hurt INFECTIONS AFTER HYSTERECTOMY:...

hurt INFECTIONS AFTER HYSTERECTOMY: OPPORTUNITIES FOR PRACTICE IMPROVEMENT

G Taylor, T Herrick, M Mah American Journal of Infection repress Vol 26 (June 1998) 254-257

Surveillance of surgical site infections (SSIs) is an important measure of patient care in the perioperative patient care setting. Comparing practice to patient consequences provides valuable information necessary in evaluating care. This meditation was designed to determine the frequent occurrence of SSIs in postoperative patients undergoing vaginal and abdominal hysterectomies. The primary intention was to report the surveillance issues to the surgeons involved in the way that that practice could be evaluated and changed as privationed As hospital stays for postsurgical patients decrease, there has been increased interest upon how this affects quality patient care, and SSIs may be an important indicator. Part of the care provided in the hereafter may require some sort of surveillance as an ongoing activity.

systems Researchers conducted a prospective postdischarge surveillance of patients undergoing abdominal (ie, total, subtotal, partial) or vaginal hysterectomies between Feb 1 and Dec 31 1995 Surgeon were contacted the same month after a patient's surgery date to determine which patients contracted SSIs. Data were gathered and categorized according to course surgeon, and the National Nosocomial Infection Surveillance (NNIS) method The NNIS system classifies cases through surgical contamination classification, duration of proceeding and presence or absence of premorbid disease processe This method allows patients to be subdivided into categories of subdued moderate, and high infection risk. A retrospective pharmacy record review also was actionsed and revealed antimicrobial prophylaxis use.

Surgeon were given the 1992 Center for Disease hinder and Prevention (CDC) definition of SSI. The CDC classifies a grief an SSI if

* corrupt drainage from the incision (excluding stitch or staple abscess) is present; organisms are isolated from an aseptically obtained tillage of fluid or tissue from a injury closed primarily;

* localized pain or tendernes is at hand and the wound spontaneously dehisces or is deliberately render free of accessed by a surgeon, unless agriculture results from the wound are negative;

* evidence of infection is rest on direct examination (eg, during the surgical proceeding by histopathologic or radiologic examination);

* suppurating drainage is obtained from a drain placed end a stab wound into the organ space; or

* the surgeon diagnoses infection.

Bimonthly, surgeon were sent a list of their patients' names, surgical processs and procedure dates. Surgeons were asked to provide the following information.

* Was patient seen in follow-up?

* Did SSI (as defined on CDC criteria) develop after discharge?

* Was infection superficial, difficult or involving organ space?

* Was patient readmitted to the hospital?

Patients were further categorized as receiving appropriate or inappropriate prophylaxis antimicrobial regimen. Patients were considered to have received appropriate prophylaxis if the antimicrobial regimen was cefazolin. All other agents were considered inappropriate unles chart review documented a history of allergy, in which case vancomycin was accepted as an alternative.

originates The total sample of patients followed from Feb 1 to Dec 31 1995 was 766 Each underwent a clean-contaminated abdominal or vaginal hysterectomy. Surgical site infections were discovered in 55 of the patients (ie, 50 abdominal, five vaginal). No statistical significance was noted in infection rates between patients undergoing vaginal hysterectomy and those undergoing abdominal hysterectomy. As was rely uponed patients classified moderate risk beneath the NNIS system had higher infection rates than the low-risk patients for the two abdominal and vaginal hysterectomies.

Twenty-six surgeon participated in the examine Infection rates among the individual surgeon ranged from 0% to 346% Three surgeon had higher infection rates in their patients who underwent abdominal hysterectomy compared to their colleagues. Among these three surgeon antimicrobial use ranged from 255% to 33% Thirteen of the 55 patients who acquired SSIs were readmitted to the hospital, and 12 of the 13 patients were treated for postoperative infection.

Of the 766 patients, 221 received a certain form of prophylaxis and 542 did not. Patients undergoing vaginal hysterectomy were more likely to receive prophylaxis than those undergoing an abdominal management The infection rate for those patients receiving prophylaxis was 86% and the infection rate for patients not receiving prophylaxis was 66% Altogether, 20% of all patients acquiring SSIs postoperatively received appropriate prophylaxis, and 654% received no prophylaxis at all.

Discussion. Surgical patients today are more likely to be discharged sooner than in the past. Health care practitioners are examining for what cause this relates to patient care issues with increasing concern. Surveillance of SSIs is single measure that can be used to gain information about patient issues Currently, there are few studies available that measure postoperative SSIs in patients undergoing outpatient gynecological actions Researchers in one study reviewed 118 patients undergoing the two inpatient and outpatient hysterectomies. Patients answered questionnaires to ascertain postdischarge infections. The infection rate noted was 76% Researchers in another thought employed multiple methods of determining infections after different proceedings The researchers reported a 2% infection rate after abdominal hysterectomies and 19% after vaginal hysterectomies.