CERRAHİ ALAN İNFEKSİYONLARI RİSK FAKTÖRLERİ

Başlık: CERRAHİ ALAN İNFEKSİYONLARI RİSK FAKTÖRLERİ
Yazar: Atilla Duran
Yazar-email: atilla-04@hotmail.com
Kurum: TC.DOKUZEYLÜL ÜNİVERSİTESİ TIP FAKÜLTESİ GENEL CERRAHİ ABD
Yil: 2009
Anahtar: cerrahi alan infeksiyonları risk faktörleri
Ozet: Giriş ve amaç : Hastane infeksiyonları; hastaların hastaneye yattığı sırada olmayan, hastaneye
yatışından 48-72 saat sonra ortaya çıkan, sıklıkla hastanede yapılan invaziv işlemler ve
uygulamalar sonucu gelişen, önemli oranda morbitide ve mortaliteye neden olan infeksiyonlar
olarak tanımlanmaktadır. Hastane infeksiyonları, hastaların hastanede kalış süresinin uzamasına
ve ciddi sosyoekonomik sorunlara yol açmaktadır. Hastane infeksiyonlarının önemli bir kısmını
da cerrahi alan infeksiyonları (CAİ) oluşturmaktadır. Çalışmamızda ; genel cerrahi servisimizde
ameliyat edilen hastalarda gelişen cerrahi alan infeksiyonlarındaki risk faktörlerinin belirlenmesi
ve anlaşılması amaçlanmıştır.
Hastalar ve metod : Mayıs 2008– Kasım 2008 tarihleri arasında meme, guatr ve
laparoskopik ameliyatlar hariç acil ve elektif ameliyat edilen ardışık 422 hasta cerrahi alan
infeksiyonu ve risk faktörlerini tespit etmek amaçlı çalışmaya dahil edildi. Hastaların preoperatif
dönemde risk faktörleri belirlendi ve postoperatif 3.—7. ve 30. günler cerrahi alan infeksiyonu
açısından çalışmayı yürüten sorumlu hekim tarafından kontrol edildi. Cerrahi alan
infeksiyonları, NNIS verilerine dayanılarak insizyonel ve organ/boşluk olarak tanımlandı.
Bulgular : Hastalardan %37,9’u (160 birey) kadın, %62,1’i (262 birey) erkek idi. Çalışmaya
alınan toplam 422 hastadan 64’ünde ( %15,1 ) cerrahi alan infeksiyonu gelişti. CAİ gelişen
hastaların 17’si kadın ve 47’si erkekti. DM ve malignite CAİ gelişiminde risk faktörleri olarak
tespit edildi ( P < 0,05 ). Ameliyat sonrası tüm nedenlere bağlı CAİ insidansı %15,1 oranında
tespit edildi. Kontaminasyon derecesi, hastanede yatış süresi CAİ gelişiminde etkili
parametrelerdi. ASA skoru ≥ 3 olanlarda CAİ daha fazla gözlendi.
Yorum : Cinsiyet, diabetes mellitus, malignite, kontaminasyon derecesi, ASA skoru ≥3 olması,
preoperatif cilt temizliği, yoğun bakımda kalış süresi, hastanede yatış süresi, yara kültüründe
üreme, ameliyat süresi ve insizyon uzunluğu CAİ oranlarını arttıran risk faktörleri olarak
belirlendi. Özellikle kontaminasyon derecesi, yoğun bakımda kalış süresi, hastanede yatış
süresi, ameliyat süresi, yara kültüründe üreme CAİ gelişiminde oldukça güçlü etkenler olarak
tespit edildi. Bu veriler eşliğinde çalışmamızın sonucunda CAİ gelişimini engellemek için
değiştirilebilir ve önceden öngörülebilen etkenlere müdahale değerlendirilebilir.
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