Year: 2004
Type: article
Study design: Observational Study
Abstract: We evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI).This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures.We compared routine surveillance to detection through inpatient antimicrobial exposure (>9 days for CABG, >2 days for cesareans, and >6 days for breast procedures), discharge diagnoses, or both.Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures.Antimicrobial exposure had the highest sensitivity, 88%-91%, compared with routine surveillance, 38%-64%.Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans.Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria.Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods.This screening method was efficient, readily standardized, and suitable for most hospitals.P reventing healthcare-associated infections, including surgical site infections (SSI), is an integral part of the national patient safety agenda developed in response to the Institute of Medicine's report, To Err is Human: Building a Safer Health System (1).Although nearly all hospitals monitor their SSI rates, no generally accepted active surveillance method is both reproducible and widely used.Fewer than 10% of hospitals participate in the Centers for Disease Control and Prevention's (CDC) National Nosocomial Infection Surveillance System (NNIS).Many hospitals use surveillance systems based more or less closely on NNIS; most of these systems are labor-intensive and their sensitivity is typically unknown.We therefore studied the ability of exposure to antimicrobial drugs and coded discharge diagnoses to identify SSI after three common procedures: coronary artery bypass graft (CABG) procedures, cesarean delivery, and breast procedures.We chose these measures because prior work suggested their usefulness (2,3), nearly all hospitals collect this information as part of routine patient care, and many hospitals store this information electronically. MethodsWe conducted this study in two phases in 13 hospitals affiliated with the seven CDC epicenters.Phase 1 involved seven teaching and community hospitals in eastern Massachusetts.Phase 2 involved hospitals in seven states.The study design was similar for each of the procedures, although the antimicrobial intervals required to trigger record review were procedure-specific and based on earlier work (2,3).We describe the methods in detail for CABG procedures and then provide additional information for cesarean delivery and breast procedures.The number of hospitals assessing the three procedures differed because of different practice patterns.
Source: Emerging infectious diseases
Authors: Deborah S. Yokoe, Gary A. Noskin, Susan M. Cunningham, Gianna Zuccotti, Theresa Plaskett, Victoria J. Fraser, Margaret A. Olsen, Jerome I. Tokars, Steven Solomon, Trish M. Perl, Sara E. Cosgrove, Richard S. Tilson, Maurice Greenbaum, David C. Hooper, Kenneth E. Sands, John Tully, Loreen A. Herwaldt, Daniel J. Diekema, Edward S. Wong, Michael Climo, Richard Platt
Institutions: Brigham and Women's Hospital, Northwestern University, Memorial Sloan Kettering Cancer Center, Washington University in St. Louis, Centers for Disease Control and Prevention, Johns Hopkins University, Johns Hopkins Medicine, Hunter Holmes McGuire VA Medical Center, Salem Hospital, North Shore Medical Center, Harvard Pilgrim Health Care, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Harvard University, Mount Auburn Hospital, University of Iowa
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2104683584