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The Effect of Frequency of Chart Review on the Sensitivity of Nosocomial Infection Surveillance in General Surgery

Published online by Cambridge University Press:  02 January 2015

Miguel Delgado-Rodríguez ,
Antonio Gómez-Ortega ,
Antonio Sierra ,
Trinidad Dierssen ,
Javier Llorca  and
María Sillero-Arenas
Miguel Delgado-Rodríguez*
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain
Antonio Gómez-Ortega
Affiliation:
Service of General Surgery, Hospital General Ciudad de Jaén, Spain
Antonio Sierra
Affiliation:
University of Canarias Hospital, School of Medicine, Tenerife, Spain
Trinidad Dierssen
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain Service of Preventive Medicine, Hospital Sierrallana, Santander, Spain
Javier Llorca
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain
María Sillero-Arenas
Affiliation:
Division of Health Programs, Provincial Office for Health, Jaén, Spain
*
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Avenida Cardenal Herrera Oria s/n, 39011-Santander, Spain
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Abstract

Objective:

To assess the sensitivity of different frequencies of nosocomial infection surveillance (NIS) in general surgery.

Design:

Data obtained with a prospective daily NIS are compared with those of hypothetical cross-sectional studies carried out with different frequencies (from one weekly visit up to one visit every other day).

Setting:

General surgery services at three hospitals.

Main Outcome Measure:

Sensitivity in the detection of nosocomial infection (overall and stratified by site), compared to a gold standard of prospective surveillance of every patient's complete medical record daily from the first day after surgery until discharge and once more after discharge.

Patients:

5,859 patients.

Results:

837 nosocomial infections were detected by the gold standard (58.8% were surgical-site infections [SSI]). The sensitivity of weekly NIS for all infections was 74.5% (95% confidence interval [CI95], 71.4%-77.5%) and varied from 65.1% (CI95, 56.2%-73.3%) for urinary tract infection to 83.3% (CI95, 62.6%-95.3%) for respiratory tract infection; it was 76.4% (CI95, 72.4%-80.1%) for SSI. As expected, sensitivity increased with the frequency of NIS. Performing NIS every 4 days improved sensitivity significantly, to 82.3% (CI95, 79.5%-84.8%) for all infections and 83.3% (CI95, 79.7%-86.5%) for SSI. One visit every other day increased the sensitivity for all infections by another 4.9%, mainly due to increased detection of urinary tract and other less severe infections.

Conclusions:

The sensitivity of two visits a week exceeded that of one weekly visit by approximately 8%, and one visit every other day added another 5% increase. Results varied according to duration of infection and postdischarge hospital stay.

Type
The International Perspective
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 3 , March 1999 , pp. 208 - 212
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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