Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-18T08:40:17.388Z Has data issue: false hasContentIssue false

Basics of Surgical-Site Infection Surveillance

Published online by Cambridge University Press:  02 January 2015

Marie-Claude Roy
Affiliation:
Hôpital de L'Enfant-Jésus, Québec City, Québec, Canada
Trish M. Perl
Affiliation:
Johns Hopkins University and the Johns Hopkins Hospital, Baltimore, Maryland

Abstract

Surgical-site infections, the third most common class of nosocomial infections, cause substantial morbidity and mortality and increase hospital costs. Surveillance programs can lead to reductions in surgical-site infection rates of 35% to 50%. Herein, we will discuss the practical aspects of implementing a hospital-based surveillance program for surgical-site infections. We will review surveillance methods, patient populations that should be screened, and interventions that could reduce infection rates.

Type
Practical Healthcare Epidemiology
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Vicary, T. The English-man's treasure. With the true anatomie of man's body. In: Sabiston, DC Jr, ed. Textbook of Surgery. Philadelphia, PA: Saunders; 1977.Google Scholar
2. Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428442.CrossRefGoogle ScholarPubMed
3. Leape, LL, Brennan, TA, Laird, N, et al. The nature of adverse events in hospitalized patients: results of the Harvard medical practice study II. N Engl J Med 1991;324:377384.CrossRefGoogle ScholarPubMed
4. Brachman, PS, Dan, BB, Haley, RW, Hooton, TM, Garner, JS, Allen, JR. Nosocomial surgical infections: incidence and cost. Surg Clin North Am 1980;60:1525.CrossRefGoogle ScholarPubMed
5. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963970.CrossRefGoogle ScholarPubMed
6. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.CrossRefGoogle ScholarPubMed
7. Olson, MM, Lee, JT Jr. Continuous 10-year wound infection surveillance: results, advantages, and unanswered questions. Arch Surg 1990;125:794803.CrossRefGoogle ScholarPubMed
8. Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:2740.CrossRefGoogle ScholarPubMed
9. Ehrenkranz, NJ, Richter, EI, Phillips, PM, Shultz, JM. An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses. Infect Control Hosp Epidemiol 1995;16:712716.CrossRefGoogle ScholarPubMed
10. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606608.CrossRefGoogle ScholarPubMed
11. Wenzel, RP, Osterman, CA, Hunting, KJ, Gwaltney, JM Jr. Hospital acquired infections, I: surveillance in a university hospital. Am J Epidemiol 1976;103:251260.CrossRefGoogle ScholarPubMed
12. Perl, TM. Surveillance, reporting and the use of computers. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:139176.Google Scholar
13. Lee, JT Jr. Wound infection surveillance. Infect Dis Clin North Am 1992;6:643655.CrossRefGoogle ScholarPubMed
14. Cardo, DM, Falk, PS, Mayhall, CG. Validation of surgical wound surveillance. Infect Control Hosp Epidemiol 1993;14:211215.CrossRefGoogle ScholarPubMed
15. Haley, RP, Schaberg, D, McClish, D, et al. The accuracy of retrospective chart review in measuring nosocomial infection rates: results of validation studies in pilot hospitals. Am J Epidemiol 1980;111:516533.CrossRefGoogle ScholarPubMed
16. Manian, FA, Meyer, L. Comprehensive surveillance of surgical wound infection in outpatient and inpatient surgery. Infect Control Hosp Epidemiol 1990;10:515520.CrossRefGoogle Scholar
17. Broderick, A, Mori, M, Nettleman, MD, Streed, SA, Wenzel RP Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am J Epidemiol 1990;131:734742.CrossRefGoogle ScholarPubMed
18. Hirschhorn, L, Currier, J, Platt, R. Electronic surveillance of antibiotic exposure and coded discharge diagnoses as indicators of postoperative infection and other quality assurance measures. Infect Control Hosp Epidemiol 1993;14:2128.CrossRefGoogle ScholarPubMed
19. Mayhall, CG. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1993:614664.Google Scholar
20. Kernodle, DS, Kaiser, AB. Postoperative infections and antimicrobial prophylaxis. In: Mandell, GL, Douglas, RG, Bennett, JE, eds. Principles and Practice of Infectious Diseases. New York, NY: Churchill Livingstone; 1990:27422753.Google Scholar
