purpose of this study is to know the effectiveness of interventions aimed at changing the conduct of surgeons regarding the correct indication and adequate time for maintenance of antimicrobial prophylaxis of SSI. It is a prospective study, before and after kind, conducted at Hospital das Clínicas de Uberlândia, an institution with a little more than 500-bed, linked to Universidade Federal de Uberlândia. There were two interventions: a prophylaxis with antimicrobial in surgery guide available, build up with the surgeon participation and Cefazolin liberation restriction, one of the more utilized antimicrobial with SSI prophylaxis purpose. Surgeries of the specialties trauma-orthopedic and general surgery and, the adaptation of antibiotic prophylaxis making reference to indication, antimicrobial prescribed and time of use. The study has been divided in three collection periods: baseline (period I), after the first intervention, elaboration and guide availableness (period II) and a third during the second intervention, Cefazolin restriction (period III). The indication of the use of prescribed antibiotic prophylaxis of SSI was considered adequate in the three collection periods. The antimicrobial choice has been convenient in the three periods of trauma-orthopedic however, in general surgery, the percents were 20%, 63,9% and 61,5% of the cases (p=0,011), respectively, in the three collection periods. The maintenance timing of the antimicrobial prophylaxis was considered adequate in 23,00% at the period I, in 46,15% at period II and 82,46% at period III (p<0,0001). The conclusion of this study is that educational interventions and mainly the administrative ones can increase of the use of antimicrobial prophylaxis in surgery.