Infection Control — A Problem for Patient Safety

Burke, John P.

doi:10.1056/nejmhpr020557

Cited by 981 publications

(640 citation statements)

References 33 publications

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“…The overall SSI rate of 3.3% observed in our setup is comparable to those in the best centres [1,2]. Barriers towards implementation of surgical prophylaxis guidelines have been studied and identifi ed as lack of awareness, non-accountability, perception of guidelines as bureaucratic rather than education tools or perception of guidelines as cookbook medicine rather than allowing oneself to make ones own medical decisions [25].…”

Section: Discussionmentioning

confidence: 57%

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How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

Parulekar¹,

Soman

Singhal

et al. 2009

Indian J Surg

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Purpose There is a need to study compliance with surgical antibiotic prophylaxis guidelines in India.Methods In this prospective study, 100 consecutive surgical procedures performed at a tertiary care private hospital in Mumbai, India were observed. The choice of antibiotic, timing and duration of administration were recorded and compared to the hospital guidelines.Results Appropriateness of choice of antibiotic was seen in 68%, timing in 89%, dose in 75% and duration in 63% of cases. Hundred percent compliance to all criteria was observed in 52% of cases. The SSI rate was 3.3%.Conclusions These compliance rates though suboptimal are similar to those reported in world literature. There is an urgent need to improve compliance with optimal surgical antibiotic prophylaxis guidelines so as to reduce risk of SSI and to prevent resistance and costs potentially associated with antibiotic misuse.

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Section: Discussionmentioning

confidence: 57%

“…Surgical site infections (SSI) are the second most common type of nosocomial infections and are an important cause of morbidity, mortality and resource utilisation [1,2]. Two to 5% of patients undergoing clean extra-abdominal operations and upto 20% undergoing intra-abdominal operations will develop a SSI [3].…”

Section: Introductionmentioning

confidence: 99%

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

Parulekar¹,

Soman

Singhal

et al. 2009

Indian J Surg

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“…Urinary tract infection (UTI) is a common nosocomial infection creating potential bacteria [5,45]. The presence of a urinary catheter is the main risk factor for UTI [44,45,50] and can precipitate bacteremia [32,44,45].…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty

Koulouvaris¹,

Sculco²,

Finerty³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Surgical wound infection is a serious and potentially catastrophic complication after joint arthroplasty. Urinary tract infection is a common infection that creates a potential reservoir of resistant pathogens and increases patient morbidity. We asked whether treated preoperative and postoperative urinary tract infections are risk factors for deep joint infection. We examined the medical records of 19,735 patients. The minimum had joint infections develop. Of these, three had preoperative and four had postoperative urinary tract infections. The majority of bacteria were not enteric. The bacteria in the two types of infections were not identical. Control subjects were randomly selected from a list of patients matched with patients having infections. Of these, eight had preoperative and one had postoperative urinary tract infections. We found no association between the preoperative urinary tract infection (odds ratio, 0.341; 95% confidence interval, 0.086-1.357) or postoperative urinary tract infection (odds ratio, 4.222; 95% confidence interval, 0.457-38.9) and wound infection. Only one of the 58 patients with wound infections had a urinary tract infection with the same bacteria in both infections. Given the infection rate was very low (0.29%), the power of the study was only 25%. Although limited, the data suggest patients with urinary tract infections had no more likelihood of postoperative infection. We believe treated urinary tract infection should not be a reason to delay or postpone surgery. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…1 Worldwide, the prevalence of healthcare-associated infections in developed and undeveloped countries ranges from 5.1% to 11.6% and 5.7% to 19.1%, respectively. 2 In the United States, roughly 2 million such infections occur annually, resulting in approximately 99,000 deaths 3 and estimated annual direct medical costs between $28.4 and $33.8 billion.…”

mentioning

confidence: 99%

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

Sakihama

Honda

Saint

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Though hand hygiene is an important method of preventing healthcare‐associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%–25%). OBJECTIVE Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. SETTING A total of 3 to 4 inpatient wards in 3 Japanese hospitals. DESIGN Pre‐post intervention study. INTERVENTION The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. MEASUREMENT We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre‐intervention adherence rates. RESULTS We observed 2982 postintervention provider‐patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre‐ to 33% postintervention; P < 0.001), but postintervention adherence rates varied considerably: hospital A + 29%, B + 5%, C + 8%. Hospital A won the contest with 40% adherence after the intervention. CONCLUSIONS Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary. Journal of Hospital Medicine 2016;11:199–205. © 2015 Society of Hospital Medicine

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Infection Control — A Problem for Patient Safety

Abstract: The Journal welcomes submissions of manuscripts for the Clinical Problem-Solving series. This regular feature considers the step-by-step process of clinical decision making. For more information, please see http://www.nejm.org/hfa/articles.asp.

Cited by 981 publications

References 33 publications

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

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