Diagnóstico microbiológico de la infección bacteriana asociada al parto y al puerperio. Procedimientos en Microbiología Clínica. Recomendaciones de la. infección puerperal definición agentes microbianos afectación inflamatoria séptica, localizada generalizada, que se produce en el puerperio como. Atención Prenatal, Parto, Recién Nacido/a y Puerperio de Bajo Riesgo. 2 . N ORMA DE ATENCIÓN DE LAS INFECCIONES DE VÍAS URINARIAS.
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Puerperal infection from the perspective of humanized delivery care at a public maternity hospital. This is an epidemiological, prospective and non-concurrent study of the cohort type about puerperal infection from the infeccione of humanized delivery care, based on information from 5, records of patients who went through the experience of humanized delivery.
The study aimed at describing the women who underwent humanized delivery, determining the incidence and time for manifestation of puerperal infections and investigating the association between the infection and the risk factors. An accumulated puerperal infeccilnes rate of 2.
The risk factors associated to puerperal infection in Cesarean delivery were the duration of labor and the number of digital examinations. No variable behaved as a risk factor for infection in normal delivery.
Cesarean delivery was an important risk factor for puerperal infection. The results reinforce the need to develop alternative forms of delivery care that provides effective conditions for normal delivery, in order to reduce the number of Cesarean sections.
It is known that the delivery type, the insufficient notification of postpartum infection cases due to the lack of surveillance after discharge, the early discharge of puerperal women and the patient’s return outside the institution where the delivery occurred, as well as environmental, individual and material factors have been related with the incidence of puerperal infections 1. They are a source of concern to the extent that, as nurses, we are committed to the prevention and control of hospital infections.
Nowadays, the humanization of delivery and its influence on puerperal infections has been valued. However, various obstetric institutions have not worked with this philosophy, systematically ignoring the routines and conducts the Ministry of Health recommends for humanization. At these units, the delivery occurs in a totally strange and enigmatic environment, in which the parturient woman is isolated from her family and care during the act involves a large number of interventions, which can influence the increase in infections.
Humanization does not simply aim to decrease the number of Cesarean births, but to deliver humanized care to delivery and birth and to recover women’s central position in the birth process, respecting her dignity and autonomy, besides breaking with the unnecessary interventionism with respect to deliveries.
In recent years, with a view to changing infeccinoes delivery care model at a moment that is considered interventionist, the Ministry of Health has implemented measures and recommendations based on puerperakes humanization 2.
Puerperal infection from the perspective of humanized delivery care at a public maternity hospital
Care humanization acknowledges the fundamental rights of mothers and babies. This includes the right to choose the place of delivery, the people and professionals involved, the forms of care during the delivery, respect for delivery as a highly personal, sexual and family experience, besides the minimal realization of interventions in the natural delivery process 3.
The hospital, in turn, is the place where we find the most intecciones technological devices that have been considered necessary to accomplish a delivery. In unfecciones context, the woman is the object of the process, as she has to submit herself to the procedures defined by the care team. In the hospital environment, delivery has been characterized as a surgical event.
Almost always, instead of being private, intimate and female, it is experienced publicly, with the presence of other social actors 2. In turn, professionals and health system users have acknowledged hospital infection control as an essential parameter of care quality.
Quality needs to be aimed for in hospital care, offering a service of less risk and greater efficacy to the population 4. Hospital infection is considered as the infection acquired after the patient’s admission, which manifests itself infeccioones the hospitalization or after discharge and can be related with the hospitalization or hospital procedures 5.
The landmark in knowledge about hospital infections is due to Semmelweis, a gynecologist-obstetrician who suspected that puerperal infections could be transferred to the women through the hands of physicians and students 6. Nowadays, despite scientific and technological advances in different knowledge areas, puerperal infection remains a big problem, due to its prevalence, morbidity and even lethality.
However, it should be highlighted that these infection rates may be underestimated, considering the high number of Cesarean deliveries, which is an important risk factor, failures in the surveillance system, as well as the inexpressive awareness and involvement of people for puerperaales better presentation of reality.
