Banca de DEFESA: ROSEMEIRE ANDREATTA

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : ROSEMEIRE ANDREATTA
DATE: 28/09/2023
TIME: 09:00
LOCAL: On-line
TITLE:

IMPROVEMENT OF PREVENTIVE MEASURES FOR SURGICAL SITE INFECTION IN CESAREANS IN A PUBLIC TEACHING HOSPITAL

KEY WORDS:

Quality Improvement Cycle; Surgical Site Infection; Cesarean Surgery

PAGES: 75
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Saúde Pública
SUMMARY:

Introduction: Brazil has high rates of delivery through cesarean section, however, one of the frequent negative consequences is surgical site infection (SSI). This complication leads to prolonged hospital stays, makes it difficult to establish a bond between mother and newborn and generates additional costs for the health system.

Objective: To analyze the effect of an intervention on the rate of SSI after cesarean sections in a public teaching hospital.

Method: The study was carried out at the Cassiano Antonio Moraes University Hospital, a reference in high-risk pregnancies. In 2021, about 70% of deliveries were cesarean sections, totaling 706 deliveries. The study was a mixed quasi-experimental, using before-after and time-series analyses, with no control group. To assess the quality of SSI prevention, eight quality criteria were used (seven processes to monitor adherence to good practices recommended in the literature and one result to monitor the SSI rate). The intervention to improve quality was multifaceted, participatory and based on the analysis of the main causes of the problem, including the results of the initial quality assessment. The implementation period of the interventions was from May 2022 to March 2023. To analyze the context and measure the project's chance of success, the MUSIQ tool, Model for Understanding Success in Quality, was used. After the interventions, the criteria were reassessed and analyzes were performed to calculate the punctual estimates of compliance with the criteria, in addition to evaluating the absolute and relative improvement. Statistical significance was tested using the one-tailed z-value test and the results were presented in pareto charts.

Results: After the intervention, there was a significant improvement in five of the seven process criteria for monitoring adherence to good practices. The greatest gains were observed in the criteria: adequate dressing, which showed a relative improvement of 95%; surgical antisepsis of the skin with adequate degerming solution, achieved absolute improvement of 63% and relative improvement of 83%; and adequate trichotomy with an absolute improvement of 49% and a relative improvement of 51%. These improvements configure a change of pattern with a p<0.001 value for the three criteria. As for the outcome criterion, an improvement in the accuracy of the SSI rate was obtained by increasing the active search rate for post-discharge cesarean sections from 63% to 93%.

Conclusions: The study proved the importance of the improvement cycle approach in conjunction with the science of improvement to drive significant transformations in the context, resulting in greater involvement of people, improved teamwork, greater adherence to best practices and the ability to leverage better outcomes for patient safety.

COMMITTEE MEMBERS:
Presidente - 1868020 - ZENEWTON ANDRÉ DA SILVA GAMA
Interna - 1645299 - MARISE REIS DE FREITAS
Externa à Instituição - HEIKO THEREZA SANTANA - ANVISA