Ciclo de melhoria da qualidade para redução de infecção de sítio cirúrgico em cesarianas em um hospital público de ensino

Abstract

Introduction: Brazil has high rates of cesarean births, however, one of the frequent negative consequences is surgical site infection (SSI). This complication leads to prolonged hospital stays; it makes it difficult to establish the bond between mother and newborn and generates additional costs for the health system. Objective: To carry out a quality improvement cycle to reduce surgical site infections after cesarean sections in the context of a public teaching hospital. Method: This is a quality improvement study carried out in a public teaching hospital. The design was mixed quasiexperimental, using before and after and time series analyses. To evaluate the quality of SSI prevention, nine criteria were established (seven for processes and two for results). The intervention was multifaceted and based on the analysis of the main causes of the problem. The main interventions were implemented from June to December 2022. To analyze the context and measure the project's chance of success, the Model for Understanding Success in Quality was used. After the interventions, the criteria were reevaluated and analyzed to calculate their point estimates of compliance. We also sought to measure the absolute and relative improvements of these criteria. Statistical significance was tested using the one-sided z value test. Results: After the intervention, a significant improvement was observed in five of the seven process criteria for monitoring adherence to good practices. The biggest gains were observed in the criteria: adequate dressing, which showed a relative improvement of 95%; surgical skin antisepsis with an appropriate degerming solution, which achieved an absolute improvement of 63% and a relative improvement of 83% and adequate trichotomy, with an absolute improvement of 49% and a relative improvement of 51%. These improvements constitute a change in pattern with a p-value <0.001 for the three criteria. Regarding the results criteria, an improvement in the accuracy of the SSI rate was obtained, after increasing the active search rate for post-discharge cesarean sections from 63% to 93%, in addition to an 83% decrease in organ or cavity SSIs. Conclusions: It can be said that there was a significant improvement in most of the evaluated criteria. However, it is crucial to continue the Improvement Cycle with monitoring to constantly improve processes, especially at points where there is room for improvement. Descriptors: Quality Improvement Cycle; Surgical Site Infection; Cesarean Surgery.