Abstract
Objective: Identify the effectiveness of telehealth in detecting infections in surgical wounds through evidence in the scientific literature. Methods: This is an integrative review, carried out in the EMBASE, PubMed, Scopus and Web of Science databases, using the following descriptors: “telemedicine”, “telehealth”, “digital health”, “surgical site infection”, “surgical wound” and “surgical wound infection”. Studies published between 2018 to 2024 that included postoperative patients evaluated using telehealth methods were included. Results: The final sample consisted of 11 articles, with a higher concentration of publications in the years 2023 and 2021. The majority of studies were conducted in the United Kingdom, and the predominant research designs were cohort studies. Telehealth has been found to significantly increase diagnostic and therapeutic efficacy in early detection of infections in surgical wounds, providing a strong correlation between in-person and remote assessments and reducing the need for in-person follow-up. Final considerations: This review highlights the potential of telehealth in monitoring surgical wounds, highlighting improvements in diagnostic efficacy and accessibility to care. Challenges such as the need to standardize monitoring techniques and the inclusion of patients less familiar with the technology point to critical areas for future research.
References
ABU-SHEASHA GA, et al. Cost-effectiveness analysis of three methods of surgical-site infection surveillance: less is more. Am. J. Infect. Control. 2020; 48(10): 1220–1224.
ALLEGRANZI B, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016; 16(12): e276-e287.
BANIASADI T, et al. Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care. BMC Med Inform Decis Mak. 2023; 23(1): 103.
BARROS CSM. Custos atribuídos às infecções de sítio cirúrgico em um hospital universitário em Salvador-Bahia. Tese (Doutorado em Biotecnologia em Saúde e Medicina Investigativa) – Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, 2016.
BLUEBELLE STUDY GROUP. Validation of the Bluebelle Wound Healing Questionnaire for assessment of surgical-site infection in closed primary wounds after hospital discharge. Br. J. Surg. 2019; 106(3): 226–235.
BRASIL. Ministério da Saúde (MS). Lei no 9.610, de 19 de fevereiro de 1998, que altera, atualiza e consolida a legislação sobre direitos autorais e dá outras providências. Diário Oficial da União. Brasília: Ministério da Saúde, 1998.
BRAZ NJ, et al. Infecção do sítio cirúrgico em pacientes submetidos a cirurgias cardíacas: uma análise do perfil epidemiológico. Rev Enfermagem Centro-Oeste Mineiro. 2018; 8:e1793.
BRUCE J, et al. Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma. Bone Joint J. 2021; 103-B (12): 1802-1808.
CALEGARI IB, et al. Métodos para vigilância de infecção do sítio cirúrgico pós-alta: revisão integrativa. Acta Paul Enferm. 2023; 36:eAPE019631.
CHERIAN T, et al. Diagnosing post-cesarean surgical site infections in rural Rwanda: development, validation, and field testing of a screening algorithm for use by community health workers. Surg. Infect. 2020; 21(7):613–620.
CROTHERS H, et al. Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study. BMJ Qual Saf. 2022; 31(7): 515-525.
DAVIS C, et al. Feasibility and acute care utilization outcomes of a post-acute transitional telemonitoring program for underserved chronic disease patients. Telemed J E Health. 2015; 21:705-713.
GAGLIOTTI C, et al. Use of health databases to deal with underreporting of surgical site infections due to suboptimal post-discharge follow-up. J Hosp Infect. 2020; 104(2): 239-42.
GUNTER RL, et al. Feasibility of an image-based mobile health protocol for postoperative wound monitoring. J. Am. Coll. Surg. 2018; 226(3): 277–286.
HALEEM A, et al. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International. 2021; 2:100117.
IANNUZZI JC, et al. Risk score for unplanned vascular readmissions. J Vasc Surg. 2014; 59: 1340-1347.e1.
LATHAN R, et al. Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis. NPJ Digit Med. 2022; 5:108.
LIU Z, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev., 2018; 2(2): CD012653.
MACEFIELD RC, et al. Remote assessment of surgical site infection (SSI) using patient-taken wound images: Development and evaluation of a method for research and routine practice. J Tissue Viability. 2023; 32(1): 94-101.
MARTINS T, et al. Risk factors for surgical site infections in potentially contaminated surgeries. Texto Contexto Enferm. 2018; 27(3): e2790016.
MCHUGH ML. Interrater reliability: the kappa statistic. Biochemia Medica, 2012; 22(3): 276-282.
MCLEAN KA, et al. Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients. npj Digital Med. 2021; 4(1): 160.
MCLEAN KA, et al. Evaluation of remote digital postoperative wound monitoring in routine surgical practice. NPJ Digit Med. 2023; 6(1): 85.
MERKOW RP, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015; 313(5): 483‐495.
MOUSA AY, et al. Results of telehealth electronic monitoring for post discharge complications and surgical site infections following arterial revascularization with groin incision. Ann. Vasc. Surg. 2019; 57: 160–169.
OWENS PL, et al. Surgical site infections following ambulatory surgery procedures. Jama. 2014; 311: 709–716.
PAGAMISSE AF, et al. post-discharge surveillance of surgical site infections in teaching hospitals in Brazil. Rev Esc Enferm USP. 2020; 54: e03542.
PUROHIT A, et al. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Health. J. 2021; 8: e85–e91.
ROSA R, et al. Preventing Surgical Site Infections: Implementing Strategies Throughout the Perioperative Continuum. AORN J. 2023; 117(5): 300-311.
SANGER PC, et al. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS ONE. 2014; 9: e114016.
SOUZA MT, et al. Integrative review: what is it? How to do it? Einstein (Sao Paulo). 2010; 8(1): 102-6.
STEWART S, et al. Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: Considerations for infection prevention and control planning. J. Hosp. Infect. 2021; 114: 10–22.
STILLWELL S, et al. Evidence– based practice: step by step. Am J Nurs, 2010; 110(5): 41-47.
TAKO KV, et al. Metodologia da pesquisa científica: dos conceitos teóricos à construção do projeto de pesquisa. Campina Grande: Editora Amplla, 2023.
TOTTY JP, et al. Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection. J. Wound Care. 2018; 27(3): 128–135.
WENZEL RP. Surgical site infections and the microbiome: An updated perspective. Infect Control Hosp Epidemiol. 2019; 40(5): 590-596.
WISEMAN JT, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg 2015; 62: 1023–1031.
WISEMAN JT, et al. Inter-rater agreement and checklist validation for postoperative wound assessment using smartphone images in vascular surgery. J Vasc Surg Venous Lymphat Disord 2016; 4: 320–328.e2.
