18 de janeiro de 2010

Indicação de artigo - Anestesia e Infecção Hospitalar

Na última publicação deste blog fizemos uma breve introdução sobre o primeiro passo da campanha Segurança no Período Perioperatório: 10 Passos para Anestesia Segura. Em resposta a esta postagem, o passo HIGIENIZAÇÃO DAS MÃOS E USO DE LUVAS – Anestesia e Infecção Hospitalar, o Dr. Florentino Fernandes Mendes gentilmente indica a leitura do seguinte artigo:

Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis
Rabih O. Darouiche, M.D., Matthew J. Wall, Jr., M.D., Kamal M.F. Itani, M.D., Mary F. Otterson, M.D., Alexandra L. Webb, M.D., Matthew M. Carrick, M.D., Harold J. Miller, M.D., Samir S. Awad, M.D., Cynthia T. Crosby, B.S., Michael C. Mosier, Ph.D., Atef AlSharif, M.D., and David H. Berger, M.D.

New England Journal of Medicine. January 7, 2010; 362:18-26. Number1

ABSTRACT
Background Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine–alcohol is more protective against infection than is povidone–iodine.

Methods We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.

Results A total of 849 subjects (409 in the chlorhexidine–alcohol group and 440 in the povidone–iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine–alcohol was significantly more protective than povidone–iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.

Conclusions Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290 [ClinicalTrials.gov] .)

Source Information
From the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine (R.O.D., S.S.A., A.A., D.H.B.), and Ben Taub General Hospital and Baylor College of Medicine (M.J.W., M.M.C., H.J.M.) — all in Houston; Veterans Affairs Boston Healthcare System and Boston University Medical School, Boston (K.M.F.I.); Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee (M.F.O.); Veterans Affairs Medical Center, Atlanta (A.L.W.); and Cardinal Health, Leawood (C.T.C.), and Washburn University, Topeka (M.C.M.) — both in Kansas.

Para ler o artigo completo:

Dr. Florentino Fernandes Mendes é presidente do Comitê de Medicina Perioperatória da SBA (Sociedade Brasileira de Anestesiologia) – Gestão 2010. Doutor em Medicina — Faculdade de Ciências Médicas da Santa Casa de São Paulo. Professor de Anestesiologia da FFFCMPA (Universidade Federal de Ciências da Saúde de Porto Alegre – RS).

Agradecemos a colaboração!

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