Avaliação de campos adesivos impregnados com iodo para prevenção de infecções em cirurgias de coluna vertebral.

Abstract

Introduction: Surgical procedures, when indicated, are intended to save lives, but the lack of security in relation to some uncontrolled risks, can cause harm to users such as infections, disabilities and death. Infections from spine surgeries increase the likelihood of complications, costs and deaths, reaching up to 12% of patients, in addition to prolonging hospitalization around 14 days and increasing readmissions for the execution of new procedures and therapies. Risk factors for surgical site infections (SSI) may be due to the patient or the procedure and they need adjustments to ensure the safety of the procedure. Contamination of the wound and other factors such as skin preparation can increase the risk of infection. There are several antiseptics to reduce the microbial load on the skin at the incision site, including alcohols, iodophores and chlorhexidine gluconate. Some recommendations refer to the use of adhesives impregnated with iodophores to reduce the number of microorganisms in the surgical bed and to avoid infections and others demonstrate the non-reduction of SSI. Thus, the information is controversial and it is recommended to expand research to increase the bibliographic arsenal due to the few studies that define this orientation. Objective: To evaluate the use of adhesive fields impregnated with iodine to prevent infection in spine surgeries. Article 1: Strategies for prevention and control of surgical infections: from history to the present. Background: Surgical procedures, when indicated, are intended to save lives, but lack of certainty about some uncontrolled risks can cause harm to users such as infections, disabilities and death. Given these serious events imposed on patients who developed surgical site infections (SSI), there is a need for efforts to implement prevention strategies. Objectives: To analyze the risk scenario for surgical site infections and discuss strategies to improve care in order to minimize risks and ensure a safe and quality health service. Content: Risk factors for SSI may be due to the patient or the procedure and these need adjustments to ensure safety. Contamination of the wound and other factors such as skin preparation may increase the risk of infection. There are several antiseptics to reduce the microbial load on the skin at the incision site. Some recommendations refer to the use of iodophor-impregnated adhesives to reduce the number of microorganisms in the surgical bed and to prevent infections. Conclusion: The identification of associated risk factors, the implementation of prevention and control strategies, and the cost-benefit ratio, can support the professionals' actions in reducing the frequency of surgical-related infectious events and reducing surgical site complications. Article 2: Iodine-Impregnated Drapes in Spine Surgery: a Comparative Analysis. Objective: To evaluate the use of Iodine-impregnated adhesive drapes (IIAD) aimed at preventing surgical site infection (SSI) of the spinal column. Method: Retrospective study that analyzed the outcome of infection associated or not with the use of IIAD, from 2015 to 2019. Results: SSI was 16.7% and normothermia was the only independent protective factor for SSI (p = 0.043). The treatment of infectious complications led to an increase in hospital costs of 83.6% per day of care. Patients who used IIAD had 10 (+ 4.9) days less of hospital stay. Conclusions: The results suggest that IIAD use was not associated with a lower risk of SSI, but the patients who used them obtained a reduction in the costs of care. Article 3: Are protocols for preventing infection of the surgical spine site favorable to non-infection? Objective: to assess adherence to care protocols for non-infection of the surgical site (NISC) of the spine. Method: Retrospective, analytical study, carried out by reviewing 60 medical records of patients undergoing spine surgery from 2015 to 2019, their outcome of non-infection and the related factors. The data were analyzed statistically using the Statistical Package for the Social Sciences program (SPSS IBM, Armonk, USA), version 23.0. To determine the protective factors against non-infection, univariate analysis was used and multiple linear regression was applied for the variables that presented p <0.20. Results: The protective variables for NISC were: oral hygiene with chlorhexidine (RR = 1.03; p = 0.023), antimicrobial prophylaxis 30 to 60 min before surgery (RR = 0.97; p = 0.026), normothermia (RR = 0.80; p = 0.050), post-ICU hospitalization (up to 3 days) (RR = 2.00; p = 0.040), hospitalization greater than 30 days (RR = 0.69; p = 0.017). The frequency of NISC was 83.3% (50/60) p = 0.728). Conclusion: Normothermia was a protective factor for SSI in linear regression. It is noteworthy that adherence to work processes is essential to protect infections, adverse events and improve safety.