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

Published online by Cambridge University Press:  21 June 2016

Katherine Hernandez ,
Elizabeth Ramos ,
Carlos Seas ,
German Henostroza  and
Eduardo Gotuzzo
Katherine Hernandez
Affiliation:
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, Lima, Peru
Elizabeth Ramos
Affiliation:
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, Lima, Peru
Carlos Seas*
Affiliation:
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, Lima, Peru Departamento de Enfermedades Infecciosas, Tropicales y Dermatologicas, Hospital Nacional Cayetano Heredia, Lima, Peru
German Henostroza
Affiliation:
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, Lima, Peru
Eduardo Gotuzzo
Affiliation:
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, Lima, Peru Departamento de Enfermedades Infecciosas, Tropicales y Dermatologicas, Hospital Nacional Cayetano Heredia, Lima, Peru
*
Instituto de Medicina Tropical “Alexander von Humboldt,”Universidad Peruana Cayetano Heredia, AP 4314, Lima 100Peru. [email protected]
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Abstract

Objective:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 473 - 477
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Kohn, L, Corrigan, J, Donaldson, M. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, National Academy Press; 1999.Google Scholar
2.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002;30:458–475.Google Scholar
3.Martone, W, Jarvis, W, Edwards, J, Culver, D, Haley, R. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Philadelphia: Lippincott-Raven; 1998:461–476.Google Scholar
4.Haley, RW, Shachtman, RH. The emergence of infection surveillance and control programs in US hospitals: an assessment, 1976. Am J Epidemiol 1980;111:574–591.Google Scholar
5.Centers for Disease Control and Prevention. Monitoring hospital acquired infections to promote patient safety: United States, 1990-1999. MMWR 2000;49:149–152.Google Scholar
6.Society for Hospital Epidemiology of America, Association for Practitioners in Infection Control, Centers for Disease Control, Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599–605.Google Scholar
7.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions for nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
8.Haley, RW, Culver, DH, Morgan, WM, et al. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.Google Scholar
9.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure and patient risk index: National Nosocomial Infections Surveillance System. Am J Med 1991;91(suppl 3B):152–157.Google Scholar
10.Horan, TC, Culver, DH, Gaynes, RP, National Academy of Sciences-National Research Council. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 1964;160(suppl 2):1–132.Google Scholar
11.Owens, WD, Felts, JA, Spitznagel, EL. ASA physical status classification: a study of consistency of ratings. Anesthesiology 1978;49:239–243.Google Scholar
12.Keats, AS. The AS classification of physical status. Anesthesiology 1978;49:223–226.Google Scholar
13.Gerberding, JL. Health-care quality promotion through infection prevention: beyond 2000. Emerg Infect Dis 2001;7:363–366.Google Scholar
14.Haley, RW. The scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates. J Hosp Infect 1995;30(suppl):S3–S14.CrossRefGoogle ScholarPubMed
15.Communicable Disease Surveillance Centre. NINSS reports on surgical site infection and hospital acquired bacteremia. CDR Wkly 2000;10:213–216.Google Scholar
16.Geubbels, EL, Mintjes-de Groot, AJ, van den Berg, JM, de Boer, AS. An operating surveillance system of surgical site infections in the Netherlands: results of the PREZIES national surveillance network. Infect Control Hosp Epidemiol 2000;21:311–318.CrossRefGoogle ScholarPubMed
17.Vilar-Compte, D, Sandoval, S, Gordillo, P, de la Rosa, M, Sanchez-Mejo-rada, G, Volkow, P. Surveillance of surgical wound infections: 18-month experience in the Instituto Nacional de Cancerologia. Salud Publico Mex 1999;41(suppl 1):S44–S50.Google Scholar
18.Wagner, MB, da Silva, NB, Vinciprova, AR, Becker, AB, Burtet, LM, Hall, AJ. Hospital-acquired infections among surgical patients in a Brazilian hospital. J Hosp Infect 1997;35:277–285.CrossRefGoogle Scholar
19.Soleto, L, Pirard, M, Boelaert, M, et al. 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. Infect Control Hosp Epidemiol 2003;24:26–30.Google Scholar
20.Ziliotto, JA, Kunzle, JE, Mendes, JA, Ferreira, JL. Hospital infection at a private hospital in Ribeirao Preto, Sao Paulo, Brazil. Revista da Associacao Medico Brasileira 1989;35:29–33.Google Scholar
21.Vails, V, Diez, M, Ena, J, Gutierrez, A, et al. Evaluation of the SENIC risk index in a Spanish university hospital. Infect Control Hosp Epidemiol 1999;20:196–199.Google Scholar
22.Nguyen, D, MacLeod, W, Phumg, D, et al. Incidence and predictors of surgical-site infections in Vietnam. Infect Control Hosp Epidemiol 2001;22:485–492.Google Scholar
23.Saldias, J, Villacorta, J, Izquierdo, G, Samanez, J. Nosocomial infection in index services of internal medicine and general surgery. Revista Medica del Instituto Peruana de Seguirdad Social 1992;1:4–7.Google Scholar
24.Manian, FA, Meyer, L. Comprehensive surveillance of surgical wound infections in outpatient and inpatient surgery. Infect Control Hosp Epidemiol 1990;11:515–520.Google Scholar
25.Medina-Cuadros, M, Sillero-Arenas, M, Martmez-Gallego, G, Delgado-Rodriguez, M. Surgical wound infections diagnosed after discharge from the hospital: epidemiological differences with in-hospital infections. Am J Infect Control 1996;24:421–428.Google Scholar
26.Garibaldi, R, Cushing, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;91(suppl 3B):S158–S163.Google Scholar
27.Lizan-Garcia, M, Garcia Caballero, J, Asensio Vegas, A. Risk factors for surgical-wound infection in general surgery: a prospective study. Infect Control Hosp Epidemiol 1997;18:310–315.Google Scholar
28.Alexander, JW, Korelitz, J, Alexander, NS. Prevention of wound infections: a case for closed suction drainage to remove wound fluids deficient in opsonic proteins. Am J Surg 1976;131:59–63.Google Scholar
29.Simchen, E, Shapiro, M, Sacks, TG, Michel, J, Durst, A, Eyal, Z. Determinants of wound infection after colon surgery. Ann Surg 1984;199:260–265.Google Scholar
30.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar