https://doi.org/10.4081/ijwc.2024.114
Prevenzione delle infezioni del sito chirurgico in ginecologia e ostetricia: una revisione di letteratura e una proposta di algoritmo gestionale
Ricevuto: 25 aprile 2024
Accettato: 4 luglio 2024
Published: 26 agosto 2024
Accettato: 4 luglio 2024
Abstract Views: 152
PDF: 111
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Autori
Le complicanze del sito chirurgico sono un importante problema sanitario irrisolto, con un impatto negativo sul decorso post-operatorio delle pazienti e sulla spesa sanitaria pubblica. Attualmente mancano chiare indicazioni sulle strategie preventive delle infezioni del sito chirurgico (Surgical Site Infection, SSI) in chirurgia ginecologica e ostetrica; pertanto, presentiamo una revisione della letteratura e proponiamo un algoritmo per la gestione della ferita chirurgica in questo ambito. È stata condotta una revisione della letteratura comprendente i lavori pubblicati in lingua inglese tra il gennaio 1965 e febbraio 2022 sulla prevenzione delle infezioni del sito chirurgico in seguito a chirurgia ostetrica o ginecologica. Complessivamente sono state identificate 118 pubblicazioni. Sono stati considerati rilevanti solo i lavori che descrivevano strategie preventive per le infezioni del sito chirurgico (n = 27). Alla fine sono stati inclusi e analizzati in questa revisione 8 studi. Proponiamo un algoritmo basato sui fattori di rischio identificati. In base alla categoria di rischio, viene identificato il tipo di medicazione post-operatoria più adeguata per la singola paziente. Infine, utilizzando una scheda dedicata, abbiamo proposto anche di valutare l’efficacia della medicazione utilizzata, in relazione sia alle caratteristiche della ferita nella visita post-operatoria, sia al grado di comfort e soddisfazione espresso dalla paziente. L’identificazione di chiari fattori di rischio e di una specifica condotta preventiva, adattata alla singola paziente, ha lo scopo di facilitare il medico nella gestione quotidiana della ferita chirurgica, migliorando l’esito dell’intervento. Il nostro sforzo principale è quello di ottenere uno strumento semplice nella gestione della ferita chirurgica per diffonderlo nella nostra pratica clinica.
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2001.
Centers for Disease Control (CDC) Surgical Site Infection (SSI) Event. 2016. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infection Control Hospital Epidemiol 1992;13:606-8.
DOI: https://doi.org/10.1017/S0195941700015241
Lazenby GB, Soper DE. Prevention, diagnosis, and treatment of gynecologic surgical site infections. Obstet Gynecol Clin North Am 2010;37:379-86.
DOI: https://doi.org/10.1016/j.ogc.2010.05.001
Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013;34:1-14.
DOI: https://doi.org/10.1086/668770
European Centre for Disease Prevention and Control. Surgical site infections. In: ECDC. Annual epidemiological report for 2015. Stockholm: ECDC; 2017.
Lake AG, McPencow AM, Dick-Biascoechea MA, et al. Surgical site infection after hysterectomy. Am J Obstet Gynecol 2013;209:490.e19.
DOI: https://doi.org/10.1016/j.ajog.2013.06.018
Chen I, Choudhry AJ, Schramm D, et al. Type of Pelvic Disease as a Risk Factor for Surgical Site Infection in Women Undergoing Hysterectomy. J Minim Invasive Gynecol 2019;26:1149-56.
DOI: https://doi.org/10.1016/j.jmig.2018.11.015
Ekanem EE, Oniya O, Saleh H, Konje JC. Surgical site infection in obstetrics and gynaecology: prevention and management. Obstetrician Gynaecologist 2021;23:124–37.
DOI: https://doi.org/10.1111/tog.12730
Nugent EK, Hoff JT, Gao F, et al. Wound complications after gynecologic cancer surgery. Gynecol Oncol 2011;121:347-52.
DOI: https://doi.org/10.1016/j.ygyno.2011.01.026
Cassimatis I, Peace JM, Premkumar A, et al. Peripartum care and obesity: A scoping review of evidence-based recommendations and practical modalities for implementation. Am J Obstet Gynecol 2022;226:S697-8.
