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Aktuelt om pasientsikkerhet

Nye oversiktsartikler om postoperative sårinfeksjoner

Publisert

Operasjon_mage_underliv_cropped.
Operasjon_mage_underliv_cropped.

Nasjonal enhet for pasientsikkerhet videreformidler ni nye oversiktsartikler om forebygging av postoperative sårinfeksjoner. Artiklene har undersøkte ulike tiltak, for eksempel forebygging av infeksjoner med antibiotika, hygienetiltak, operasjonsteknikker, instrumentering og bruk av fysiske barrierer.


Aktuelt om pasientsikkerhet

Folkehelseinstituttet innhenter og videreformidler jevnlig aktuell informasjon som kan være nyttig for dem som er opptatt av pasientsikkerhet.

Referansene kommer fra to typer kilder: 1) bibliografiske databaser eller 2) nyhetsbrev fra fagmiljøer som arbeider med kvalitet og pasientsikkerhet i helsetjenesten.

For å kvalifisere til formidling skal innholdet være relevant og fortrinnsvis basert på oppsummert forskning. Vi vurderer ikke metodisk kvalitet på publikasjoner som videreformidles.

Les mer om søkekriteriene i Metodebeskrivelse - Aktuelt om pasientsikkerhet (pdf)

Har du funnet en feil?

Alle oversiktsartiklene nedenfor er publisert i 2015. Blant annet viser en oversikt fra Cochrane Collaboration at vask av huden med klorheksidin ikke gir færre infeksjoner enn bruk av andre antiseptiske midler (9).

En annen Cochrane-oversikt finner at tidlig fjerning av bandasje (før det er gått 48 timer) ikke øker infeksjonsfaren for rene kirurgiske snitt. En av de inkluderte studiene tyder på at tidlig bandasjefjerning kan være ressursbesparende både med hensyn til liggetid og totale behandlingskostnader (6).

Ethvert kirurgisk inngrep innebærer en risiko for at det kan oppstå en infeksjon i operasjonssåret etter operasjonen. Det skyldes at bakterier under eller etter inngrepet spres til sårområdet. Forskere og klinikere over hele verden er opptatt av problemet. I USA er postoperative sårinfeksjoner den nest hyppigste typen sykehusinfeksjon og ca. 60 prosent av tilfellene antas å kunne forebygges (2).  I følge årsrapporten for 2014 fra Norsk overvåkingssystem for antibiotikabruk og helsetjenesteassosierte infeksjoner (NOIS) var forekomsten av infeksjon i operasjonsområdet for de fem inngrepene som overvåkes ca. fem prosent.

Se kriteriene for formidling av oversiktsartikler i høyre kolonne.

1. Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons
Ariyan S, Martin J, Lal A, Cheng D, Borah GL, Chung KC, et al.
Plast Reconstr Surg 2015;135(6):1723-1739

The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty. Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.

2. Surgical site infection and prevention guidelines: a primer for Certified Registered Nurse Anesthetists
Diaz V, Newman J
AANA J 2015;83(1):63-68

Surgical site infections are the second most common healthcare-associated infections resulting in readmissions, prolonged hospital stays, higher medical costs, and increased morbidity and mortality. Surgical site infections are preventable in most cases by following evidence-based guidelines for hand hygiene, administration of prophylactic antibiotics, and perioperative patient temperature management.

3. What is new in the diagnosis and prevention of spine surgical site infections
Radcliff KE, Neusner AD, Millhouse PW, Harrop JD, Kepler CK, Rasouli MR, et al.
The spine journal : official journal of the North American Spine Society 2015;15(2):336-347

Surgical site infection (SSI) after spinal surgery can result in several serious secondary complications, such as pseudoarthrosis, neurological injury, paralysis, sepsis, and death. There is an increasing body of literature on risk factors, diagnosis, and specific intraoperative interventions, including attention to sterility of instrumentation, application of minimally invasive fusion techniques, intraoperative irrigation, and application of topical antibiotics, that hold the most promise for reduction of SSI.

