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Nosocomial Infections in Surgical Patients in the United States, January 1986-June 1992

  • Teresa C. Horan (a1), David H. Culver (a1), Robert P. Gaynes (a1), William R. Jarvis (a1), Jonathan R. Edwards (a1), Casetta R. Reid (a1) and National Nosocomial Infections Surveillance (NNIS) System (a1)...



To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.


Surveillance of surgical patients during January 1986-June 1992 using standard definitions and protocols for both comprehensive (all sites, all operations) and targeted (all sites, selected operations) infection detection.

Setting and Patients:

Acute care US hospitals participating in the National Nosocomial Infection Surveillance (NNIS) System: 42,509 patients with 52,388 infections from 95 hospitals using comprehensive surveillance protocols and an additional 5,659 patients with 6,963 infections from 11 more hospitals using a targeted protocol.


Surgical site infection was the most common nosocomial infection site (37%) when data were reported by hospitals using the comprehensive protocols. When infections reported from both types of protocols were stratified by type of operation, other sites were most frequent following certain operations (e.g., urinary tract infection after joint prosthesis surgery [52%]). Among the infected surgical patients who died, the probability that an infection was related to the patient's death varied significantly with the site of infection, from 22% for urinary tract infection to 89% for organ/space surgical site infection, but was independent of the type of operation performed. The probability of developing a secondary bloodstream infection also varied significantly with the primary site of infection, from 3.1% for incisional surgical site infection to 9.5% for organ/space surgical site infection (p<.001). For all infections except pneumonia, the risk of developing a secondary bloodstream infection also varied significantly with the type of operation performed (p<.00l) and was generally highest for cardiac surgery and lowest for abdominal hysterectomy. Surgical patients who developed ventilator-associated pneumonia were more than twice as likely to develop a secondary bloodstream infection as nonventilated pneumonia patients (8.1% versus 3.3%, p<.001).


For surgical patients with nosocomial infection, the distribution of nosocomial infections by site varies by type of operation, the frequency with which nosocomial infections contribute to patient mortality varies by site of infection but not by type of operation, and the risk of developing a secondary bloodstream infection varies by type of primary infection and, except for pneumonia, by type of operation.


Corresponding author

Hospital Infections Program, Mailstop A07, Centers for Disease Control and Prevention, Atlanta, GA 30333


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1.Graves, EJ. National hospital discharge survey: annual summary, 1987. National Center for Health Statistics. Vital Stat. 1989;13:11.
2.Cruse, PJE, Foord, R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206.
3.Farber, BEWenzel, RPPostoperative wound infection rates: results of prospective statewide surveillance. Am J Surg. 1980;140:343346.
4.Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg. 1983;118:303307.
5.Olson, MM, Lee, JT Jr. Continuous, 10-year wound infection surveillance: results, advantages, and unanswered questions. Arch Surg. 1990;125:794803.
6.Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance System (NNIS): description of surveillance methodology. Am J Infect Control. 1991;19:1935.
7.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomiai infections, 1988. Am J Infect Control. 1988;16:128140.
8.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;13:606608.
9.Yonekura, ML. Prevention of postcesarean febrile morbidity. In: Wenzel, RP, ed. Prevention and Control of Nosocomial infections. Baltimore, Md: Williams and Wilkins; 1987:541559.
10.Penin, GB, Ehrenkranz, NJ. Priorities for surveillance and cost-effective control of postoperative infection. Arch Surg. 1988;123:13051308.
11.Simmons, BPWong, ES. Guideline for prevention of nosocomial pneumonia. Infect Control. 1982;3:327333.
12.Driks, MR, Craven, DE, Celli, BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med. 1987;317:13761382.
13.Cruse, PJE, Foord, RThe epidemiology of wound infections: a 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:2740.
14.Lennard, ES, Hargiss, CO, Schoenknecht, FD. Postoperative wound infection surveillance by use of bacterial contamination categories. Am /Infect Control. 1985;13:147153.
15.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Am J Epidemiol. 1985;121:182205.
16.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol. 1985;121:206215.
17.Mead, PB, Pories, SE, Hall, P, Vacek, PM, Davis, JH, Gamelli, RL. Decreasing the incidence of surgical wound infections: validation of a surveillance-notification program. Arch Surg. 1986;121:458461.
18.Collier, C, Miller, DP, Borst, M. Community hospital surgeon-specific infection rates. Infect Control. 1987;8:249254.
19.Gil-Egea, MJ, Pi-Sunyer, MTVerdaguer, A, Sanz, F, Sitges-Serra, A, Eleizegui, LT. Surgical wound infections: prospective study of 4,468 clean wounds. infect Control. 1987;8:277280.
20.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med. 1991;19(suppl 3B):152S157S.
21.Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol. 1991;12:609621.


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