Incidence of Surgical-Site Infections and the Validity of the National Nosocomial Infections Surveillance System Risk Index in a General Surgical Ward in Santa Cruz, Bolivia

2003 ◽  
Vol 24 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Lorena Soleto ◽  
Marianne Pirard ◽  
Marleen Boelaert ◽  
Remberto Peredo ◽  
Reinerio Vargas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Procedures ◽  
Nosocomial Infections ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Santa Cruz ◽  
Surgical Ward ◽  
System Risk ◽  
Local Risk

AbstractObjectives:To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.Design:A prospective study with patient follow-up until the 30th postoperative day.Setting:A general surgical ward of a public hospital in Santa Cruz, Bolivia.Patients:Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed.Results:Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a “local” risk index constructed with the above cut-off points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3.Conclusions:SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.

scholarly journals Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review

2007 ◽  
Vol 11 (1) ◽  
pp. 134-141 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Carlos Ernesto Ferreira Starling ◽  
Tânia Couto Machado Chianca ◽  
Mariângela Carneiro
Keyword(s):  
Nosocomial Infections ◽  
Surveillance System ◽  
Risk Index ◽  
Surgical Site Infections ◽  
System Risk

scholarly journals Prospective Nationwide Surveillance of Surgical Site Infections after Gastric Surgery and Risk Factor Analysis in the Korean Nosocomial Infections Surveillance System (KONIS)

2012 ◽  
Vol 33 (6) ◽  
pp. 572-580 ◽  
Author(s):  
Eu Suk Kim ◽  
Hong Bin Kim ◽  
Kyoung-Ho Song ◽  
Young Keun Kim ◽  
Hyung-Ho Kim, ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Demographic Data ◽  
Risk Index ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Gastric Surgery ◽  
Increased Risk ◽  
Male Sex

Objective.To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea.Design.A nationwide prospective multicenter study.Setting.Twenty university-affiliated hospitals in Korea.Methods.The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.Results.Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 (±12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09–2.58]), increased operation time (1.20 [1.07–1.34] per 1-hour increase), reoperation (7.27 [3.68–14.38]), combined multiple procedures (1.79 [1.13–2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09–8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26–5.64]) were independently associated with increased risk of SSI.Conclusions.Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.

Validation of a Modified Version of the National Nosocomial Infections Surveillance System Risk Index for Health Services Research

2009 ◽  
Vol 30 (6) ◽  
pp. 563-569 ◽  
Author(s):  
Nick Daneman ◽  
Andrew E. Simor ◽  
Donald A. Redelmeier
Keyword(s):  
Surgical Site Infection ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Elective Surgery ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Population Based ◽  
Site Infection ◽  
Services Research ◽  
System Risk

Objective.To validate the National Nosocomial Infections Surveillance system risk index through administrative data to predict surgical site infections.Design.Retrospective cohort study.Setting.Population-based analysis in Ontario, Canada.Patients.All elderly patients who underwent elective surgery from April 1, 1992, through March 31, 2006 (n = 469,349).Methods.Data on procedural and patient outcomes were gathered from linked population-wide hospital discharge records and physician claims. The 75th percentile of surgical duration was estimated through anesthesiologist billing fees recorded in 15-minute increments; the American Society of Anesthesiology score of at least 3 out of 5 was estimated by diagnostic codes for severe systemic illness; and all surgeries were classified as clean or clean-contaminated because of their elective nature (thus, the maximum score on the modified index was 2).Results.A total of 147,216 surgeries (31%) had a score of 0;246,592 (53%) had a score of 1; and 75,541 (16%) had a score of 2 on the modified index. The 30-day risk of surgical site infection increased with each increment in the modified index (score of 0, 5.4%; score of 1, 8.0%; score of 2, 14.3%; P < .001). The association was evident for surgical site infection diagnosed during the index admission (score of 0, 2.0%; score of 1, 3.7%; score of 2, 8.9%; P < .001), as well as that associated with reoperation or death (score of 0, 0.04%; score of 1, 0.23%; score of 2, 0.73%; P < .001). The modified index predicted increases in surgical site infection risk within each of 11 surgical subgroups. In accord with past research, the modified index had modest discrimination (C statistic, 0.59), and the majority of surgical site infections (72%) occurred within lower risk strata.Conclusions.The modified index predicts surgical site infection in population-based analyses and is associated with incremental increases in risk.

Surgical-Site Infection After Cardiac Surgery: Incidence, Microbiology, and risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 466-472 ◽  
Author(s):  
Didier Lepelletier ◽  
Stéphanie Perron ◽  
Philippe Bizouarn ◽  
Jocelyne Caillon ◽  
Henri Drugeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Artery Bypass ◽  
Risk Index ◽  
Bypass Graft ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Internal Mammary ◽  
System Risk

AbstractObjective:To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.Design:Prospective survey conducted during a 12-month period.Setting:A 48-bed cardiac surgical department in a teaching hospital.Patients:Patients admitted for cardiac surgery between February 2002 and January 2003.Results:Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen wasStaphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4;P< .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.Conclusions:Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.