4. Glycopeptides versus beta-lactams for the prevention of surgical site infections in cardiovascular and orthopedic surgery: a meta-analysis
Saleh A, Khanna A, Chagin KM, Klika AK, Johnston D, Barsoum WK
Ann Surg 2015;261(1):72-80

The objective of this article was to compare the efficacy of glycopeptides and beta-lactams in preventing surgical site infections (SSIs) in cardiac, vascular, and orthopedic surgery. The cost-effectiveness of switching from beta-lactams to glycopeptides for preoperative antibiotic prophylaxis has been controversial. beta-Lactams are generally recommended in clean surgical procedures, but they are ineffective against resistant gram-positive bacteria. Glycopeptides reduce the risk of resistant staphylococcal SSIs and enterococcal SSIs, but increase the risk of respiratory tract infections.

5. Surgical site infections in dermatologic surgery: etiology, pathogenesis, and current preventative measures
Saleh K, Schmidtchen A
Dermatol Surg 2015;41(5):537-549

This article reviews and summarizes the pathogenesis of Surgical site infections (SSIs) after dermatologic surgery, factors contributing to SSIs, current preventative guidelines, and evidence supporting their use are explored. Most measures used to prevent SSIs in dermatologic surgery are based on studies of wounds in general surgery. Evidence specific to dermatologic surgery is scarce. More research related to the pathogenesis of SSIs is needed to establish effective preventative measures that are key to reducing incidences of SSIs.

6. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds
Toon Clare D, Lusuku C, Ramamoorthy R, Davidson Brian R, Gurusamy Kurinchi S
Cochrane Database of Systematic Reviews 2015 (9):CD010259

The utility of dressing surgical wounds beyond 48 hours of surgery is controversial. This review evaluates the benefits and risks of removing a dressing covering a closed surgical incision site within 48 hours permanently (early dressing removal) or beyond 48 hours of surgery permanently with interim dressing changes allowed (delayed dressing removal), on surgical site infection.

The early removal of dressings from clean or clean contaminated surgical wounds appears to have no detrimental effect on outcomes. Early dressing removal may result in a significantly shorter hospital stay, and significantly reduced costs, than covering the surgical wound with wound dressings beyond the first 48 hours after surgery.

7. Early versus delayed post-operative bathing or showering to prevent wound complications
Toon Clare D, Sinha S, Davidson Brian R, Gurusamy Kurinchi S
Cochrane Database of Systematic Reviews 2015 (7):CD010075

This systematic review compares the benefits (such as potential improvements to quality of life) and harms (potentially increased wound-related morbidity) of early post-operative bathing or showering (i.e. within 48 hours after surgery, the period during which epithelialisation of the wound occurs) compared with delayed post-operative bathing or showering (i.e. no bathing or showering for over 48 hours after surgery) in patients with closed surgical wounds.

The authors conclude that there is currently no conclusive evidence available from randomised trials regarding the benefits or harms of early versus delayed post-operative showering or bathing for the prevention of wound complications.

8. Use of plastic adhesive drapes during surgery for preventing surgical site infection
Webster J, Alghamdi A
Cochrane Database of Systematic Reviews 2015 (1):CD006353

Following surgery, up to 30% of wounds may become infected. This complication of surgery may cause distress for the patient and lead to higher treatment costs. Many interventions have been designed to reduce postoperative infections. One of these is the use of a drape which adheres to the skin, and through which the surgeon cuts. It is thought that adhesive drapes prevent germs (which may be on the skin) from entering the open wound. This updated review of over 4000 patients, in seven separate trials could find no evidence that adhesive drapes reduce surgical site infection rates, and some evidence that they may increase infection rates.

9. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection
Webster J, Osborne S
Cochrane Database of Systematic Reviews 2015 (2):CD004985

Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.