Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-26T23:11:42.069Z Has data issue: false hasContentIssue false
  • English
  • Français

Postdischarge Nosocomial Infections in Primary Care

Published online by Cambridge University Press:  02 January 2015

Laurent Letrilliart ,
Marguerite Guiguet ,
Thomas Hanslik  and
Antoine Flahault
Laurent Letrilliart
Affiliation:
Unit 444, WHO Collaborating Center for Electronic Disease Surveillance, National Institute for Health and Medical Research, Paris 6 University, France
Marguerite Guiguet
Affiliation:
Unit 444, WHO Collaborating Center for Electronic Disease Surveillance, National Institute for Health and Medical Research, Paris 6 University, France
Thomas Hanslik
Affiliation:
Department of Internal Medicine, Ambroise-Pari Hospital, Boulogne-Billancourt, and Paris 5 University, France
Antoine Flahault*
Affiliation:
Unit 444, WHO Collaborating Center for Electronic Disease Surveillance, National Institute for Health and Medical Research, Paris 6 University, France
*
INSERM Unit 444, WHO Collaborating Center for Electronic Disease Surveillance, 27 rue Chaligny, 75571 Paris CEDEX12, France
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To study both surgical and nonsurgical nosocomial infections (NIs) seen by primary-care physicians (general practitioners [GPs]) in France.

Design:

Ongoing surveillance of postdischarge NIs by an organized group of GPs, from August 1997 to July 1999. Both the GP who personally examined the case spontaneously presenting with NI and the responsible hospital physician or surgeon were interviewed by telephone.

Setting:

305 general practices from all French regions.

Results:

2,199 (29%) of 7,540 patients referred for hospitalization reconsulted the GP within 30 days of discharge. In 21 (1%) of the 2,199 cases, an NI was diagnosed by the GP and confirmed as plausible by the responsible hospital physician. We diagnosed an NI in 8 (1.3%) of the post-surgical patients and in 13 (0.8%) of the non-surgical cases within the cohort We saw eight urinary tract infections, seven surgical-site infections, three soft-tissue infections, two respiratory tract infections, and one primary bloodstream infection. In 19 patients (90%), clinical signs of NI appeared within 7 days of discharge. Assuming that all 5,431 patients who were missed for follow-up did not experience any NI, an attack rate of 0.3 per 100 admissions may be estimated for the whole group.

Conclusion:

