Characterization of children submitted to cardiac surgery that developed surgical site infection

1. Hospital Dr. Carlos Alberto Sturdart Gomes – Messejana (CE), Brazil. 2. Universidade Estadual do Ceará – Centro de Ciências da Saúde – Fortaleza (CE), Brazil. 3. Hospital Universitário Walter Cantídio – Fortaleza (CE), Brazil. 4. Hospital Universitário Walter Cantídio – Setor de Clínica médica – Fortaleza (CE), Brazil. *Correspondence author: sinarafariasbc@gmail.com Received: May 13, 2020 | Accepted: Aug. 10, 2020 ABSTRACT Objective: Characterize the clinical and surgical profile of children undergoing cardiac surgery who developed surgical site infection in a public hospital in the city of Fortaleza, Ceará. Methods: Descriptive research with a quantitative approach, developed in a pediatric cardiology unit, with data collected from April to June 2018. The study sample consisted of 26 children with surgical wound infection in the year 2017. Results: There were none gender prevalence; the weight range varied from 3 to 6 kg (42.3%) and neonates had a prevalence of 38%. Corrective surgeries represented 88% of the total; the surgical time varied from 2 to 6 hours (38%); 70% of the children were submitted to cardiopulmonary bypass with the predominant time of 90 to 120 minutes (27%); the diagnosis of infection was made between 4 and 6 days after the procedure. There was prophylactic antibiotic coverage in 88% and skin preparation in 92% of children. Conclusion: Characterizing the clinical-surgical profile of children undergoing cardiac surgery becomes essential for decision-making in the care processes of nurses, emphasizing the findings as a basis for the development of strategies for the prevention of surgical site infection in this clientele.


INTRODUCTION
Health care-associated infection (HAI) is a major concern of the health services. Among the topographies of the HAIs, the surgical site infection (SSI) is directly related to the surgical procedures, and is currently one of the most important ones 1  Many are the prevention efforts and programs developed by the competent agencies; however, the SSI remains today as one of the main risks to the safety of patients. According to national studies, the occurrence of SSI ranks 3rd among the HAIs, comprising 14 to 16% of those found in hospitalized patients. It is estimated that SSIs can be avoided in up to 60% of the cases, through the application of orientation and prevention measures 4 .

METHODS
It is a retrospective study of documental analysis, with a quantitative approach. This research is part of a larger project, implemented in a pediatric cardiology unit, with a view to reducing infection rates in children undergoing heart surgery. The data were collected from April to June 2018 in a quaternary hospital specialized in the diagnosis and treatment of heart and lung diseases, with capacity to perform highly complex procedures in these areas.
To guide the data collection and achieve the proposed objectives, an instrument used by the hospital's pediatric department was the evolution tool for root cause analysis

RESULTS
Data regarding the sample are presented below, namely: gender, weight, age, surgical procedure and preoperative SSI preventive actions. Table 1 shows the gender, weight, and age range of the study participants.
Regarding age, the age range of newborns (from 0 to 28 days) predominated, with a prevalence of 38%. Table 2 presents the characteristics of the surgical procedure to which the children participating in the study were submitted.
Corrective surgeries accounted for 88.5% of surgical procedures. As shown in Table 2, the surgical time between 2 and 6 hours represented 77% of the total. Of the 26 surgeries performed, CPB was used in 69.2% of the cases; of these, 27% lasted from 90 to 120 minutes.
The amount from 4 to 6 days after the procedure until the diagnosis of infection represented 27% of the total. Table 3 shows SSI preventive actions in the preoperative period.

DISCUSSION
In a research on the profile of children submitted to heart surgery, of the 55 children studied, 27 (49%) were male, data that are similar to those of the present study 7 . It is known that weight is an important factor in the rehabilitation of a disease 8  Cardiopulmonary bypass (CPB) is a necessary procedure in 90% of surgical cases. Age is a preexisting risk factor, the newborn being the most exposed to complications due to immaturity of the organism7. It is known that, in surgical procedures, the team must rigorously follow the routine of SSI preventive actions, being the degermination of the hands and the use of an antiseptic product to remove the microorganisms, unique actions to reduce the microbial load 14 .
In this context, the nursing team must be attentive Regarding the limitations of the study, data collection must be highlighted, since it is a retrospective study of document analysis, which requires an interpretation of the data already recorded, which implies the veracity of the documented information.
In this sense, it is worth emphasizing that the demand in the treatment process of SSI in children requires actions based on the knowledge of scientific evidence, but also involves social relations, characterizing transdisciplinary involvement. It is also necessary to emphasize that identifying related variables is relevant, since they can help to redefine the methods of care, the development of strategies that address the complexity of treatment and the ways of production and dissemination of knowledge about this undesirable event.

FINANCING
Study financed by the authors.