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To assess the performance of the Study of the Efficacy of Nosocomial Infection Control (SENIC) risk index for the evaluation of the risk of surgical-site infection (SSI) in a country other than the United States, having a different health system.
350-bed university hospital in Spain belonging to the National Health System (Insalud).
Observational cohort study of 1,019 patients who underwent consecutive surgery from January to December 1992. Surgical-infection risk factors assessed by the traditional wound-classification system (clean, clean-contaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty-infected wound) were compared by forward logistic regression.
The SENIC risk index showed a greater ability to predict SSI than the traditional wound-classification system. The study carried out in our institution reproduced the estimators provided by the SENIC study in the United States. The SENIC risk index provided a stepwise increase in SSI rates, according to the number of factors present, for every traditional wound-classification group. In the case of clean wounds, the incidence of surgical infection (per 100 interventions) increased (1.5, 2.4, 5.3, and 50; P<.001) for patients having from zero to three risk factors of the SENIC risk index.
This study shows that the SENIC risk index results are reproducible, and the index can be used to compare rates of wound infection across countries with different health systems than the United States.
To evaluate the efficacy of an educational program for the prevention of catheter colonization.
Two cross-sectional studies were carried out in a 500-bed randomly selected area of the hospital, separated by an educational program on the care of intravenous lines based on the Centers for Disease Control and Prevention (CDC) recommendations for the control of catheter-related infections.
A 2,100-bed urban general hospital affiliated with the University of Madrid (Spain).
Characteristics of patients and catheters and appropriateness of catheter care were evaluated. Cultures were taken from the point of insertion of the vascular catheter, the hubs, and infusion fluids. When catheter-associated infection was suspected, the distal end of the catheter was sent for culture and two blood cultures were taken. We compared the clinical and microbiological data before and after carrying out an educational program based on CDC recommendations for the control of catheter-related infections.
Characteristics of patients and catheters did not differ between the two cross-sectional studies. Compared with baseline data, after the educational program we observed a reduction of inappropriate catheter care, from 83% to 38% (45% difference, 95% confidence interval [CI95], 55% to 35%, P<0.0000), and a reduction in the rate of skin colonization, from 34% to 18% (16% difference, CI95, 26% to 5%, P<0.001). The frequency of phlebitis (15% versus 14%), hub colonizations (12% versus 11%), catheter colonizations (2% versus 1%), and catheter-related bacteremias (0% versus 0%) remained unchanged between the two cross-sectional studies.
Our educational program improved catheter care and reduced significantly the proportion of skin colonization around the insertion point. However, the educational program did not modify the proportion of hub colonization; because hub colonization has been demonstrated to be a source of line sepsis, our data suggest the need for a specific program directed to the maintenance of catheter hubs.
To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections.
Cross-sectional, including the entire hospitalized population.
A university-affiliated hospital.
Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intraarterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-1 1) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1- 130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR]=8.7, CI=4.13-18.3, p<.0001), inappropriate catheter care (OR= 5.3, CI = 2.5-11.2, p<.0001), inappropriate length of catheter use (OR= 3.5, CI = 1.4-9.02, p<.01), and duration of hospitalization exceeding 14 days (OR=2.6, CI=O.9-7.83,p=.07).
The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.
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