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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

Published online by Cambridge University Press:  02 January 2015

Lorena Soleto ,
Marianne Pirard ,
Marleen Boelaert ,
Remberto Peredo ,
Reinerio Vargas ,
Alberto Gianella  and
Patrick Van der Stuyft
Lorena Soleto
Affiliation:
Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia
Marianne Pirard
Affiliation:
Belgian Technical Co-operation, Santa Cruz, Bolivia
Marleen Boelaert
Affiliation:
Institute of Tropical Medicine, Epidemiology Unit, Antwerpen, Belgium
Remberto Peredo
Affiliation:
Hospital San Juan de Dios, Santa Cruz, Bolivia
Reinerio Vargas
Affiliation:
Hospital San Juan de Dios, Santa Cruz, Bolivia
Alberto Gianella
Affiliation:
Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia
Patrick Van der Stuyft*
Affiliation:
Institute of Tropical Medicine, Epidemiology Unit, Antwerpen, Belgium
*
Institute of Tropical Medicine, Epidemiology Unit, Nationale Straat 155, 2000 Antwerpen, Belgium
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Abstract

Objectives:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 26 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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