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Our goal was to estimate the performance statistics of an electronic surveillance system for surgical site infections (SSIs), generally applicable in French hospitals
Three detection algorithms using 2 different data sources were tested retrospectively on 9 types of surgical procedures performed between January 2010 and December 2011 in the University Hospital of Nantes. The first algorithm was based on administrative codes, the second was based on bacteriological data, and the third used both data sources. For each algorithm, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. The reference method was the hospital’s routine surveillance: a comprehensive review of the computerized medical charts of the patients who underwent one of the targeted procedures during the study period.
A 3,000-bed teaching hospital in western France.
We analyzed 4,400 targeted surgical procedures.
Sensitivity results varied significantly between the three algorithms, from 25% (95% confidence interval, 17–33) when using only administrative codes to 87% (80%–93%) with the bacteriological data and 90% (85%–96%) with the combined algorithm. Fewer variations were observed for specificity (91%–98%), PPV (21%–25%), and NPV (98% to nearly 100%). Overall, performance statistics were higher for deep SSIs than for superficial infections.
A reliable computer-enhanced SSI surveillance can easily be implemented in French hospitals using common data sources. This should allow infection control professionals to spend more time on prevention and education duties. However, a multicenter study should be conducted to assess the generalizability of this method.
Infect Control Hosp Epidemiol 2014;35(11):1330–1335
To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.
Prospective survey conducted during a 12-month period.
A 48-bed cardiac surgical department in a teaching hospital.
Patients admitted for cardiac surgery between February 2002 and January 2003.
Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen was Staphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4; P < .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.
Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.
Efforts to enhance standard precautions and to isolate patients with positive routine clinical cultures during 3 years were insufficient to decrease multidrug-resistant bacteria infection rates. Routine screening for carriage in high-risk patients may be necessary to hait transmission and control the hospital reservoir.
To assess the way French hospitals conduct surveillance for, and control infections caused by, methicillin-resis-tant Staphylococcus aureus (MRSA), and to evaluate the incidence of these infections.
Retrospective analysis of sample surveillance data.
Representative sample of French hospitals.
Representative sample of 38 French public hospitals.
Hospitals were selected randomly in 1996, taking into account their location and number of beds. Administrative data, surveillance denominators used, antimicrobial resistance rates, and infection control practices were analyzed for the period 1990 to 1995. The same 38 centers were contacted 3 years later, in 1998, to reassess their surveillance and control activities.
French hospitals were slow to implement MRSA surveillance programs; only 5% had such programs in 1990, when the median incidence per admission (0.37%) and per patient-days (0.04%) of MRSA infections was already high. Despite the implementation of surveillance programs in 66% of French hospitals in 1995 and 87% in 1998, the MRSA infection rates remained stable from 1990 to 1995 and increased from 1995 to 1998. The proportion of French hospitals having a policy for the transfer of MRSA-infected patients to other hospitals increased from 47% in 1995 to 61% in 1998, whereas screening for MRSA colonization (42%-53%) and isolation for colonized or infected patients (87%-89%) remained stable.
This first national survey showed that French hospitals probably were not optimally prepared to control and prevent MRSA infections, since they were slow to respond to the growing problem.