DOI: https://doi.org/10.1016/j.ajog.2021.11.1150
Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022;158:502-11.
DOI: https://doi.org/10.1002/ijgo.14058
Mahdi H, Goodrich S, Lockhart D, et al. Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data. J Minim Invasive Gynecol 2014;21:901-9.
DOI: https://doi.org/10.1016/j.jmig.2014.04.003
ACOG Practice Bulletin No 195: Prevention of infection after gynecologic procedures. Obst Gynecol 2018;131:e172–89.
DOI: https://doi.org/10.1097/AOG.0000000000002670
World Health Organization (WHO). Global guidelines for the prevention of surgical site infection. Geneva: WHO; 2018.
Al-Niaimi AN, Ahmed M, Burish N, et al. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients. Gynecol Oncol 2015;136:71-6.
DOI: https://doi.org/10.1016/j.ygyno.2014.09.013
Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Site Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg 2017;224:59–74.
DOI: https://doi.org/10.1016/j.jamcollsurg.2016.10.029
Oh CA, Kim DH, Oh SJ, et al. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy. World J Gastroenterol 2012;18:673-678.
DOI: https://doi.org/10.3748/wjg.v18.i7.673
Seaman SJ, Han E, Arora C, Kim JH. Surgical site infections in gynecology: the latest evidence for prevention and management. Curr Opin Obstet Gynecol 2021;33:296-304.
DOI: https://doi.org/10.1097/GCO.0000000000000717
Seal LA, Paul-Cheadle D. A systems approach to preoperative surgical patient skin preparation. Am J Infect Control 2004;32:57–62.
DOI: https://doi.org/10.1016/j.ajic.2003.11.001
Privitera GP, Costa AL, Brusaferro S, et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis. Am J Infect Control 2017;45:180-189.
DOI: https://doi.org/10.1016/j.ajic.2016.09.017
Singh P, Gothwal M, Pradhan HK, et al. Skin preparation for prevention of surgical site infection after obstetrics and gynecological abdominal surgery: A quality improvement project. J Obstet Gynaecol Res 2022;48:824-9.
DOI: https://doi.org/10.1111/jog.15137
Davidson C, Enns J, Bennett C, et al. Reducing abdominal hysterectomy surgical site infections: a multidisciplinary quality initiative. Am J Infect Control 2020;48:1292–7.
DOI: https://doi.org/10.1016/j.ajic.2020.05.001
Kenyon SL, Taylor DJ, Tarnow-Mordi W, ORACLE Collaborative Group. Broad spectrum antibiotics for preterm, prelabour rupture of fetal membranes. The ORACLE study. Lancet 2001;357:979–88.
DOI: https://doi.org/10.1016/S0140-6736(00)04233-1
National Institute for Health and Care Excellence (NICE). Surgical site infections: prevention and treatment. NICE guideline [NG125]. London: NICE; 2019. p. 1–28.
Tuuli MG, Liu J, Stout MJ, et al. A Randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 2016;374:647-55.
DOI: https://doi.org/10.1056/NEJMoa1511048
Skeith AE, Morgan DM, Schmidt PC. Vaginal preparation with povidone-iodine or chlorhexidine before hysterectomy: a propensity score matched analysis. Am J Obstet Gynecol 2021;225:560.e1-560.e9.
DOI: https://doi.org/10.1016/j.ajog.2021.08.035
Hill AM, Pauls RN, Basil J, et al. Chlorhexidine versus iodine for vaginal preparation before hysterectomy: a randomized clinical trial. Female Pelvic Med Reconstr Surg 2022;28:77-84.
DOI: https://doi.org/10.1097/SPV.0000000000001066
Temming L, Frolova AI, Raghuraman N, et al. Vaginal cleansing before cesarean delivery in labor to reduce infection: a randomized trial. Am J Obstet Gynecol 2022;226:S19-S20.
DOI: https://doi.org/10.1016/j.ajog.2021.11.078
=1#H3098500
Clay FSH, Walsh CA, Walsh SR. Staples vs subcuticular sutures for skin closure at cesarean delivery: a metanalysis of randomized controlled trials. Am J Obstet Gynecol 2011;204:378–83.
