Infection périprothétique : le rôle de l’infirmière en soins périopératoires
Mots-clés :
infection articulaire périprothétique, arthroplastie totale de la hanche, arthroplastie totale du genou, soins infirmiers périopératoires, approche diagnostique algorithmique, incidence sur le patientRésumé
L’incidence de l’infection articulaire périprothétique et son impact sur les patients et le système de santé sont considérables, en raison des taux élevés de morbidité et de mortalité qui y sont associés. Une revue systématique de la littérature parue à ce jour réalisée par des chirurgiens de Christchurch a donné lieu à la mise au point d’un algorithme permettant de mettre en lumière les meilleures pratiques pour le diagnostic et la prise en charge de l’infection articulaire périprothétique (Ailabouni, Jennings et Hooper, 2015). L’algorithme en question et le rôle de l’infirmière en soins périopératoires dans la prise en charge des patients aux prises avec une infection articulaire périprothétique sont examinés.
La demande en matière d’arthroplastie par prothèse totale continue sans cesse de croître à l’échelle mondiale. En effet, des prévisions des États-Unis portent à croire que d’ici 2030, la demande nationale relative à l’arthroplastie totale de la hanche (ATH1) et à l’arthroplastie totale du genou (ATG2) augmentera de 174 et 673 %, respectivement (Kutz, Ong, Lau, Mowat et Halpern, 2007).
En Nouvelle-Zélande, une tendance similaire devrait être observée; des augmentations de 110 % du taux d’ATH et de 260 % du taux d’ATG sont prévues d’ici 2030 (Hooper, Lee, Rothwell et Frampton, 2014). Le pourcentage de procédures de révision a connu très peu de changements au cours de la dernière décennie. Environ 6 % des implants primaires font l’objet d’une révision après cinq ans et 12 % d’entre eux, après dix ans (Labek, Thaler, Janda, Argreiter et Stockl, 2011).
Bien que le pourcentage de procédures de révision demeure statique, les chiffres absolus, eux, augmentent en raison du nombre accru d’arthroplasties primaires (Ailabouni, Jennings et Hooper, 2015)
Les infections du site opératoire posent un problème important. Elles représentent la deuxième infection associée aux soins de santé la plus couramment signalée (Organisation mondiale de la santé [OMS], 2011). Les infections sont la première cause d’échec d’ATG et la troisième cause d’échec d’ATH en importance (Bozic et al., 2009; Bozic et al., 2010). L’arthroplastie de révision en cas d’infection après cinq ans est associée à un taux de mortalité cinq fois supérieur à celui de l’arthroplastie de révision visant à corriger un descellement aseptique (Zmistowski, Karam et Durinka, 2013).
Le coût approximatif d’une procédure de révision en cas d’infection est environ quatre fois plus élevé que celui d’une arthroplastie primaire (Dreghorn et Hamblin, 1989; Klouche, Sarali et Mamoudy, 2010). Si une infection n’est pas diagnostiquée ou traitée de façon adéquate dès les premiers symptômes, d’autres interventions seront requises, ce qui augmentera le coût total des procédures et diminuera la qualité des résultats fonctionnels pour le patient.
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