Showing papers on "Nosocomial infection control published in 1993"

Antimicrobial Prophylaxis for Surgical Wounds: Guidelines for Clinical Care

Abstract: • Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce the overall costs attributable to infections. Principles of prophylaxis include providing effective levels of antibiotics in the decisive interval, and, in most instances, limiting the course to intraoperative coverage only. Use in The National Research Council clean contaminated operations is appropriate and, in many instances, has been proven beneficial. Antibiotic prophylaxis is also indicated for clean operations, such as those involved with insertion of prosthetic devices, that are associated with low infection risk and high morbidity. Extension of antibiotic prophylaxis to other categories of clean wounds should be limited to patients with two or more risk factors established by criteria in the study of the efficacy of nosocomial infection control (SENIC) because the baseline infection rate in these patients is high enough to justify their use. Cefazolin (or cefoxitin when anaerobic coverage is necessary) remains the mainstay of prophylactic therapy. Selection of an alternate agent should be based on specific contraindications, local infection control surveillance data, and the results of clinical trials. Newer criteria for determining the risk of "site infection" (wound and intracavitary) are in evolution and may lead to modification of these recommendations over the next several years. (Arch Surg. 1993;128:79-88)

Critical study of surveillance of nosocomial infections

Abstract: The institution of a continuous surveillance program is a compulsory prerequisite to the effective control of nosocomial infections. This is actually the main task of the Committee for Nosocomial Infection Control as ruled by the decree of 8 May 1988. The methodology of this surveillance relies on the continuous collection of data. It must apply to hospitals of any size and lead to practical actions, at the general or local level according to circumstances. Data concern patients and staff as well. They must be collected from different sources among which the bacteriology and hygiene laboratories play an important role. However infection records from wards constitute the cornerstones for the surveillance program: the personnel involved in the filling of the forms must be clearly identified. The scope of the surveillance and analytical methods are also discussed: a comprehensive control of the whole hospital associated with incidence measurement appears to be the best approach. Prevalence surveys are also performed. They allow a better control of continuous surveillance processes. However these processes will only be profitable if the data to be recorded have been previously specified. It is of importance to get the most comprehensive data about infectious hazards. One might rely not on global infection rates per hospital, as they have no significance, but on specific infection rates in correlation with body sites or risk factors.