The research has been conducted through the analysis, done in part retrospectively, of data collected from 1094 patients who presented to the Emergency Department of the Fondazione IRRCS Policlinico San Matteo between April 2016 and November 2017, with wounds potentially at risk for infection with Clostridium Tetani. Of these 1094 patients, only 620 of them were included, due to the incompleteness of the digital records for the remaining 474 patients. From a first analysis of the data, it is possible to observe some critical aspects in the management and treatment of patients with tetanus prone wounds. When considering other medical systems, both European and non-European ones, and analyzing their guidelines for the prevention of tetanus infection, which remains one of the most important possible complications of the majority of wounds, the necessity of adopting a well-defined algorithm becomes evident. This, also in order to avoid the excessive administration of prophylaxis, as well as to allow to put in place the necessary preventive measures for each patient. The analyzed data, suggests the need for a specific standardized protocol for the management of wounds and for the prevention of tetanus infection. An example of guidelines that could be considered for this purpose, is the one proposed by J.C. Cavenaile and utilized at the Emergency Department of the CHU Brugmann in Bruxelles. This protocol, also involves the use of a point of care test (Tetanus Quick Stick, TQS) in order to determine the immunization status of the patients.
La ricerca è stata condotta sull’analisi, parzialmente retrospettiva, dei dati di 1094 pazienti che si sono presentati, nel periodo intercorso tra aprile 2016 e novembre 2017, presso il Pronto Soccorso della Fondazione IRRCS Policlinico San Matteo, riportando ferite potenzialmente a rischio di infezione da Clostridium Tetani. Di questi 1094 pazienti, sono stati presi in considerazione per lo studio 620 casi, a causa dell’impossibilità di ricavare dai referti digitali le informazioni necessarie per i restanti 474 pazienti. Da una prima analisi dei dati, sono emerse alcune criticità nel management del trattamento dei pazienti con ferite a rischio di infezione da tetano. Dal confronto con altre realtà EU ed extra EU nel management del tetano, che resta comunque una importante potenziale complicanza della maggior parte delle ferite, si evince la necessità di avere un algoritmo al quale potersi attenere, in modo tale da poter limitare una eventuale somministrazione superflua di profilassi ed evitare la dimissione di pazienti senza aver predisposto le necessarie misure preventive. I dati dunque suggeriscono la necessità di adottare un protocollo univoco per il management del tetano. Un esempio di questo sistema, potrebbe essere quello adottato a CHU Brugmann di Bruxelles con il protocollo elaborato da J.C. Cavenaile, che include anche un quick test di valutazione dello stato vaccinale.
Management of tetanus prophylaxis in patients at risk for Clostridium Tetani infection: the state-of-the-art in the Emergency Department of IRCCS San Matteo in Pavia.
BAVESTRELLO PICCINI, GAIA
2017/2018
Abstract
The research has been conducted through the analysis, done in part retrospectively, of data collected from 1094 patients who presented to the Emergency Department of the Fondazione IRRCS Policlinico San Matteo between April 2016 and November 2017, with wounds potentially at risk for infection with Clostridium Tetani. Of these 1094 patients, only 620 of them were included, due to the incompleteness of the digital records for the remaining 474 patients. From a first analysis of the data, it is possible to observe some critical aspects in the management and treatment of patients with tetanus prone wounds. When considering other medical systems, both European and non-European ones, and analyzing their guidelines for the prevention of tetanus infection, which remains one of the most important possible complications of the majority of wounds, the necessity of adopting a well-defined algorithm becomes evident. This, also in order to avoid the excessive administration of prophylaxis, as well as to allow to put in place the necessary preventive measures for each patient. The analyzed data, suggests the need for a specific standardized protocol for the management of wounds and for the prevention of tetanus infection. An example of guidelines that could be considered for this purpose, is the one proposed by J.C. Cavenaile and utilized at the Emergency Department of the CHU Brugmann in Bruxelles. This protocol, also involves the use of a point of care test (Tetanus Quick Stick, TQS) in order to determine the immunization status of the patients.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/24920