The occurrence of wound infections following cardiothoracic surgery has significant implications. However, the epidemiology of all chest and leg wound infections is infrequently described, and the effects on morbidity, mortality, and cost of care remain undefined. We identified 182 superficial and deep chest and leg infections in 163 patients following 1,554 coronary artery bypass graft (CABG), valve, and CABG/valve procedures over 30 months. The overall infection rate was 11.7%; infections of specific sites involved in the 1,554 procedures occurred at the following rates: 3.1%, superficial chest wounds; 2.3%, deep chest wounds; 4.6%, superficial leg wounds; and 2.2%, deep leg wounds. Chest infection rates were similar for all procedures. Multiple infections occurred in 9.8% of patients and were associated with female sex, diabetes, and prolonged surgery (P < .05). Purulent drainage and fever were more common in chest infections; erythema and pain were more common in leg infections (P < .05). Staphylococcus aureus (32.9%), coagulase-negative staphylococci (27.4%), and Enterobacteriaceae (26.0%) were identified most commonly. Enterobacteriaceae were more commonly isolated from leg wounds (P < .05). Adverse outcomes included reexploration (20.9%), flap surgery (12.3%), and death (4.3%). All adverse outcomes were more commonly associated with deep chest infections (P < .05), but superficial chest and leg infections also had a substantial impact on cardiothoracic surgery-related morbidity. Studies are needed to define site-specific risk factors so that the full potential of prevention and control measures can be realized.

Akduman, Deniz; Kim, Lynn E.; Parks, Rodney L.; L'Ecuyer, Paul B.; Mutha, Sunita; Jeffe, Donna B.; Evanoff, Bradley A.; and Fraser, Victoria J., "Use of personal protective equipment and operating room behaviors in four surgical subspecialties: personal protective equipment and behaviors in surgery".

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We describe a prolonged nosocomial outbreak of Salmonella senftenberg, an uncommon human pathogen. We detected 22 cases of infection due to S. senftenberg that occurred from March 1993 through November 1994 and involved 18 patients and four healthy employees. All infected persons had consumed food prepared by the hospital kitchen. The estimated attack rate for the period of the outbreak was 0.19-0.23 cases per 100,000 meals served. Infection control interventions included observation of food preparation, disinfection of kitchen devices, and education of food handlers. The consumption of lettuce (11 of 15 patients who could recount extended dietary histories vs. 4 of 20 controls; P = .005), cauliflower (5 of 15 vs. 0/20; P = .02), cottage cheese (4 of 15 vs. 0/20; P = .03), and deli turkey (8 of 15 vs. 0/20; P < .001) was associated with S. senftenberg infection. The isolates had identical antibiograms and pulsed-field gel electrophoretic patterns. Cultures of stool samples from food handlers as well as food items, kitchen devices, and kitchen surroundings were negative for S. senftenberg. Interruption of the outbreak occurred coincidentally with the institution of infection control measures. This prolonged outbreak of salmonellosis was probably related to contamination in the kitchen from turkey, with cross-contamination via equipment.