Incidence of and Risk Factors for Surgical-Site Infections in a Peruvian Hospital

2005 ◽  
Vol 26 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Katherine Hernandez ◽  
Elizabeth Ramos ◽  
Carlos Seas ◽  
German Henostroza ◽  
Eduardo Gotuzzo
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Tertiary Care Hospital ◽  
Risk Index ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Developed Countries ◽  
Care Hospital ◽  
System Risk ◽  
Clean Contaminated

AbstractObjective:To determine the incidence of and risk factors for surgical-site infections (SSIs) after abdominal surgery.Design:A cohort study was conducted from January to June 1998. CDC criteria for SSI and the NNIS System risk index were used.Setting:A tertiary-care hospital in Peru.Patients:Adult patients undergoing abdominal surgery who consented were enrolled and observed until 30 days after surgery. Patients who had undergone surgery at another hospital or who died or were transferred to another hospital within 24 hours after surgery were excluded.Results:Four hundred sixty-eight patients were enrolled. Their mean age was 37.2 years. One hundred twenty-five patients developed SSIs, 18% of which were identified after discharge. The overall incidence rate (IR) was 26.7%. The IR was 13.9% for clean, 15.9% for clean-contaminated, 13.5% for contaminated, and 47.2% for dirty interventions. The IR was 3.6% for NNIS System risk index 0 and 60% for index 3. Risk factors for SSI on logistic regression analysis were dirty or infected wound (RR, 3.8; CI95, 1.7-8.4), drain use longer than 9 days (RR, 6.0; CI95, 2.5-12.5), and length of surgery greater than the 75th percentile (RR, 2.1; CI95, 1.0-4.4). Patients with SSI had a longer hospital stay than did non-infected patients (14.0 vs 6.1 days; P < .001).Conclusions:SSI is a major problem in this hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.

scholarly journals Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

2006 ◽  
Vol 27 (08) ◽  
pp. 809-816 ◽  
Author(s):  
Judith Manniën ◽  
Jan C. Wille ◽  
Ruud L. M. M. Snoeren ◽  
Susan van den Hof
Keyword(s):  
Medical Record ◽  
Surgical Procedures ◽  
Clinical Symptoms ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Abdominal Hysterectomy ◽  
Surveillance Network ◽  
Femorotibial Bypass ◽  
Registration Card

Objective. To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. Design. Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record. Setting. Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004. Results. We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%). Conclusions. For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

Risk-Adapted Treatment in Clinical Stage I Testicular Seminoma: The Third Spanish Germ Cell Cancer Group Study

2011 ◽  
Vol 29 (35) ◽  
pp. 4677-4681 ◽  
Author(s):  
Jorge Aparicio ◽  
Pablo Maroto ◽  
Xavier García del Muro ◽  
Josep Gumà ◽  
Alfonso Sánchez-Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Clinical Stage ◽  
Cell Cancer ◽  
Stage I ◽  
Adequate Treatment ◽  
Local Risk ◽  
Stage I Seminoma ◽  
Disease Free

Purpose To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate. Patients and Methods From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance. Results After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%. Conclusion With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model.

scholarly journals Surgical site infection incidence and risk factors in thoracic surgical procedures: A 12-year prospective cohort study

2019 ◽  
Vol 13 (03) ◽  
pp. 212-218
Author(s):  
Vlado S Cvijanovic ◽  
Aleksandar S Ristanović ◽  
Nebojsa T Maric ◽  
Natasa V Vesovic ◽  
Vanja V Kostovski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Surgery ◽  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Thoracic Surgical Procedures ◽  
Wound Contamination ◽  
Surgical Site Infection Incidence ◽  
Independent Risk Factors ◽  
American Society ◽  
Duration Of Operation

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

scholarly journals A prospective study on risk factors for development of surgical site infections at a tertiary care hospital: a two years study

2018 ◽  
Vol 5 (2) ◽  
pp. 460
Author(s):  
Vakamudi Prakash ◽  
Ramalinga Reddy Rachamalli ◽  
Jithendra Kandati ◽  
Sreeram Satish
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Nosocomial Infections ◽  
Antibiotic Susceptibility ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Care Hospital ◽  
Multiple Factors ◽  
The Common

Background: Surgical site infections (SSI) are the second most common Nosocomial infections after urinary tract infections accounting to 20-25% of Nosocomial infections worldwide. Based on the depth of the infections, SSI is classified by CDC as superficial incisional, deep incisional and organ/space. The development of SSI is dependent upon multiple factors like class of wound, immune status, type of surgery, type of anesthesia; surgical techniques etc and are interplay of multiple factors. Objective of the present study was conducted in identifying the predictors, risk factors and incidence rates of SSI at a tertiary care hospital. The study also identifies the causative bacterial pathogens and their antibiotic susceptibility patternMethods: A prospective cross-sectional study was conducted for a period of two years by department of general surgery involving all patients who underwent surgery, and pre-operative, intra operative and risk factors of the cases were collected using standardized data collection form. Specimens from the infected wounds were collected and processed for isolation of pathogens. Antibiotic susceptibility of pathogens was done using standard guidelines.Results: The incidence of SSI in present study was 25.34% with 81.58% superficial SSI and 18.42% deep SSI. Laparotomy was the common procedure and 63.2% of cases were females and 41-60 years was the most common age group. Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli were the common pathogens and were sensitive to carbapenems, vancomycin and linezolid. Significant association was observed with presence of pre-morbid analysis, presence of drain, use of povidone iodine alone and development of SSI.Conclusions: In present study the incidence of SSI was significantly high in this hospital and associated with premorbid illness, duration of surgery, presence of drain and use of drain at site of surgery. Staphylococcus aureus was the common pathogen and incidence of MRSA is higher than many other reports. A continuous monitoring and surveillance of patients with a predefined protocol will help in early identification of cases with risk of development of SSI. A feedback of appropriate data to surgeons is highly recommended to reduce the SSI rate in developing countries.

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