DOI: https://doi.org/10.1016/j.ajog.2010.11.018
Frishman GN, Schwartz T, Hogan JW. Closure of Pfannenstiel skin incisions. Staples vs. subcuticular suture. J Reprod Med 1997;42:627–630.
Basha SL, Rochon ML, Quiñones JN, et al. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol 2010;203:285.e1-8.
DOI: https://doi.org/10.1016/j.ajog.2010.07.011
Toon CD, Lusuku C, Ramamoorthy R, et al. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev 2015;2015:CD010259.
DOI: https://doi.org/10.1002/14651858.CD010259.pub3
Smid MC, Dotters-Katz SK, Grace M, et al. Prophylactic negative pressure wound therapy for obese women after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol 2017;130:969-78.
DOI: https://doi.org/10.1097/AOG.0000000000002259
Tuuli MG, Liu J, Tita ATN, et al. Effect of prophylactic negative pressure wound therapy vs standard wound dressing on surgical-site infection in obese women after cesarean delivery: a randomized clinical trial. JAMA 2020;324:1180-9.
DOI: https://doi.org/10.1001/jama.2020.13361
Kawakita T, Iqbal SN, Overcash RT. Negative pressure wound therapy system in extremely obese women after cesarean delivery compared with standard dressing. J Matern Fetal Neonatal Med 2021;34:634-8.
DOI: https://doi.org/10.1080/14767058.2019.1611774
Peterson AT, Bakaysa SL, Driscoll JM, et al. Randomized controlled trial of single-use negative-pressure wound therapy dressings in morbidly obese patients undergoing cesarean delivery. Am J Obstet Gynecol MFM 2021;3:100410.
DOI: https://doi.org/10.1016/j.ajogmf.2021.100410
Hyldig N, Vinter CA, Kruse M, et al. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. BJOG 2019;126:628-35.
DOI: https://doi.org/10.1111/1471-0528.15413
Yu L, Kronen RJ, Simon LE, et al. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol 2018;218:200-210.e1.
DOI: https://doi.org/10.1016/j.ajog.2017.09.017
Angarita AM, Jayakumaran J, Di Mascio D, Berghella V. Prophylactic negative pressure wound therapy on wound complications after cesarean delivery in women with obesity: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 2022;4:100617.
DOI: https://doi.org/10.1016/j.ajogmf.2022.100617
Leitao MM Jr, Zhou QC, Schiavone MB, et al. Prophylactic negative pressure wound therapy after laparotomy for gynecologic surgery: a randomized controlled trial. Obstet Gynecol 2021;137:334-41.
DOI: https://doi.org/10.1097/AOG.0000000000004243
Chambers LM, Morton M, Lampert E, et al. Use of prophylactic closed incision negative pressure therapy is associated with reduced surgical site infections in gynecologic oncology patients undergoing laparotomy. Am J Obstet Gynecol 2020;223:731.e1-9.
DOI: https://doi.org/10.1016/j.ajog.2020.05.011
Martí MTC, Fernandez-Gonzalez S, Martí MD, et al. Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies. Int Wound J 2022;19:272-7.
DOI: https://doi.org/10.1111/iwj.13628
Asciutto KC, Acosta S, Borgfeldt C. Negative Pressure Wound Therapy (NPWT) in groin wounds after lymphadenectomy in vulvar cancer patients. In Vivo 2020;34:3511-7.
DOI: https://doi.org/10.21873/invivo.12192
National Wound Care Strategy Programme. Recommendations for Surgical Wounds. 2021. Available from: https://www.nationalwoundcarestrategy.net/wp-content/uploads/2021/05/Surgical-Wound-Recommendations-WEB-25Feb21-1.pdf
Come citare
Surace, A., Mauro, J., Tripodi, E., Perotto, S., Borghi, C., Paracchini, S., … Buda, A. A. (2024). Prevenzione delle infezioni del sito chirurgico in ginecologia e ostetricia: una revisione di letteratura e una proposta di algoritmo gestionale. Italian Journal of Wound Care, 8(2). https://doi.org/10.4081/ijwc.2024.114
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