Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-19T05:38:21.185Z Has data issue: false hasContentIssue false

Surgical-Site Infection Rates and Risk Factor Analysis in Coronary Artery Bypass Graft Surgery

Published online by Cambridge University Press:  02 January 2015

Glenys Harrington*
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Philip Russo
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Denis Spelman
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Sue Borrell
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Kerrie Watson
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Wendy Barr
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Rhea Martin
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Diedre Edmonds
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Joanne Cocks
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
John Greenbough
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Jill Lowe
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Leesa Randle
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Jan Castell
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Elizabeth Browne
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Kaye Bellis
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
Melissa Aberline
Affiliation:
Victorian Infection Control Surveillance Project (VICSP), Middle Park, Victoria, Australia
*
P.O. Box 5202, Middle Park, Victoria 3206, Australia

Abstract

Background:

The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.

Objective:

To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.

Method:

Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.

Results:

For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia colt) from 18%, and miscellaneous organisms from the remainder.

Conclusion:

We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Davies, J, Senes, S. Cardiac Surgery in Australia 1998: AIHW Cat. No. CVD 15. Canberra, Australia: AIHW & National Heart Foundation of Australia; 2001.Google Scholar
2.Gastmeier, P, Sohr, D, Just, HM, Nassauer, A, Daschner, P, Ruden, H. How to survey nosocomial infections. Infect Control Hosp Epidemiol 2000;21:366370.CrossRefGoogle ScholarPubMed
3.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.CrossRefGoogle ScholarPubMed
4.Hacek, DM, Suriano, T, Noskin, GA, Kruszynski, J, Reisberg, B, Peterson, LR. Medical and economic benefit of a comprehensive infection control program that includes routine determination of microbiol clonality. Am J Clin Pathol 1999;11:6754.Google Scholar
5.Condon, RE, Shulte, WJ, Malagoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303307.CrossRefGoogle ScholarPubMed
6.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.CrossRefGoogle ScholarPubMed
7.Emori, TG, Culver, DH, Horan, TC, et al.National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methodology. Am J Infect Control 1991;19:1935.CrossRefGoogle Scholar
8.Gaynes, RP, Horan, TC. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, ed. 2. Philadelphia: Lippincott Williams & Wilkins; 1999:12851317.Google Scholar
9.Horan, TC, Emori, TG. Definitions of key terms used in the NNIS system. Am J Infect Control 1997;25:112116.CrossRefGoogle ScholarPubMed
10.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WJ, Emori, TG. CDC definitions of surgical-site infection, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606608.CrossRefGoogle ScholarPubMed
11.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guidelines for prevention of surgical-site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250278.CrossRefGoogle ScholarPubMed
12.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;91(suppl 3B):152S157S.CrossRefGoogle ScholarPubMed
13.Australian Council on Healthcare Standards, ACHS Care Evaluation Program. Clinical Indicators: A User's Manual Version 3 for Surveys After January 1995. Victoria, Australia: The ACHS Care Evaluation Program; 1995.Google Scholar
14.McLaws, ML, Murphy, C, Keogh, G. The validity of surgical wound infection as a clinical indicator in Australia. Australian and New Zealand Journal of Surgery 1997;67:675678.CrossRefGoogle ScholarPubMed
15.Zacharias, A, Habib, RH. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest 1996;110:11731178.CrossRefGoogle ScholarPubMed
16.Borger, MA, Rao, V, Weisel, RD, et al.Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998;65:10501056.CrossRefGoogle Scholar
17.Kainer, MA, Pearson, SR, Mayhall, BC. Epidemiological and molecular investigation of a nosocomial outbreak of sternal wound infections. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections; March 5-9, 2000; Atlanta, GA. Abstract P-MI-43.Google Scholar
18.Spelman, DW, Russo, P, Harrington, G, et al.Risk factors for surgical wound infection and bacteremia following coronary artery bypass surgery. Australian and New Zealand Journal of Surgery 2000;70:4751.CrossRefGoogle ScholarPubMed
19.Rosenfeldt, FL, Negri, J, Holdaway, D, et al.Occlusive wrap dressing reduces infection rate in saphenous vein harvest site. Ann Thorac Surg 2003;75:101105.CrossRefGoogle ScholarPubMed
20.McLaws, ML, Murphy, C, Whitby, M. Standardising surveillance of nosocomial infections: the HISS program. J Qual Clin Pract 2000;20:611.CrossRefGoogle ScholarPubMed
21.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from 1992-April 2000, issued June 2000. Am J Infect Control 2000;6:429448.Google Scholar
22.Jenney, AW, Harrington, GA, Russo, PI, Spelman, DW. Cost of surgical site infections following coronary artery bypass graft surgery. Australian and New Zealand Journal of Surgery 2001;71:602604.Google Scholar