Vigilância epidemiológica da infecção do local cirúrgico nas artroplastias da anca e do joelho

Abstract

Introduction - Epidemiological Surveillance is the prime area of Prevention and Infection Control, being "... essential to ensure the continuous recording, analysis, interpretation and feedback concerning Healthcare Associated Infections (HCAI) ...". (1) The literature review related to the topic focused on the HCAI, the surveillance system proposed by Direcção Geral da Saúde, Surgical Site Infection (SSI), Hip and Knee Replacements and the existing Nationally and Internationally Guidelines for Prevention and Control of the SSI. Objective - Investigate SSI in Hip and Knee Replacements in a Central Hospital. Methodology - A descriptive, prospective and quantitative study was performed. We evaluated 626 surgical procedures, according to the coding system - ICD-9-CM: Total Hip Replacement (81.51), Partial Hip Replacement (81.52), Revision of Hip Replacement (81.53), Total Knee Replacement (81.54) and Revision of Knee Replacement (81.55). 27 surgical procedures (81.53 and 81.55) relating to 18 patients were excluded in accordance with the Protocol "Hospital in Europe Link for Infection Control Through Surveillance” (HELICS) SSI Epidemiological Surveillance 2007 (Annex I). These procedures were clean surgeries, with insertion of implants and thus required one-year follow-up. We used the HELICS Surgery Form (Annex II). Data collection was done through consultation of either hand-written medical records or of the computer programs SONHO, SAPE, SAM, Webapollo Clinical Analysis and Drug Circuit from CPCHS. Data confidentiality was guaranteed. The data obtained were compared with the listings of the Office of Planning and Management Control in order to validate the number of procedures obtained. The Clinical Pathology Laboratory was asked to provide all the bacteriology positive results in the Orthopaedics Department, in order to facilitate early screening of infectious processes. For the statistical analysis we used the Statistical Package for Social Science SPSS 17.0 and Microsoft Excel 2007. Results - Our population revealed a female predominance, with 68.85 % females to 31.15 % males, where the average age was 71.18 years and the median of 72 years. The incidence of SSI was 1.28 % with 2.03 % for Hip Arthroplasty and 0.35 % for the Knee ones. From these values, 75 % were detected after discharge. Emergency procedures had higher rates than those of the planned procedures, with 3.1 % for the former and 0.8 % for the latter. The most commonly isolated organism was Staphylococcus aureus with a frequency of 83.3 %, 80% representing MRSA cases infections. Conclusion: The use of HELICS Surgery Prortocol allowed to know SSI rates in surgical procedures that are already referred to. Identified areas to be investigated in future studies, such as Antibiotic Prophylaxis and the pathological Fractures. Considering our results (Annex III), we will delineate interventional strategies to improve these results, particularly in the verification of existing protocols and recommendations in the institution.

Date of Award	23 Dec 2011
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Fernando Mena Martins (Supervisor) & Nuno Manuel da Conceição Diogo (Co-Supervisor)