OBJECTIVE:To determine mortality, morbidity, and costs attributable to surgical-site infections (SSIs) in the 1990s.DESIGN: A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI.SETTING: A 415-bed community hospital. STUDY POPULATION: 255 pairs of patients with and without SSI were matched on age, procedure, National Nosocomial Infection Surveillance System risk index, date of surgery, and surgeon. OUTCOME MEASURES: Mortality, excess length of hospitalization, and extra direct costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital.RESULTS: Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected patients (3.5%) died during the postoperative hospitalization (relative risk [RR], 2.2; 95% confidence interval [CI 95 ], 1.1-4.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI 95 , 1.3-2.0). The median length of hospitalization was 11 days for infected patients and 6 days for uninfected patients. The extra hospital stay attributable to SSI was 6.5 days (CI 95 , 5-8 days). The median direct costs of hospitalization were $7,531 for infected patients and $3,844 for uninfected patients. The excess direct costs attributable to SSI were $3,089 (CI 95 , $2,139-$4,163). Among the 229 pairs who survived the initial hospitalization, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI 95 , 4.0-7.7). When the second hospitalization was included, the total excess hospitalization and direct costs attributable to SSI were 12 days and $5,038, respectively.CONCLUSIONS: In the 1990s, patients who develop SSI have longer and costlier hospitalizations than patients who do not develop such infections. They are twice as likely to die, 60% more likely to spend time in an ICU, and more than five times more likely to be readmitted to the hospital. Programs that reduce the incidence of SSI can substantially decrease morbidity and mortality and reduce the economic burden for patients and hospitals (Infect Control Hosp Epidemiol 1999;20:725-730).Each year, more than 18 million surgical procedures are performed in US hospitals. 1 The Centers for Disease Control and Prevention (CDC) estimates that 2.7% of these are complicated by surgical-site infections (SSIs), accounting for at least 486,000 nosocomial infections each year. 2 Such infections often lead to substantial morbidity and probably contribute to mortality in some patients. 3,4 However, the extent of morbidity and mortality attributable to SSI is not known. It is generally accepted that SSIs, like other nosocomial infections, prolong hospital stays and add to the economic costs of hospitalization. However, published estimates of the actual excess days and costs attributable to SSI reflect hospitalization patterns prior to the current era of diagnosis-related groups (DRGs) and managed care. [5][6][7][8][9][10][11] We conducted a ...
Data for 479 patients were analyzed to assess the impact of methicillin resistance on the outcomes of patients with Staphylococcus aureus surgical site infections (SSIs). Patients infected with methicillin-resistant S. aureus (MRSA) had a greater 90-day mortality rate than did patients infected with methicillin-susceptible S. aureus (MSSA; adjusted odds ratio, 3.4; 95% confidence interval, 1. 5-7.2). Patients infected with MRSA had a greater duration of hospitalization after infection (median additional days, 5;), although this was not significant P ! .001 on multivariate analysis ( ). Median hospital charges were $29,455 for control subjects, $52,791 for P p .11 patients with MSSA SSI, and $92,363 for patients with MRSA SSI ( for all group comparisons). Patients P ! .001 with MRSA SSI had a 1.19-fold increase in hospital charges ( ) and had mean attributable excess charges P p .03 of $13,901 per SSI compared with patients who had MSSA SSIs. Methicillin resistance is independently associated with increased mortality and hospital charges among patients with S. aureus SSI.Although methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common pathogen, the independent contribution of methicillin resistance to the outcomes for patients with S. aureus infection is unclear because patients who develop MRSA infections are typically older and sicker than are patients who develop methicillin-susceptible S. aureus (MSSA) infection. Surgical site infection (SSI) complicates 2%-5% of all
We evaluated all surgical site infections (SSI) and postoperative bacteremias secondary to SSI as part of an ongoing active surgical surveillance program at a community hospital. Among 40,191 surgical procedures, we identified 515 patients with SSI and 47 with postoperative bacteremia secondary to SSI. Four variables were examined as potential predictors for developing postoperative bacteremia secondary to an SSI: National Nosocomial Infections Surveillance risk index, abdominal surgery, surgical procedures with an implantable device, and the presence of Staphylococcus aureus in wounds. Of these 4 variables, only one, S. aureus isolated from a wound culture, was associated with an increased risk of developing postoperative bacteremia secondary to SSI. Patients with S. aureus isolated in either pure or mixed culture from SSI were more than twice as likely to have postoperative bacteremia secondary to SSI than were those without S. aureus wound infection.
BackgroundIn 2000, the Millennium Development Goals set targets for social achievements by 2015 including goals related to maternal and child health, with mixed success. Several initiatives supported these goals including assuring availability of appropriate medicines and commodities to meet health service targets. To reach the new Sustainable Development Goals by 2030, information is needed to address policy and systems factors to improve access to lifesaving commodities.MethodsWe compiled indicator data on 15 commodities related to reproductive, maternal, newborn, and child health (RMNCH) and analyzed them across 75 Countdown to 2015 countries from eight regions to identify problems with specific commodities and determinants of access. The determinants related to policy, regulatory environment, financing, pharmaceutical procurement and supply chain, and information systems. We mapped commodity information from four datasets from the World Health Organization and the United Nation’s Commission on Life Saving Commodities creating a stoplight dashboard to illustrate countries’ environment to assure access. We also developed a dashboard for policy and systems indicators for select countries.ResultsThe commodities we identified as having the fewest barriers to access had been in use longer, including oral rehydration solution and oxytocin injection. Looking across the different systems and policy determinants of access, only Zimbabwe had all 15 commodities on both its essential medicines list and in its standard treatment guidelines, and only Cameroon and Zambia had at least one product registered for each commodity. Senegal alone procured all tracer commodities centrally in the previous year, and 70% of responding countries had costed plans for maternal, newborn, and child health. No country reported recent stock-outs of all the 15 commodities at the central level—countries always had some of the 15 commodities available; however, products with frequent stock-outs included misoprostol, calcium gluconate, penicillin injections, ceftriaxone, and amoxicillin dispersible tablets.ConclusionsThis analysis highlights country deficiencies in policies and systems, such as incoherent policy guidelines, problems in product registration, lack of logistics data, and central-level stock-outs that may affect access to essential RMNCH commodities. To tackle these deficiencies, countries need to integrate commodity-related indicators into other health monitoring activities to improve service quality.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3766-6) contains supplementary material, which is available to authorized users.
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