Title Prevencija kirurških infekcija Title (english) Prevention of surgical site infections Author Lana Šepec Rožmarić Mentor Ana Budimir (mentor)Committee member Zrinka Bošnjak (predsjednik povjerenstva) Committee member Goran Tešović (član povjerenstva)Committee member Ana Budimir (član povjerenstva)Granter University of Zagreb Defense date and country 2016-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Kirurške infekcije čine gotovo jednu trećinu svih bolničkih infekcija. Predstavljaju velik javnozdravstveni problem i financijsko opterećenje za zdravstveni sustav. Povezane su pojavom teških komplikacija koje uključuju boravak pacijenata u jedinicama za intenzivno liječenje, ponovne operativne zahvate, dulji boravak u bolnici, produljen oporavak pacijenta, estetske i funkcionalne defekte te višu stopu mortaliteta. Značajan utjecaj na pojavu komplikacija imaju sami uzročnici kirurških infekcija. To su sojevi bakterija često rezistentni na širok spektar i standardne doze antibiotika koje stoga vrlo teško tretirati.
Da bi se infekcija smatrala kirurškom infekcijom mora se pojaviti unutar 30 dana od operativnog zahvata ili unutar jedne godine od operacije ako je ugrađen implantat uz tipične znakove i simptome upalnog zbivanja ili mora biti potvrđena laboratorijskim ili drugim dijagnostičkim metodama.
Prevencija kirurških infekcija obuhvaća niz mjera vezanih (direkno i indirektno) uz pripremu pacijenta, medicinskog osoblja i okoliša za izvođenje operativnog zahvata i oporavak pacijenta.
Preoperativne preventivne mjere zahtijevaju tuširanje pacijenta antiseptikom noć ili jutro prije zahvata, davanje adekvatne antibiotske profilakse u vrijeme i u dozi koja je određena ovisno o vrsti operativnog zahvata i očekivanim uzročnicima infekcije te eventualno odstranjivanje dlaka s operativnog polja i dekolonizaciju nositelja S. aureusa.
Intraoperativne mjere veoma su složene i ovise o ustroju medicinske ustanove u kojoj se operativni zahvat poduzima. Obuhvaćaju sterilizaciju instrumenata i druge medicinske opreme, ulazak osoblja u operacijski trakt, odijevanje osoblja u sterilnu odjeću, kirurško pranje ruku, posebne uvjete u operacijskoj dvorani koji uključuju ventilaciju, pravilnu upotrebu sterilnih rukavica, pranje operacijskog polja, adekvatnu oksigenaciju pacijenta, prevenciju hipotermije, održavanje euglikemije te pravilno zatvaranje rane.
Koncentracija lijeka mora biti unutar terapijskih vrijednosti tokom cijelog operativnog zahvata i par sati nakon zatvaranja kirurškog reza i završetka operacije.
Nakon operacije potrebno je prekinuti antibiotsku profilaksu unutar vremena zadanog važećim smjernicama, održavati normoglikemiju, pregledavati i njegovati ranu. Pacijent otpušten iz bolnice mora dolaziti nadležnom kirurgu i obiteljskom liječniku na redovite kontrole.
Abstract (english) Surgical site infections (SSI) account for almost one-third of all hospital infections. They represent a major public health problem and financial burden for the health system. SSI are associated with treatment in an intensive care unit, longer post-operative hospital stays, additional surgical procedures, prolonged recovery, aesthetic and functional defects and often higher mortality. A significant impact on the incidence of complications have SSI pathogens themselves. These are often drug-resistant bacteria which are difficult to treat with standard dosage regimens. Surgical site infection occurs within 30 days after the operation if no implant is left in place or within 1 year if implant is in place, the infection appears to be related to the operation and the patient has typical signs or symptoms of inflammation or other evidence of infection is found on examination or with other diagnostic methods.
Prevention of surgical site infections includes a series of measures related (directly or indirectly) with the preparation of the patient, medical staff and the environment for the surgical procedure and the patient’s postoperative recovery.
Preoperative preventive measures require preoperative whole-body washing the night before or the morning of the procedure, administration of adequate antibiotic prophylaxis at the time and in a dosage determined by the type of surgery and the expected pathogens and optional decolonization of S. aureus carriers and hair removal.
Intraoperative measures are very complex and depend on the structure of the medical institution where the surgery takes place. They include sterilization of surgical instruments and other medical equipment , personnel entering the operating tract , dressing in sterile clothing , surgical hand washing , specific conditions in the operating room involving ventilation , proper use of sterile gloves ,
preoperative preparation of the skin at the incision site including antiseptic agents, adequate oxygenation of the patient, preventing intraoperative hypothermia, maintaining normoglycemia and proper wound closure .
Therapeutic concentrations of the drug should be maintained throughout the procedure as well as for several hours after the incision is closed. Antibiotic prophylaxis should be discontinued within the time specified in the guidelines. Other postoperative measures include glucose control and postoperative wound care.
After discharge from the hospital the patient should see the primary care physician and the surgeon for a follow-up appointment.
Keywords
kirurške infekcije
prevencija
preventivne mjere
antibiotska profilaksa
Keywords (english)
surgical site infections (SSI)
prevention
preventive measures
antibiotic prophylaxis
Language croatian URN:NBN urn:nbn:hr:105:171072 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-08-18 10:11:34
