Wound infections in orthopedic surgery: Effect of extended surveillance on infection rate
Infection Control Unit, University of Alberta Hospitals, Edmonton.Canadian journal of surgery. Journal canadien de chirurgie (Impact Factor: 1.51). 03/1991; 34(1):31-5.
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.
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- "Reviews have also been compiled on preoperative patient education in general (Shuldham 1999a, 1999b) and on specific nursing areas, such as heart surgery patients (Shuldham 2001), but not on orthopaedic nursing. Orthopaedic patient education focuses on information about possible complications, physical limitations, exercise, rehabilitation and financial matters (Pearce et al. 1991, Fisher et al. 1997, Johansson et al. 2002a, 2002b). While these issues are often dealt with in patient education provided for other surgical patients, the content for orthopaedic patients differs from that aimed, e.g. at cardiological patients. "
ABSTRACT: This paper presents a systematic review whose aim was to describe the scope and methods of the current literature on preoperative patient education and to identify the effects of this education. Preoperative patient education is a common and important intervention in surgical nursing, yet there is very limited systematic evidence on its precise role. The Medline, CINAHL, Eric, Psycinfo and Social Sciences Index databases and the Cochrane Library were searched, covering the period from the beginning of each database to April 2003. Studies were included if they concerned adult orthopaedic patients, preoperative nursing patient education and were based on randomized controlled or clinical trials. Meta-analysis was carried out where appropriate. We identified 11 articles involving 1044 participants. Most studies included one experimental and one control group; only two had more than one experimental and control group. The educational interventions varied widely, but the majority were based on written materials alone, or written materials in combination with other teaching methods. The most common outcome measures related to pain, knowledge, anxiety, exercises and length of stay, and the least common to self-efficacy and empowerment. The methodological quality of the studies varied. Almost all reported one or more statistically significant effects. Based on the findings of the meta-analysis, preoperative education appears to have some impacts on patients' anxiety and knowledge levels. The review clearly highlights the need for well-designed, methodologically sound research into the outcomes of patient education. It also points to the need to study patient education from the point of view of empowerment.
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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.
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ABSTRACT: Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals. There was a high degree of diagnostic agreement between the prevalence survey and the clinical data. Four point six percent had a deep, and another 4.6%, a superficial surgical wound infection (SWI). Two months after the second survey only one third of these patients had their infection correctly recorded by the routine hospital surveillance of SWI. Better routines need to be developed to secure a valid, reliable and simple registration of relevant infectious wound complications. A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded. This post-discharge survey showed that 15.7% had been treated with antibiotics, because of pus in the wound, 12.4% had to have the wound reopened and 6.6% experienced both these treatments.
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