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Surgical wound infections: A 5-year prospective study of 20,193 wounds at the Minnesota VA Medical Center
94
American INFECTION
Reviews: Literature
may be needed to evaluate tiveness of these teams.
the true cost-effec-
Surgical wound infections: A 5.year prospective study of 20,193 wounds Minnesota VA Medical Center
at the
Olson M, O’Connor M, Schwartz ML: Ann Surg 199:253-259, 1984. Reprint requests: Mary Olson, R.N., Department of Surgery (112) Veterans Administration Medical Center, 54th St. and 48th Ave. South, Minneapolis, MN 55417.
This article describes a prospective study of the impact of surveillance on surgical wound infections. The surveillance was conducted during a 5-year period and involved 20,193 operations. A study nurse examined each wound daily, cultured all suspicious wound drainage, and followed up on the patients in outpatient clinics for 30 days postoperatively. Infection rates were reported to individual surgeons as well as operating room personnel on a monthly basis. There was a steady decline in the overall infection rates through the 5-year period from 4.2% to 1.9% (p < 0.005). This impact was observed for both clean and clean contaminated surgeries. The investigators hypothesize that early identification of problems enabled the hospital and physicians to change practices or procedures to prevent infections. They estimated that this program saved 2740 in-hospital days and nearly $750,000. This study confirms the observations of others that ongoing surveillance of surgical wounds plus feedback of results to those involved in the surgery is an effective method of reducing nosocomial surgical wound infections. The investigators believed that their program had a significant direct impact on infection rates and resulted in considerable cost savings. Multiple exposure of hospital employees hepatitis B: Five case studies
to
Dandoy S, Kirkman-Liff 8, Krakowski F: Arch Intern Med 144:720-723, 1984. Reprint requests: Dr. Suzanne Dandoy, Center for Health Services Administration, Arizona State Unive,sity, Tempe, AZ 85287.
This report describes five episodes of exposures of hospital employees to presumed cases
Journal of CONTROL
of hepatitis B. On each occasion employees were exposed to the risk before the patient’s condition was known to be potentially infectious. The report reviews the settings of the exposure, types of personnel involved, the actions taken, and the costs of subsequent preventive treatment. In four hospitals the hepatitis B-exposed employees received hepatitis B immune globulin (HBIG), some with no consideration of the actual extent of the exposure. In the fifth hospital hepatitis B vaccine was given. Procedures followed in the hospitals indicated problems in understanding the potential communicability of hepatitis B, in transferring information between hospital units, in using hospital charts to determine diagnosis, and in obtaining serologic confirmation of hepatitis B. None of the hospitals appeared to have effective leadership in infection control activities. The costs to the hospital for attempted postexposure prophylaxis in these occurrences ranged from $982 to $7998. Several errors were noted in the strategies that were used for postexposure management, including possible overuse of both HBIG and vaccine, delayed administration of treatment, and incomplete follow-up of prophylactic therapy. The investigators stressed the need for an organized, effective approach to hepatitis prophylaxis to prevent the needless waste of money and resources in other hospitals with similar exposures. Care must be given to document the infection status of the index case and validate the exposure histories of personnel. Postexposure prophylaxis should be limited to susceptible individuals who might be at high risk of contracting disease from their patient contacts. The investigators concluded that many of the problems that they identified could have been overcome by better education of hospital personnel regarding the infectivity and routes of transmission of hepatitis B, more careful epidemiologic investigation of exposures, development and dissemination of detailed procedures for hepatitis exposures within the hospital, education of physicians and infection control personnel regarding proper postexposure prophylaxis, and consideration for immunization of high-risk employees with hepatitis B vaccine.
American INFECTION
Reviews: Literature
may be needed to evaluate tiveness of these teams.
the true cost-effec-
Surgical wound infections: A 5.year prospective study of 20,193 wounds Minnesota VA Medical Center
at the
Olson M, O’Connor M, Schwartz ML: Ann Surg 199:253-259, 1984. Reprint requests: Mary Olson, R.N., Department of Surgery (112) Veterans Administration Medical Center, 54th St. and 48th Ave. South, Minneapolis, MN 55417.
This article describes a prospective study of the impact of surveillance on surgical wound infections. The surveillance was conducted during a 5-year period and involved 20,193 operations. A study nurse examined each wound daily, cultured all suspicious wound drainage, and followed up on the patients in outpatient clinics for 30 days postoperatively. Infection rates were reported to individual surgeons as well as operating room personnel on a monthly basis. There was a steady decline in the overall infection rates through the 5-year period from 4.2% to 1.9% (p < 0.005). This impact was observed for both clean and clean contaminated surgeries. The investigators hypothesize that early identification of problems enabled the hospital and physicians to change practices or procedures to prevent infections. They estimated that this program saved 2740 in-hospital days and nearly $750,000. This study confirms the observations of others that ongoing surveillance of surgical wounds plus feedback of results to those involved in the surgery is an effective method of reducing nosocomial surgical wound infections. The investigators believed that their program had a significant direct impact on infection rates and resulted in considerable cost savings. Multiple exposure of hospital employees hepatitis B: Five case studies
to
Dandoy S, Kirkman-Liff 8, Krakowski F: Arch Intern Med 144:720-723, 1984. Reprint requests: Dr. Suzanne Dandoy, Center for Health Services Administration, Arizona State Unive,sity, Tempe, AZ 85287.
This report describes five episodes of exposures of hospital employees to presumed cases
Journal of CONTROL
of hepatitis B. On each occasion employees were exposed to the risk before the patient’s condition was known to be potentially infectious. The report reviews the settings of the exposure, types of personnel involved, the actions taken, and the costs of subsequent preventive treatment. In four hospitals the hepatitis B-exposed employees received hepatitis B immune globulin (HBIG), some with no consideration of the actual extent of the exposure. In the fifth hospital hepatitis B vaccine was given. Procedures followed in the hospitals indicated problems in understanding the potential communicability of hepatitis B, in transferring information between hospital units, in using hospital charts to determine diagnosis, and in obtaining serologic confirmation of hepatitis B. None of the hospitals appeared to have effective leadership in infection control activities. The costs to the hospital for attempted postexposure prophylaxis in these occurrences ranged from $982 to $7998. Several errors were noted in the strategies that were used for postexposure management, including possible overuse of both HBIG and vaccine, delayed administration of treatment, and incomplete follow-up of prophylactic therapy. The investigators stressed the need for an organized, effective approach to hepatitis prophylaxis to prevent the needless waste of money and resources in other hospitals with similar exposures. Care must be given to document the infection status of the index case and validate the exposure histories of personnel. Postexposure prophylaxis should be limited to susceptible individuals who might be at high risk of contracting disease from their patient contacts. The investigators concluded that many of the problems that they identified could have been overcome by better education of hospital personnel regarding the infectivity and routes of transmission of hepatitis B, more careful epidemiologic investigation of exposures, development and dissemination of detailed procedures for hepatitis exposures within the hospital, education of physicians and infection control personnel regarding proper postexposure prophylaxis, and consideration for immunization of high-risk employees with hepatitis B vaccine.