Surveillance of selected post-caesarean infections based on electronic registries: validation study including post-discharge infections

Leth, Rita Andersen; Nørgaard, Mette; Uldbjerg, Niels; Thomsen, Reimar Wernich; Frimodt‐Møller, Niels

doi:10.1016/j.jhin.2009.11.018

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…in line with local protocols), optimal dosing, improved adherence to guidelines/protocols, and a decrease in the total number of antibiotics prescribed . Some studies also reported a reduction in prescribing errors and increased de‐escalation, as well as improved antibiotic sensitivity and increase in sensitivity of surgical site infection detection . Others reported a timelier discontinuation of antibiotics and a decrease in the meantime to antibiotic administration .…”

Section: Resultsmentioning

confidence: 99%

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Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

et al. 2016

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Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.

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Section: Resultsmentioning

confidence: 99%

“…Most evidence came from specialty settings (such as intensive care, emergency medicine and paediatrics); and from high‐risk patient groups (e.g. those at risk for or with infections); and from tertiary care …”

Section: Resultsmentioning

confidence: 99%

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

et al. 2016

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“…23,24 One of the reviews 23 included surgical site infection following cesarean delivery and identified 3 validation studies. 15,25,26 Leth and colleagues 26 found sensitivities of infection diagnosed in hospital and after discharge of 77.1% and 68.9%, respectively, and specificities of 99.5% and 98.2%, respectively. A Canadian study showed that the sensitivity for detection of surgical site infection after cesarean delivery was 16.7% when using hospital data but 77.3% when including emergency department and physician claims databases; those authors concluded that the low sensitivity and positive predictive value make claims databases inadequate for use as quality indicators.…”

Section: Limitationsmentioning

confidence: 99%

Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study

et al. 2017

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Background:The rate of cesarean delivery is increasing in North America. Surgical site infection following this operation can make it difficult to recover, care for a baby and return home. We aimed to determine the incidence of surgical site infection to 30 days following cesarean delivery, associated risk factors and whether risk factors differed for predischarge versus postdischarge infection. Methods:We identified a retrospective cohort in Nova Scotia by linking the provincial perinatal database to hospital admissions and physician billings databases to follow women for 30 days after they had given birth by cesarean delivery between Jan. 1, 1997 and Dec. 31, 2012. Logistic regression with generalized estimating equations was used to determine risk factors for infection.Results: A total of 25 123 women had 33 991 cesarean deliveries over the study period. Of the 25 123, 923 had surgical site infections, giving an incidence rate of 2.7% (95% CI 2.54%-2.89%); the incidence decreased over time. Risk factors for infection (adjusted odds ratios ≥ 1.5) were prepregnancy weight 87.0 kg or more, gaining 30.0 kg or more during pregnancy, chorioamnionitis, maternal blood transfusion, anticoagulation therapy, alcohol or drug abuse, second stage of labour before surgery, delivery in 1997-2000 and delivery in a hospital performing 130-1249 cesarean deliveries annually. Women who gave birth earlier in the study period, those who gave birth in a hospital with 130-949 cesarean deliveries per year and those with more than 1 fetus were at a significantly higher risk for surgical site infection before discharge; women who smoked were at significantly higher risk for surgical site infection after discharge.Interpretation: Most risk factors are known before delivery, and some are potentially modifiable. Although the incidence of surgical site infection decreased over time, targeted clinical and infection prevention and control interventions could further reduce the burden of illness associated with this health-care-related infection. Abstract ResearchResearch CMAJ OPEN CMAJ OPEN, 5(3) E547

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“…ICD-9 4,9–11,15–19 , SNOMED-CT 20–22 and free text from notes were used to determine hospital billing diagnosis and procedures 10,11,17,21 . Microbiology results were formatted in institution-specific codes 10,11,13,14,17 , textual results 3–5,9,12,16,18,22–30 , and LOINC 22 codes.…”

Section: Resultsmentioning

confidence: 99%

Data elements and validation methods used for electronic surveillance of health care-associated infections: A systematic review

Cato

Cohen

Larson

2015

American Journal of Infection Control

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Objective This study describes the primary data sources, data elements, and validation methods currently used in electronic surveillance systems (ESS) for identification and surveillance of healthcare-associated infections (HAIs), and compares these data elements and validation methods with recommended standards. Methods Using PRISMA guidelines, a PubMed and manual search was conducted to identify research articles describing ESS for identification and surveillance of HAIs published from January 1, 2009 through August 31, 2014. Selected articles were evaluated to determine what data elements and validation methods were included. Results Among the 509 articles identified in the original literature search, 30 met the inclusion criteria. While the majority of studies (83%) used recommended data sources and validated the numerator (80%), only 10 percent of studies performed external and internal validation. In addition, there was variation in ESS data formats used. Conclusions The findings of this review suggest that the majority of ESS for HAI surveillance are using standard definitions, but the lack of widespread internal data, denominator, and external validation in these systems reduces the reliability of their findings. Additionally, advanced programming skills are required to create, implement and maintain these systems and to reduce the variability in data formats.

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Surveillance of selected post-caesarean infections based on electronic registries: validation study including post-discharge infections

Cited by 20 publications

References 22 publications

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study

Data elements and validation methods used for electronic surveillance of health care-associated infections: A systematic review

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