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Highly Sensitive and Efficient Computer–Assisted System for Routine Surveillance for Surgical Site Infection

Published online by Cambridge University Press:  21 June 2016

Annie Chalfine ,
Daniel Cauet ,
Wei Chi Lin ,
Jacqueline Gonot ,
Nadine Calvo-Verjat ,
François-Emile Dazza ,
Olivier Billuart ,
Marie Dominique Kitzis ,
Jean Pierre Blériot  and
Marie Laure Pibarot
...Show all authors
Annie Chalfine*
Affiliation:
Infection Control Unit, Paris, France
Daniel Cauet
Affiliation:
Saint Joseph Hospital, the Information System in Public Health Department, EpiConcept, Paris, France
Wei Chi Lin
Affiliation:
Infection Control Unit, Paris, France
Jacqueline Gonot
Affiliation:
Infection Control Unit, Paris, France
Nadine Calvo-Verjat
Affiliation:
Gastrointestinal Surgery Department, Paris, France
François-Emile Dazza
Affiliation:
Gastrointestinal Surgery Department, Paris, France
Olivier Billuart
Affiliation:
Computer System and Medical Information Department, Paris, France
Marie Dominique Kitzis
Affiliation:
Microbiology Laboratory, Paris, France
Jean Pierre Blériot
Affiliation:
Hospital Information System, Health Ministry, Paris, France
Marie Laure Pibarot
Affiliation:
Clinical Risk Management Department, Assistance Publique–Hôpitaux de Paris, Paris, France
Jean Carlet
Affiliation:
Infection Control Committee, Paris, France
*
Infection Control Unit, Saint–Joseph Hospital, 185 rue Raymond Losserand, 75614 Paris CEDEX, France, ([email protected])
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Abstract

Objectives.

Surveillance of surgical site infections (SSIs) is effective in reducing the rates of these complications, but it is extremely time-consuming and, consequently, underused. We determined the sensitivity and specificity of a computer-assisted surveillance system, compared with a conventional method involving review of medical records, and the time saved with the computer-assisted system.

Method.

A prospective study was conducted from January 1 to December 31, 2001. With the computer-assisted method, screening for SSIs relied on identification in the laboratory database of positive results of microbiological tests of surgical-site specimens; confirmation was obtained via computer-generated questionnaires completed by the surgeon in charge of the patient. In the conventional method, SSIs were identified by exhaustive chart review. The time spent on surveillance was recorded for both methods.

Setting.

A 25-bed gastrointestinal surgery unit in a tertiary care hospital.

Patients.

A total of 766 consecutive patients who underwent gastrointestinal surgery.

Results.

The sensitivity of the computer-assisted method was 84.3% (95% confidence interval, 0.66-0.94); the specificity was 99.9%. For the 807 surgical procedures in the study, 197 had an SSI identified by culture of a surgical-site specimen. After elimination of 63 duplicate cultures with positive results, 134 questionnaires were sent to the surgeons, who confirmed 27 SSIs. The conventional method identified 32 SSIs. The computer-assisted method required 60% less time than the conventional method (90 hours vs 223 hours).

Conclusion.

Surveillance for SSIs using computer-assisted, laboratory-based screening and case confirmation by surgeons is as efficient as and far less time-consuming than the conventional method of chart review. This method permits routine surveillance for SSIs with reliable accuracy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 8 , August 2006 , pp. 794 - 801
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121:182–205.Google Scholar
2. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27:97–134.Google Scholar
3. Comité Technique National des Infections Nosocomiales. 100 Recommandations pour la Surveillance et la Prévention des Infections Nosocomiales. Paris, France: Ministère de l'Emploi et de la Solidarité; 1999.Google Scholar
4. Agence Nationale d'Accréditation et d'Evaluation en Santé. Manuel d'accréditation des établissements de santé. Agence Nationale d'Accréditation et d'Evaluation en Santé; 1999.Google Scholar
5. Tokars, JI, Richards, C, Andrus, M, et al. The changing face of surveillance for health care-associated infections. Clin Infect Dis 2004; 39:1347–1352.Google Scholar
6. Cauet, D, Quenon, JL, Desvé, G. Surveillance of hospital acquired infections: presentation of a computerized system. Eur J Epidemiol 1999; 15: 149–153.Google Scholar
7. Glenister, HM, Taylor, LJ, Bartlett, CL, Cooke, EM, Mulhall, AB. Introduction of laboratory ward liaison surveillance of hospital infection into six district general hospitals. J Hosp Infect 1993; 25:161–172.Google Scholar
8. Glenister, HM, Taylor, LJ, Bartlett, CL, Cooke, EM, Sedgwick, JA, Mackintosh, CA. An evaluation of surveillance methods for detecting infections in hospital inpatients. J Hosp Infect 1993; 23:229–242.CrossRefGoogle ScholarPubMed
9. Glenister, HM, Taylor, LJ, Bartlett, CL, Cooke, EM, Mackintosh, CA, Leigh, DA. An 11-month incidence study of infection in wards of a district general hospital. J Hosp Infect 1992; 21:261–273.Google Scholar
10. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13:606–608.Google Scholar
11. Horan, TC, Emori, TG. Definition of key terms used in the NNIS system. Am J Infect Control 1997; 25:112–116.Google Scholar
12. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by surgical procedure, and patient risk index. National nosocomial infections surveillance system. Am J Med 1991; 16;91:152S–157S. Google Scholar
13. Gastmeier, P, Brauer, H, Hauer, T, Schumacher, M, Daschner, F, Ruden, H. How many nosocomial infections are missed if identification is restricted to patients with either microbiology reports or antibiotic administration. Infect Control Hosp Epidemiol 1999; 20:124–127.CrossRefGoogle ScholarPubMed
14. Chalfine, A, Gonot, J, Roche, A, et al. Assessment of a laboratory-based surveillance method for the detection of surgical site infection (SSI) in a general surgery department. In: Proceedings of the 39th Interscience Conference on Antimicrobial Agents and Chemothrapy; September 26-29, 1999; San Francisco, CA. Abstract 519.Google Scholar
15. Goldmann, DA, Weinstein, RA, Wenzel, RP et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996; 275:234–240.Google Scholar
16. Campaign to prevent antimicrobial resistance in healthcare settings. 2002. Available at: http://www.cdc.gov/drugresistance/healthcare/tools.htm. Accessed July 18, 2006.Google Scholar
17. Yokoe, DS, Shapiro, M, Simchen, E, Platt, R. Use of antibiotic exposure to detect postoperative infections. Infect Control Hosp Epidemiol 1998; 19:317–322.Google Scholar
18. Evans, RS, Larsen, RA, Burke, JP, et al. Computer surveillance of hospital-acquired infections and antibiotic use. JAMA 1986; 256:1007–1111.Google Scholar
19. Gravel-Tropper, D, Oxley, C, Memish, Z, Garber, GE. Underestimation of surgical site infection rates in obstetrics and gynecology. Am J Infect Control 1995; 23:22–26.Google Scholar
20. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996; 173:963–970.Google Scholar
21. Gravel-Tropper, D, Oxley, C, Memish, Z, Garber, GE. Efficient identification of postdischarge surgical site infections: use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis 1999; 179:434–441.Google Scholar