Construção de protocolo clínico para cuidados com ferida operatória e lesões mamilares no pós cesárea em uma UBS de Caicó- RN

Abstract

Introduction: Every surgical procedure can be accompanied by various complications, among them, surgical site infections (SSI). In Brazil, SSIs rank third among hospital- acquired infections, accounting for 14.66%, and in countries with high poverty rates, they can affect up to one-third of patients undergoing surgery. This issue has become a global concern due to its association with increased infection rates following cesarean sections, known as puerperal infections. Objective: To develop and validate a clinical protocol to guide primary health care (PHC) nursing professionals in the management of postoperative wound care during the postpartum period. Method: This is a methodological study focused on the development of a health technology in the form of a protocol. The municipality of Caicó, Rio Grande do Norte (RN), was the setting for this research, where the protocol was applied in one of the 23 Basic Health Units (BHU), the Santa Costa BHU, located in the Paraíba neighborhood. The study began with the systematization of literature evidence on the topic of SSI, followed by the construction of the protocol based on evidence-based healthcare practices and considering the resources available within the local health network. During the literature review phase, evidence related to the management of nipple injuries was also sought.The development of the clinical protocol aimed to guide PHC nursing professionals in the care of postoperative wounds during the postpartum period. The material was validated with nurses working in PHC in the municipality of Caicó/RN and presented to professionals in the Multiprofessional Residency Programs in Primary Care and Maternal-Child Health. The field research was conducted in 2024, following approval by the Ethics and Research Committee under CAAE no. 78019924.4.0000.5568. Results and Discussion: Factors found in the literature that inhibit surgical site infections include controlling BMI, reducing cesarean duration, blood loss, and catheterization time. The literature also supports the efficacy of antimicrobial dressings containing Dialkylcarbamoyl Chloride (DACC) in preventing SSIs after surgery. Predisposing factors for SSIs include obesity, smoking, and the use of standard occlusive dressings.Regarding nipple trauma, factors increasing the risk of lactational mastitis were identified, such as previous mastitis, nipple discontinuity, duct blockage, and the use of nipple shields. The construction of the protocol enabled the systematization of available evidence to incorporate scientifically supported practices into PHC nursing teams in the municipality. Validation involved the participation of nurses to adapt the material to the local context, bringing greater coherence to the proposal. Final Considerations: The literature review, along with the development and validation of the protocol, contributes to addressing existing knowledge gaps on the subject. It provides health and nursing professionals with a foundation for planning and implementing humanized and high-quality care, meeting the diverse needs of patients experiencing surgical site infections and nipple trauma within primary health care.