Abstract
to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.
Highlights
Despite all medical advances in the field of surgery and all the knowledge acquired over the last decades regarding infection control, surgical site infection (SSI) continues to be a subject of great concern in health institutions, and is closely related to increased nosocomial morbimortality[1]
There is no literature study reporting the impact of care bundle interventions on obese patients undergoing bariatric surgery
There are several types of surgical care bundles reported in literature
Summary
Despite all medical advances in the field of surgery and all the knowledge acquired over the last decades regarding infection control, surgical site infection (SSI) continues to be a subject of great concern in health institutions, and is closely related to increased nosocomial morbimortality[1]. It is plausible to infer that surgical procedures performed primarily in obese patients, such as bariatric surgery, should be related to high SSI rates[5]. Data on the incidence of SSI after bariatric surgery vary from 1% to 21.7%, depending on the surgical access performed (laparoscopy or laparotomy)[6]. In view of the best knowledge of risk factors for SSI, several interventions with varying levels of evidence have been introduced in clinical practice with the aim of reducing the incidence of postoperative infection[7]. Care bundles have been implemented to this end and, even literature presenting conflicting data on this topic, their application seems to be a useful strategy to control SSI in the most diverse performed procedures[3]. Data on care bundles related to SSI prevention in bariatric
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