21. Nagachinta, T, Stephens, M, Reitz, B, Polk, BF. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967973.CrossRefGoogle ScholarPubMed
22. Roy, M-C, Herwaldt, LA, Embrey, R, Kuhns, K, Wenzel, RP, Perl, TM. Does the NNIS risk index predict which patients are at high risk of wound infections after cardiothoracic surgery? 34th Interscience Conference on Antimicrobials Agents and Chemotherapy; 09 1994; Orlando, FL.Google Scholar
23. Haley, RW. Surveillance by objective: a new priority-directed approach to the control of nosocomial infections. Am J infect Control 1985;13:7889.CrossRefGoogle Scholar
24. National Academy of Sciences—National Research Council. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 1964; 160(suppl 2):1132.Google Scholar
25. Ferraz, EM, Bacelar, TS, Lamartine De Andrade Aguiar, J, Ferraz, AAB, Pagnossin, G, Batista, JEM. Wound infection rates in clean surgery: a potentially misleading risk classification. Infect Control Hosp Epidemiol 1993;13:457462.CrossRefGoogle Scholar
26. Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infections: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206215.CrossRefGoogle ScholarPubMed
27. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S157S.CrossRefGoogle ScholarPubMed
28. Horan, TC, Gaynes, R, Culver, D. Development of predictive risk factors for nosocomial surgical site infections. The Fourth Annual Meeting of the Society of Healthcare Epidemiology of America; 03 1994; New Orleans, LA.Google Scholar
29. Nichols, RL, Smith, JW, Klein, DB, et al. Risk of infection after penetrating abdominal trauma. N Engl J Med 1984;311:10651070.CrossRefGoogle ScholarPubMed
30. Nichols, RL, Smith, JW, Robertson, GD, et al. Prospective alterations in therapy after penetrating abdominal trauma. Arch Surg 1993;128:5564.CrossRefGoogle Scholar
31. Richet, HM, Chidiac, C, Prat, A, et al. Analysis of risk factors for surgical site infections following vascular surgery. Am J Med 1991;91(suppl 3B):170S172S.CrossRefGoogle ScholarPubMed
32. Burns, SJ, Dippe, SE. Postoperative wound infections detected during hospitalization and after discharge in a community hospital. Am J Infect Control 1982;10:6065.CrossRefGoogle Scholar
33. Garner, JS. CDC guidelines for the prevention and control of nosocomial infection. Guideline for prevention of surgical wound infection surveillance, 1985. Am J Infect Control 1986;14:7182.CrossRefGoogle Scholar
34. Seaman, M, Lammers, R. Inability of patients to self-diagnose wound infections. J Emerg Med 1991;9:215219.CrossRefGoogle ScholarPubMed
35. Rosendorf, LL, Octavio, J, Estes, JP. Effect of methods of postdischarge wound infection surveillance on reported infection rates. Am J Infect Control 1983;11:226229.CrossRefGoogle ScholarPubMed
36. Weintraub, WS, Jones, EL, Craver, J, Guyton, R, Cohen, C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation 1989;80:276284.CrossRefGoogle ScholarPubMed
37. Taylor, GJ, Mikel, FL, Moses, HW, et al. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol 1990;65:309313.CrossRefGoogle ScholarPubMed
38. Perl, TM, Roy, M-C. Postoperative wound infections: risk factors and role of Staphylococcus aureus nasal carriage. J Chemother 1995;7:1925.Google ScholarPubMed
39. Wenzel, RP, Perl, TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect 1995;31:1324.CrossRefGoogle ScholarPubMed
40. Meier, P. Same-day surgery care issues. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Baltimore, MD: Williams & Wilkins; 1997:261282.Google Scholar
41. Eickhoff, T, Brachman, P, Bennett, J, Brown, J. Surveillance of nosocomial infections in community hospitals, I: surveillance methods, effectiveness, and initial results. J Infect Dis 1969;12:305317.CrossRefGoogle Scholar
42. Laxson, L, Blaser, M, Parkhurst, S. Surveillance for the detection of nosocomial infections and the potential for nosocomial outbreaks, I: microbiology culture surveillance is an effective method of detecting nosocomial infection. Am J Infect Control 1984;12:318324.CrossRefGoogle ScholarPubMed
43. Yokoe, DS, Platt, R. Surveillance for surgical site infections: the uses of antibiotic exposure. Infect Control Hosp Epidemiol 1994;15:717723.CrossRefGoogle ScholarPubMed