Prevenzione Infezioni Ferite Chirurgiche

8/9/2019 Prevenzione Infezioni Ferite Chirurgiche

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PREVENZIONEDELLEINFEZIONIDELLE

FERITECHIRURGICHEEGESTIONEDELLE

MEDICAZIONI

InfermierePaoloBaldazzi-Medicinad'UrgenzaInfermieraCatiaBiavati-CardiologiaPediatricaInfermieraSimonaMengoli-S.O.CardiochirurgiaInfermiereRobertoMigliorucci-S.O.Cardiochirurgiacibi@[email protected]

Attivit1999

Lo schema che segue rappresenta un suntodelle principali evidenze scientifiche cheabbiamo individuato nel corso del nostro lavoro. La ricerca si svolta quasiesclusivamente attraverso Internet: abbiamo avuto modo di analizzare decine didocumenti (articoli, lineeguida, protocolli)concernenti il temadella gestionedelle feritechirurgicheedellaprevenzionedelleinfezioni.LeGuidelineforpreventionofsurgicalsiteinfection,1999pubblicatoallinternodelsitoCentersfordiseaseControlandpreventionrappresentanosicuramenteildocumentopicompletoedesaustivo,almenoperquantoconcerne la prevenzione delle infezioni. Di questo documento, e delle fondamentaliRaccomandazioni che contiene abbiamo prodotto una traduzione integrale che

ovviamenteadisposizionedichiunqueallinternodellaziendanefacciarichiesta.Leevidenzecheseguonosonosolounapiccolapartediquelleindividuate:sipreferitodaremaggioreevidenzaaquegliaspetticheforsesonomenoradicatinellapraticadelleUnitOperative.ASPETTIPREVENTIVINoncisonoindicazionipereffettuarelatricotomia,amenocheipeliattornoosullincisionenoninterferiscanoconloperazione(IA)

Seipelidevonoessererimossiindispensabilefarloimmediatamenteprimadellinterventocontosatriceelettrica(IA)

Ifattoriindividualicherappresentanoinmanieracertaunincrementodelrischiodiinfezionedellaferitasonoildiabetemellitoelabitudinealfumodisigaretta(IB)

Sebbenelapresenzadistafilococcoaureonellevieaereerappresentiunfattoredirischiocertononvisonoindicazioniperlapplicazionedimupirocinnellenaricicomeprevenzione

Gliantisetticipiefficaciperladisinfezionedellacutesononellordine:alcool,povidone-iodio,clorexidina.

Eindispensabilecheilpersonalechirurgicocheabbiamalattieinfettivetrasmissibiliolesioniapertedellacutesiassentidalserviziofinoachenonsiaesclusaogniinfezione(IB)

Laprofilassiantimicrobicavaeseguitasoloquandoindicato,perviaendovenosainmodocheilivellisiericidellantibioticosianoottimalialmomentodellincisione.Selinterventononsiprolungaesenoninsorgonocomplicanzeaccertatenonoccorronoaltre


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somministrazioni(IA)

Nonoccorreeffettuarepulizieparticolariochiusuredellesaleoperatoriedopooperazionisporcheocontaminate(IB)

Eindispensabileaderireaiprincipidiasepsianchepergliinterventicollateraliallintervento(posizionamentocateterivenosiospinali-preparazioneesomministrazione

farmacie.v.)(IA)Lassemblaggiodellequipaggiamentosterileedeiliquididisoluzionevaeffettuataimmediatamenteprimadellintervento(II)

Lamedicazionedellaferitapuessererimossadopo48oreselincisionesichiusadiprimaintenzione(IB)

Nonvisonoindicazionicerteperlesecuzionediunbagnoodiunadocciaconlaferitascoperta

Visonoindicazionipercalcolare,allinternodelleUnitOperativeinteressate,lastimadelleinfezionichirurgichesenzanecessitdicomunicarelestesseaicomitatidicontrollo(IB)

CURADELLEFERITEINFETTE

Iprincipalifattorifavorentilaguarigionesono:buongradodiumidit,temperaturasui37,pulizia,buonostatodiossigenazione.

Epreferibileusareantibioticiperviasistemicapiuttostochelocalmente.

Allinternodellaferitainfettasconsigliatoapplicaresoluzionidisinfettanti-Noalmercurocromoeallegarzeiodoformiche.IlPovidone-iodioistiolesivo,lacquaossigenatadistruggelecelluleinviadiriepitelizzazione.Quotidianamentenecessarioeffettuareunapuliziadellaferitaconfisiologicasterileerinnovodellamedicazionetradizionalecontecnicapulita.

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