Methods for identifying surgical wound infection after discharge from hospital: a systematic review

Petherick, Emily; Dalton, Jane; Moore, P. J.; Cullum, Nicky

doi:10.1186/1471-2334-6-170

Cited by 148 publications

(122 citation statements)

References 12 publications

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“…With the current global trend toward a shortened hospital stay and outpatient and same-day surgery, an increasing proportion of SSI cases occur after the patient is discharged from the hospital. 31,32 In fact, more than 50% of all cases of SSI for certain procedures, such as appendectomy, mastectomy, and peripheral bypass surgery, occur after the patient is discharged. 33 Outpatients who develop SSI are not being identified by most SSI surveillance systems in U se.…”

Section: Discussionmentioning

confidence: 99%

Economic Burden of Surgical Site Infections at a European University Hospital

Weber

Zwahlen

Reck

et al. 2008

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.DESIGN. Matched case-control study nested in a prospective observational cohort study.SETTING. Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.METHODS. All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.RESULTS. A total of 6,283 procedures were performed: 187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492-SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (« = 76).CONCLUSIONS. Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers. 2008; 29:623-629 Surgical site infections (SSIs) account for 14%-16% of all nosocomial infections in inpatients and are considered the most common form of nosocomial infection among surgical patients. 1 A number of risk factors have been associated with the onset of SSI, and they can be broadly subdivided into patientrelated characteristics (eg, greater age, poor nutritional status, and more numerous and/or more severe combrbid conditions) and surgery-related characteristics (eg, long duration of procedure, high wound classification, and absence of antibiotic prophylaxis). 26 Based on such risk factors, SSI prediction scores have been developed that allow the identification of patients at high risk for developing SSI. 5,7,8 For these high-risk patients, clinicians can implement appropriate prevention strategies and effective measures to diagnose infection and initiate therapy at an early stage. In addition, in the past few years, SSI surveillance systems have been shown to decrease the rates of SSI in various countries. 1 ' 916 In such systems, clinicians share feedback on infection rates with surgical staff and reinforce adherence to Centers for Disease Control and Prevention standards. A nosocomial infection surveillance system was introduced at Basel University Hospital in 1999 to decrease the rate of SSI. Infect Control Hosp EpidemiolNowadays, hospital infections, particularly SSIs-which are potentially preventable complications directly linked to surgery-are considered to reflect the quality of...

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Section: Discussionmentioning

confidence: 99%

Economic Burden of Surgical Site Infections at a European University Hospital

Weber

Zwahlen

Reck

et al. 2008

Infect. Control Hosp. Epidemiol.

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“…One of these changes is illustrated by the decreasing length of hospital postoperative stay. In the last decades, we have progressively moved to shorter and shorter postoperative hospital stays, so an ever increasing number of SSI are becoming evident after the patient has been discharged from the hospital [34] . The NNIS risk index was developed at a time in which few hospitals around the world had post discharge SSI surveillance programs.…”

Section: The National Nosocomial Infections Surveillance Risk Indexmentioning

confidence: 99%

Rates of surgical site infection as a performance measure: Are we ready?

Biscione¹

2009

WJGS

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With the introduction of quality assurance in health care delivery, there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities. Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs. Adverse post-operative events, and very especially surgical site infection (SSI) rates after specific procedures, gained popularity as hospital quality indicators in the 1980s. For a SSI rate to be considered a valid indicator of the quality of care, it is essential that a proper adjustment for patient case mix be performed, so that meaningful comparisons of SSI rates can be made among surgeons, institutions, or over time. So far, a significant impediment to developing meaningful hospital-acquired infection rates that can be used for intra-and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix. This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment, and identifies areas in which significant improvement is still needed.

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“…The methods include direct examination of the wounds of patients during follow-up visits, review of medical records and surveys by phone or email with patients and surgeons 1,16 . For the epidemiological surveillance of SSI at FPMF / IMIP, patient return occurs in two periods, 15 and 30 to 45 postoperative days, but the patient can return to the Service at any time, when identifying any change in the wound.…”

Section: Melo Melo Melo Melomentioning

confidence: 99%

Infecção cirúrgica em colecistectomia videolaparoscópica usando ácido peracético como esterilizante dos instrumentais

Melo

Leão

Andreto

et al. 2013

Rev. Col. Bras. Cir.

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OBJETIVO: Determinar a frequência de infecção de sítio cirúrgico em pacientes submetidos à colecistectomia videolaparoscópica usando o ácido peracético como esterilizante. MÉTODOS: Foi realizado estudo retrospectivo descritivo do tipo coorte transversal. O ácido peracético foi usado para esterilização seguindo protocolo preconizado pelo fabricante. Foram observados os critérios e indicadores de processo e estrutura para prevenção de infecção de sítio cirúrgico no pré e intraoperatório. Para a vigilância epidemiológica, consultas ambulatoriais eram agendadas para o 15º e entre o 30º e 45º dias após a alta. RESULTADOS: Entre 247 pacientes foram diagnosticados dois casos de infecção de sítio cirúrgico (0,8%). Um paciente reinternou para antibioticoterapia sistêmica e punção percutânea; no outro, a infecção foi superficial e acompanhada ambulatorialmente. CONCLUSÃO: Eticamente não é permitida a realização de um estudo prospectivo pelo fato do ácido peracético ter sido proibido para a esterilização de instrumentais que penetrem em órgãos e cavidades; contudo, estes resultados encorajam estudo prospectivo caso-controle, comparando o uso dele (controle histórico) com a esterilização por óxido de etileno.

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Methods for identifying surgical wound infection after discharge from hospital: a systematic review

Cited by 148 publications

References 12 publications

Economic Burden of Surgical Site Infections at a European University Hospital

Economic Burden of Surgical Site Infections at a European University Hospital

Rates of surgical site infection as a performance measure: Are we ready?

Infecção cirúrgica em colecistectomia videolaparoscópica usando ácido peracético como esterilizante dos instrumentais

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