Showing papers on "Nosocomial infection control published in 2000"

Prevention of surgical-wound infections.

Abstract: Wound infections are common, serious, and expensive complications after surgery. About 5 percent of all patients who have undergone surgery and as many as 10 to 20 percent of patients who have undergone colorectal surgery have postoperative wound infections. Historically, surgical wounds have been classified as clean, clean–contaminated, contaminated, or infected.1 However, this classification has not proved useful in predicting the occurrence of wound infection,2 which is the key to effective prevention. Scoring systems such as that developed by the Centers for Disease Control and Prevention for the Study on the Efficacy of Nosocomial Infection Control and the National Nosocomial . . .

Surgical-site infections and the NNIS SSI Risk Index: room for improvement.

Abstract: Surveillance of surgical-site infections (SSI), with feedback of appropriate data to surgeons, has been shown to be an important component of strategies to reduce SSI risk.1-3 For SSIs, the traditional wound classification system, which stratifies each wound into one of four categories (clean, clean-contaminated, contaminated, and dirty-infected), has been available since 1964.2-4 Limitations of this system of risk stratification are well recognized. One of the major problems is its failure to account for the intrinsic patient risk of developing an SSI. A composite risk index that captures the joint influence of this and other risk factors is required before meaningful comparisons of SSI rates can be made among surgeons, among institutions, or across time. A simple index was developed during the Study on the Efficacy of Nosocomial Infection Control Project.5 Since 1991, a modification of this risk index has been used by National Nosocomial Infection Surveillance (NNIS) System hospitals.6 The NNIS Basic SSI Risk Index is a significantly better predictor of SSI risk than is the traditional wound classification system and performs well across a broad range of operative procedures. Initially, it seemed most attractive to collect and analyze the same few data fields for risk adjustment in calculation of SSI rates, primarily to decrease the data-collection burden and add simplicity to the interpretation of the rates. In fact, it was surprising that the same few risk factors stratified better than wound class alone for so many diverse procedures. The NNIS Basic SSI Risk Index performed reasonably well for all but a handful of procedures. Ah, but this simplicity could not last. . . . The last decade has witnessed changes to healthcare delivery with regard to surgical procedures. Considerable numbers of procedures are now performed on outpatients, and the surgical patients admitted to hospitals tend to have higher intrinsic risk and often are discharged earlier.7-9 Roy and colleagues report in this issue of the Journal a simple matched case-control study of 201 cardiothoracic patients who developed an SSI and 398 controls who did not (two controls per case matched on age, gender, type of procedure, and date of procedure).10 Two main results that the authors found were equally simple to describe and were totally consistent with previously published NNIS results, which were based on a cohort of patients many times larger and coming from many hospitals: ● For coronary artery bypass graft (CABG) procedures, the NNIS Basic SSI Risk Index is largely just a dichotomization of patients based on the cut point for duration of surgery, because almost all of these procedures are clean and done on patients with anesthesiology scores of 3 or 4. ● The SSI rate is significantly higher in patients with a risk index score 2 compared with patients having a risk index score <2. The authors found an odds ratio of 1.83 (P=.01), which is nearly identical to the odds ratio of 1.75 in NNIS-published data.11 Thus, the NNIS Basic SSI Risk Index does stratify patients undergoing CABG operations by their risk of SSIs, as evidenced by the authors’ own data. A major point of the authors’ manuscript, that for CABG, the elements of the NNIS Basic SSI Risk Index may not have equal weights, is valid but not new.11 This criticism is inconsequential, though, compared with the issue at hand. The NNIS Basic SSI Risk Index could be improved for CABG and many other procedures as well. Efforts are needed to use available NNIS data at the Centers for Disease Control and Prevention to improve the NNIS Basic SSI Risk Index. Recent NNIS analyses from the 4th Decennial International Conference on Nosocomial Infections for cholecystectomy, gastric surgery,

Applicability of two surgical-site infection risk indices to risk of sepsis in surgical patients.

Abstract: Objective: To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery. Design: 1-year prospective case-control study. Setting: A tertiary-care center in Spain. Patients: Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance. Methods: Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient. Results: 99 cases and 97 controls were included. After controlling for confounders, both the SENIC index ( P P =.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41). Conclusions: Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.

Geography is destiny: global nosocomial infection control.

Abstract: The global nature of the emergence and spread of multiresistant bacteria has resulted in a slow response from governmental bodies, but surveillance networks are being set up and there is evidence, cited in this review, of an element of cooperation among professional bodies. Most developed and many developing countries have recognized the need for nosocomial infection control.