Wound infections in orthopedic surgery: effect of extended surveillance on infection rate.
Substantial evidence now exists that ongoing surveillance of surgical wound infections can contribute to reduced infection rates. What is not yet determined is whether surveillance should be limited to the postoperative hospital stay or should be continued after patient discharge. To determine the number of infections occurring after discharge, the authors contacted a random sample of their patients who did not have wound infections during their hospitalization after orthopedic surgery. This was done 30 days after the procedure. The authors selected 273 patients of 1375 who underwent orthopedic surgery over a 7-month period and were able to contact 199 (73%). At the 30-day follow-up 23 patients (11.6%) had wound infections, as judged by wound discharge and physician prescription of antibiotics in 20 and the patient's description of pus issuing from the wound in 3. During the same period postoperative wound infections were found in only 19 (1.5%) of 1278 patients who were subjected to in-hospital surveillance. The authors conclude that, in patients who undergo orthopedic procedures, the majority of wound infections occur after discharge from the hospital and that infection rates based only on in-hospital surveillance greatly under represent true surgical wound infection rates for orthopedic procedures.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: Several studies have shown that wound infection (surgical site infection [ ssi ]) rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis) data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001), 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8), 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96) and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0). In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002). ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.
The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses 11/1994; 5(6):263-7. · 0.76 Impact Factor
Infection Control and Hospital Epidemiology 08/2002; 23(7):361-3. DOI:10.1086/502066 · 4.18 Impact Factor
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ABSTRACT: • The purpose of this study was to describe patients' learning needs after hip arthroplasty and compare them prior to and 2 weeks after hospital discharge.• Data were collected in two phases from 22 surgical wards in 17 hospitals in Finland using a Canadian Patient Learning Needs Scale (Galloway et al., 1996). The first questionnaire (n=212, 81%) was completed before hospital discharge and the second (n=144, 55%) was completed at home after hospital discharge.• Results indicated that patients' learning needs diminished significantly after hospital discharge. In both questionnaires patients felt that the most important information was about complications and symptoms. Information about medication was ranked the second most important.• Demographic variables such as age, gender, education and working life were clearly related to learning needs. Women over 60 years old, and less educated and retired respondents had many learning needs.
Journal of Clinical Nursing 08/2002; 11(5):634 - 639. DOI:10.1046/j.1365-2702.2002.00648.x · 1.26 Impact Factor
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