Cerrahi Alan Enfeksiyonunun Önlenmesi
Özet
Cerrahi alan enfeksiyonları (CAE), ameliyat sonrası ilk 30 gün içinde veya protez varlığında 90 güne kadar insizyon bölgesinde ortaya çıkan, hastane enfeksiyonlarının %38'ini oluşturarak ciddi morbidite, mortalite ve maliyet artışına yol açan durumlardır. CDC kriterlerine göre yüzeysel insizyonel, derin insizyonel ve organ/boşluk olarak sınıflandırılan CAE riskini azaltmak için ameliyat yaraları da temizden kirli-enfekteye kadar dört gruba ayrılır. Enfeksiyon gelişiminde acil cerrahi, malnütrisyon, sigara kullanımı ve hiperglisemi gibi hasta bazlı faktörlerin yanı sıra perioperatif uygulamalar da kritik öneme sahiptir. CAE riskini minimize etmek adına elektif cerrahi öncesi sigaranın bırakılması, kolorektal işlemlerde bağırsak hazırlığı, antiseptik banyolar ve ameliyathanenin dezenfeksiyonu önerilir. Cerrahi personel için tırnakların kısa olması, takıların çıkarılması, alkol bazlı solüsyonlarla uygun el hijyeni sağlanması ve bariyer yöntemlerin kullanılması esastır. Profilaktik antibiyotik kullanımında, gram negatif ve stafilokoklara karşı etkili sefazolin geniş spektrumu ve düşük maliyetiyle öne çıkar. Ameliyat sırasında ise kıl foliküllerindeki bakteriler tamamen yok edilemediğinden tıraş bıçağından kaçınılmalı, hipotermi ve gereksiz kan transfüzyonları önlenmelidir. Ayrıca sert doku traksiyonundan kaçınma, etkin hemostaz, yara koruyucu kullanımı ve negatif basınçlı yara tedavisi gibi teknik yaklaşımlar enfeksiyon oranlarını azaltmada orta düzeyde katkı sağlamaktadır.
Surgical site infections (SSIs) are conditions occurring within the first 30 days post-surgery, or up to 90 days if a prosthesis is present, accounting for 38% of nosocomial infections and causing significant morbidity, mortality, and increased healthcare costs. According to CDC criteria, SSIs are classified as superficial incisional, deep incisional, and organ/space, while surgical wounds are divided into four classes from clean to dirty-infected to assess risk. Patient-related factors such as emergency surgery, malnutrition, smoking, and hyperglycemia, along with perioperative practices, are critical in infection development. To minimize SSI risk, smoking cessation before elective surgery, bowel preparation in colorectal procedures, antiseptic baths, and operating room disinfection are recommended. For surgical personnel, maintaining short nails, removing jewelry, ensuring proper hand hygiene with alcohol-based solutions, and utilizing barrier methods are essential. In prophylactic antibiotic use, cefazolin stands out due to its broad spectrum against gram-negative organisms and staphylococci, combined with low cost. Intraoperatively, razors should be avoided since bacteria in hair follicles cannot be entirely eliminated, and hypothermia as well as unnecessary blood transfusions must be prevented. Furthermore, technical approaches including avoiding harsh tissue traction, effective hemostasis, using wound protectors, and applying negative pressure wound therapy moderately contribute to reducing infection rates.
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