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Lesiones percutáneas durante procedimientos quirúrgicos.

J I Tokars1, D M Bell, D H Culver

  • 1Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga 30333.

JAMA
|June 3, 1992
PubMed
Resumen

El personal quirúrgico sufre frecuentes lesiones percutáneas, principalmente por agujas de sutura, que representan riesgos de infección para ellos y los pacientes. Muchas lesiones se pueden prevenir a través de mejores dispositivos y técnicas quirúrgicas.

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Área de la Ciencia:

  • Infecciones asociadas al cuidado de la salud.
  • Seguridad laboral en cirugía.
  • Infecciones en el sitio quirúrgico infecciones en el sitio quirúrgico.

Sus antecedentes:

  • Las lesiones percutáneas durante la cirugía presentan riesgos de transmisión de patógenos transmitidos por la sangre a los trabajadores de la salud y los pacientes.
  • Comprender la incidencia y las circunstancias de estas lesiones es crucial para desarrollar estrategias efectivas de prevención.

Objetivo del estudio:

  • Cuantificar la frecuencia e identificar las circunstancias de las lesiones percutáneas que ocurren en entornos quirúrgicos.
  • Para evaluar el riesgo de exposición del paciente a la sangre del trabajador sanitario a través de instrumentos quirúrgicos contaminados.

Principales métodos:

  • Diseño de estudio de observación que involucra el monitoreo directo de 1382 procedimientos quirúrgicos en cinco especialidades quirúrgicas en cuatro hospitales universitarios de los Estados Unidos.
  • Recopilación de datos sobre lesiones percutáneas, incluido el tipo, el mecanismo y el personal involucrado, por observadores in situ.
  • Análisis de regresión logística para determinar los factores asociados con el riesgo de lesiones.

Principales resultados:

  • El 6,9% de los procedimientos resultaron en 99 lesiones percutáneas, principalmente de agujas de sutura (77%) que afectan a la mano no dominante.
  • Se observó un mayor riesgo de lesión durante la histerectomía vaginal, mientras que se observó un menor riesgo en ciertos procedimientos ortopédicos.
  • El uso de los dedos para el manejo de tejidos durante la sutura contribuyó al 35% de las lesiones; el 32% de las lesiones a los cirujanos involucraron el contacto de nuevo con la herida del paciente.

Conclusiones:

  • Las lesiones percutáneas son comunes durante la cirugía, creando importantes riesgos laborales y de seguridad del paciente.
  • Las medidas preventivas que se centran en la modificación del dispositivo, el refinamiento de la técnica y el equipo de protección son esenciales, pero requieren una evaluación rigurosa de la eficacia y el impacto en la atención al paciente.