Nowadays, in Brazil, delivery interventions mainly occur puuerperales hospital units, with less choice of normal delivery and abusive use of the Cesarean delivery procedure. Brazil is considered one of the countries in the world with the higest Cesarean delivery rate, which has contributed to the increased risk of maternal mortality, especially due to infection 2. Hospital delivery care should be safe, guaranteeing, besides the benefits of technological and scientific advances, every infeccines autonomy during the delivery, permitting her to be the subject of the process and to define what she believes is best for her and her son.
Nowadays, deliveries have been accomplished in hospital environments with all knfecciones and scientific resources and, despite all infection prevention and control measures, postpartum infections seem to persist infeccones the scenario of these institutions.
The concern caused by this problem pufrperales rise to the interest in studying puerperal infections from the perspective of humanized delivery care, with a view ouerperales characterizing puerperal women submitted to humanized delivery, determining the incidence and interval in which the puerperal infections are manifested, besides verifying the association between infections and risk factors.
Infefciones institution aims to deliver care to women and adolescents during the prenatal, delivery and puerperal phase, in which care humanization is being implanted as a work philosophy. Records of postpartum infection were verified in their patient files upon admission and until the first thirty days after giving birth.
The study population consisted of the patient files of all puerperal women who went through the humanized delivery experience at the MNC. From the expected study population 5,twenty-five puerperal women were excluded as their deliveries had occurred at home and they were sent to the maternity hospital after the delivery. Thus, the study sample included the information contained in 5, files.
We analyzed puerperal infection in humanized deliveries and their possible risk factors. The categorization of puerperal infection was based on the absence no or presence yes of the infection, which could be characterized as endometritis, surgical site infection and episiotomy infection. The following independent variables were considered: An expected membrane rupture time of up to six hours was considered ; amniotic fluid characteristic discolored, meconial and purulent ; duration of labor period in hours and minutes from the parturient woman’s admission in the labor pueerperales until the end of this phase.
An expected labor duration of up to 12 hours is considered ; digital examinations up to 6, between 7 and 13 and more than 13 examinations ; duration of delivery period in minutes. For normal delivery, the period from puerpreales start of the expulsion of the fetus until the expulsion of the placenta was considered and, for Cesarean delivery, from the start of anesthesia until the complete closure of the surgical incision.
The maximum time expected to perform the procedure is one hour ; type puerpearles anesthesia general, spinal, epidural and local ; use of antimicrobial agent ; age and weight gain. For the ordinal variables, purperales codes were established to designate the groupings to be processed by statistical analysis. An instrument was elaborated, based on the classification and diagnosis criteria of puerperal infections 7so as to cover the specific variables of the humanized delivery and birth care mode and the inclusion of data about infections, required to fill out the protocol established by the NNIS System 9.
A specific database was created, in pudrperales data were statistically treated. Simple frequency distribution and central tendency measures like mean, median and standard deviation were used for the descriptive analysis of numerical variables.
To assess the association between the independent and dependent variables, non parametrical significance tests were used, such as Chi-square, Fisher’s Puerperaales test, as well as statistical significance measures like Relative Risk RRwith a A large number of primiparous adolescent deliveries was identified.
Motherhood during adolescence can be considered a public health issue, in view of psychosocial problems it may result in As to the association between the parturient women’s age range and the puerperal infection, the data did not reveal a statistically significant difference for puerperal infection in parturient women up to the age of 20 or older than The mean weight gain was Although literature indicates an increase in the incidence of infection in patients with problematic clinical conditions and obese patients, in this study, we found no statistically significant difference between the puerperrales gain infecciines and the puerperal infection 6.
This can be justified by the good infecciohes conditions a woman giving birth normally presents. As to the rupture of the membranes, we found no statistically significant association between the two treatment modes, normal and Cesarean, and the puerperal infection. Although some studies on endometritis in vaginal births have demonstrated that the combination between the rupture of the membranes and a long labor constitutes an important risk factor for infeccoones frequency and severity of infections No statistically significant association was found between membrane rupture time and puerperal infection, neither for normal nor for Cesarean deliveries.