We diagnosed 1% of NIs following discharge from a hospital in a cohort of 2,199 patients, of which 1.3% were seen post-surgery and 0.8% following nonsurgical admissions. The percentage of postdischarge visits that were for an NI in nonsurgical patients warrants a major effort with feedback to the hospital physician to reduce infection rates.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 8 , August 2001 , pp. 493 - 498
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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. Rosendorf, L, Octavio, J, Estes, J. Effects of methods of postdischarge wound infection surveillance on reported infection rates. Am J Infect Control 1983;11:226–229.Google Scholar
2. Reimer, K, Gleed, C, Nicolle, L. The impact of postdischarge infection on surgical wound infection rates. Infect Control 1987;8:237–240.Google Scholar
3. Brown, R, Bradley, S, Opitz, E, Cipriani, D, Pieczarka, R, Sands, M. Surgical wound infections documented after hospital discharge. Am J Infect Control 1987;15:54–58.Google Scholar
4. Weigelt, J, Dryer, D, Haley, R. The necessity and efficiency of wound surveillance after discharge. Arch Surg 1992;127:77–82.Google Scholar
5. Byrne, D, Lynch, W, Napier, A, Davey, P, Malek, M, Cuschieri, A. Wound infection rates: the importance of definition and post-discharge wound surveillance. JHosp Infect 1994;26:37–43.Google Scholar
6. Keeling, N, Morgan, M. Inpatient and post-discharge wound infections in general surgery. Ann R Coll Surg Engl 1995;77:245–247.Google ScholarPubMed
7. Ferraz, EM, Ferraz, AA, Coelho, HS, Pereira Viana, VP, Sobral, SM, Vasconcelos, MD, et al. Postdischarge surveillance for nosocomial wound infection: does judicious monitoring find cases? Am J Infect Control 1995;23:290–294.Google Scholar
8. Poulsen, K, Meyer, M. Infection registration underestimates the risk of surgical wound infections. J Hosp Infect 1996;33:207–216.Google Scholar
9. Sands, K, Vineyard, G, Piatt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963–970.Google Scholar
10. Weiss, C, Statz, C, Dahms, R, Remucal, M, Dunn, D, Beilman, G. Six years of surgical wound infection surveillance at a tertiary care center. Arch Surg 1999;134:1041–1048.Google Scholar
11. Mangram, A, Horan, T, Pearson, M, Silver, L, Jarvis, W. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
12. Horan, T, Gaynes, R, Martone, W, Jarvis, W, Emori, T. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical site infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
13. Ministère de l'Emploi et de la Solidarité. 100 recommandations pour la surveillance et la prévention des infections nosocomiales. Paris, France: Comité Technique national des Infections Nosocomiales; 1999.Google Scholar
14. Bennenson, A. Control of Communicable Diseases Manual. 16th ed. Washington, DC: APHA; 1995.Google Scholar
15. Ministère de l'Emploi et de la Solidarité. Annuaire des Statistiques Sanitaires et Sociales. Paris, France: SESI; 1999.Google Scholar
16. Holtz, T, Wenzel, R. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992;20:206–213.CrossRefGoogle ScholarPubMed
17. Holbrook, K, Nottebart, V, Hameed, S, Piatt, R. Automated postdischarge surveillance for postpartum and neonatal nosocomial infections. Am J Med 1991;91(suppl 3B):125–130.Google Scholar
18. Sorum, P. Two tiers of physicians in France: general pediatrics declines, general practice rises. JAMA 1998;280:1099–1101.Google Scholar
19. Valleron, A, Garnerin, P. Computer networking as a tool for public health surveillance: the French experiment. MMWR 1992;41:101–110.Google Scholar
20. Etude de faisabilitê de l'observation epidemiologique nationale de la fil-iere ville-hopital grace au Reseau Sentinelles. http://www.b3e.jussieu.fr/sentiweb/fr/bulletins/lepointsur/index.html. Last updated September 1998.Google Scholar
21. Kleisser, D. Introducing MEDWatch: a new approach to reporting medication and device adverse effects and product problems. JAMA 1993;269:2765–2768.Google Scholar
22. Garner, J, Jarvis, W, Emori, T, Horan, T, Hughes, J. CDC definitions for nosocomial infections. J Infect Control 1988;16:128–140.Google Scholar
23. Freeman, J, McGowan, J Jr. Risk factors for nosocomial infection. J Infect Dis 1978;138:811–819.Google Scholar
24. Gardner, M, Altaian, D. Statistics With Confidence. Confidence Intervals and Statistical Guidelines. London, UK: BMJ Publishing Group; 1989.Google Scholar
25. Haley, R, Hooton, T, Culver, D, Stanley, R, Emori, T, Hardison, G, et al. Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med 1981;70:947–959.Google Scholar
26. Horan, T, Culver, D, Gaynes, R, Jarvis, W, Edwards, J, Reid, C, et al. Nosocomial infections in surgical patients in the United States, January 1986June 1992. Infect Control Hosp Epidemiol 1993;14:73–80.Google Scholar
27. Emori, T, Culver, D, Horan, T, Jarvis, W, White, J, Olson, D, et al. National Nosocomial Infections Surveillance System (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
28. Petignat, C, Blanc, D, Francioli, P. Occult nosocomial infections. Infect Control Hosp Epidemiol 1998;19:593–596.Google Scholar
29. Comite Technique National des Infections nosocomiales, Cellule infections nosocomiales, Centres interregionaux de Coordination de la Lutte contre les Infections Nosocomiales Est, Ouest, Paris-Nord, Sud-Est et Sud-Ouest Enquete nationale de prévalence des infections nosocomiales, 1996. Bulletin Epidemiologique Hebdomadaire 1997;36:161–163.Google Scholar
30. Hajjar, J, Savey, A. Pinzaru, G, Coiron, M, Fabry, J. Réseau ISO Sud-est: un an de surveillance des infections du site opératoire. Bulletin Epidemiologique Hebdomadaire 1996;42:183–185.Google Scholar
31. Frey, K, Briggs, J, Broadhead, W. Postdischarge, postoperative nosocomial infection surveillance using random sampling. Am J Infect Control 1990;18:383–385.Google Scholar
32. Nicolas, F. Ethical issues about nosocomial infections. Ann Fr Anesth Réanim 1998;17:415–422.Google Scholar
33. Simchen, E, Wax, Y, Galai, N, Israeli, A. Discharge from hospital and its effect on surgical wound infections: The Israeli Study of Surgical Wound Infections (ISSD). J Clin Epidemiol 1992;45:1155–1163.Google Scholar
34. Mertens, R, Jans, B, Kurz, X. A computerized nationwide network for nosocomial infection surveillance in Belgium. Infect Control Hosp Epidemiol 1994;15:171–179.Google Scholar
35. Williams, E, Fitton, F. Factors affecting early unplanned readmissions of elderly patients to hospital. BMJ 1998;297:784–787.CrossRefGoogle Scholar