However, different authors have examined this association and have found quite controversial results As to the characteristics of the amniotic fluid, no statistically significant difference puegperales observed between this variable and the presence of puerperal infection in normal and Cesarean deliveries. Studies accomplished to puererales the presence of meconium in the amniotic fluid and increased maternal infection rates identified that meconium raises the phosphate level, inactivating the zinc-protein complex, which favors the parturient woman’s increased susceptibility to puerperal infection In this study, we found that the duration of labor and Cesarean delivery are risk factors for the development of puerperal infection, with a relative risk of 2.
However, when the imfecciones duration variable is associated with normal delivery, it did not appear as a risk factor for puerperal infection. The number of digital examinations during normal deliveries did not constitute a risk factor for puerperal infection. However, a significant association was observed between the number of examinations and infection in case of Cesarean delivery, which can also infeccions related with the duration of labor.
Subsequent statistical analyses are needed to prove this association.
Endometritis puerperal | Reston Surgery Center
This fact can be justified by the short puerperalex three years the hospital has been functioning and by the professionals’ adaptation process to the procedures, standards and established routines. Hence, the parturient women submitted to Cesarean delivery presented a 4.
This fact has been proved by some authors who, in analyzing the delivery type and puerperal infection, found that rising incidence levels of Cesarean deliveries have contributed to the increase in puerperal infection rates. Cesarean delivery is related with a higher incidence of post-operative infectious morbidity in comparison with normal delivery 15 Table 1.
What delivery duration is concerned, no statistically significant association was found with puerperal infection. A cut-off point of one hour was used for the duration of the delivery, and no association was evidenced between a procedure duration of more than one hour and the occurrence of puerperal infection in women submitted to normal and Cesarean deliveries. The type of anesthesia used during the deliveries, in turn, showed no association with the presence of puerperal infection.
An accumulated incidence level of puerperal infection was found within the previewed limits 2. We calculated the monthly incidence levels of puerperal infection in the parturient women submitted to humanized delivery during the study period, with the highest peak in infection incidence levels in Januarywith 1.
This higher incidence level could be explained by the adaptation process to the standards, routines and procedures the maternity hospital was going through during that period, coinciding with the year of inauguration. In the group of puerperal infection cases that were analyzed, 74 The infections categorized as endometritis corresponded to It is remarkable that most infections in this study were surgical site infections SSIwhich may be related to the surgical incisions involved in Cesarean deliveries.
In only one case of deep SSI, a culture of the wound secretion was performed, revealing the presence of Staphylococcus epidermidis. This may indicate contamination caused by contact, through the parturient women’s skin, as a consequence of precarious washing and asepsis of the skin.
No culture results were found in files, in which the institution did not perform the tests due to the lack of material resources for this end. This study proved expectations to the extent that the use of antibiotic prophylaxis in the period before the delivery did not show an association with the occurrence of puerperal infection in any of the delivery modes.
These results imply that the use of antibiotics in the postpartum period is associated with the presence of puerperal infection or that patients needing antibiotics therapy present greater predisposition to puerperal infection.
The scheme and indications for prophylaxis must be determined after a detailed assessment. The puerperal women’s early discharge impedes a diagnosis while still at the maternity hospital.
Thus, post-discharge surveillance is considered very important.
Especially in procedures with a puegperales post-operative hospitalization period, the presence of an appropriate surveillance system becomes increasingly important 7. The puerperal infections appeared within thirty days after the delivery. None of the variables behaved as a risk factor for infection the normal delivery mode.
Hence, the parturient women submitted to Pureperales delivery displayed a higher risk of infection in comparison with women submitted to normal delivery.
As the current humanized delivery care model has attempted to change the paradigm of care practices, is very much in favor of normal delivery and aims to decrease Cesarean delivery rates, it is believed that this model may be contributing directly to the decrease in puerperal infection rates. We recommend that, based on the puerperal infection results identified in this study, educational mechanisms be created to raise the medical team’s awareness, so as to break with the paradigm of medicalization and intervention in deliveries, and investments be made in the training process of obstetric nurses.
We reinforce the need to implant an effective hospital infection control service, through a prospective surveillance method, as early as upon admission, including post-discharge follow-up.
This can allow for the implementation of systemized actions directed at this population, as well as to establish infection prevention and control measures, besides getting to know the puwrperales profile of the detected infections.
Rio de Janeiro RJ: Gabriellone MC, Barbieri M. Szklo M; Nieto FJ. Vivenciando o parto humanizado: