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The Effect of Frequency of Chart Review on the Sensitivity of Nosocomial Infection Surveillance in General Surgery

Published online by Cambridge University Press:  02 January 2015

Miguel Delgado-Rodríguez ,
Antonio Gómez-Ortega ,
Antonio Sierra ,
Trinidad Dierssen ,
Javier Llorca  and
María Sillero-Arenas
Miguel Delgado-Rodríguez*
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain
Antonio Gómez-Ortega
Affiliation:
Service of General Surgery, Hospital General Ciudad de Jaén, Spain
Antonio Sierra
Affiliation:
University of Canarias Hospital, School of Medicine, Tenerife, Spain
Trinidad Dierssen
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain Service of Preventive Medicine, Hospital Sierrallana, Santander, Spain
Javier Llorca
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Hospital Sierrallana, Santander, Spain
María Sillero-Arenas
Affiliation:
Division of Health Programs, Provincial Office for Health, Jaén, Spain
*
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Avenida Cardenal Herrera Oria s/n, 39011-Santander, Spain
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Abstract

Objective:

To assess the sensitivity of different frequencies of nosocomial infection surveillance (NIS) in general surgery.

Design:

Data obtained with a prospective daily NIS are compared with those of hypothetical cross-sectional studies carried out with different frequencies (from one weekly visit up to one visit every other day).

Setting:

General surgery services at three hospitals.

Main Outcome Measure:

Sensitivity in the detection of nosocomial infection (overall and stratified by site), compared to a gold standard of prospective surveillance of every patient's complete medical record daily from the first day after surgery until discharge and once more after discharge.

Patients:

5,859 patients.

Results:

837 nosocomial infections were detected by the gold standard (58.8% were surgical-site infections [SSI]). The sensitivity of weekly NIS for all infections was 74.5% (95% confidence interval [CI95], 71.4%-77.5%) and varied from 65.1% (CI95, 56.2%-73.3%) for urinary tract infection to 83.3% (CI95, 62.6%-95.3%) for respiratory tract infection; it was 76.4% (CI95, 72.4%-80.1%) for SSI. As expected, sensitivity increased with the frequency of NIS. Performing NIS every 4 days improved sensitivity significantly, to 82.3% (CI95, 79.5%-84.8%) for all infections and 83.3% (CI95, 79.7%-86.5%) for SSI. One visit every other day increased the sensitivity for all infections by another 4.9%, mainly due to increased detection of urinary tract and other less severe infections.

Conclusions:

The sensitivity of two visits a week exceeded that of one weekly visit by approximately 8%, and one visit every other day added another 5% increase. Results varied according to duration of infection and postdischarge hospital stay.

Type
The International Perspective
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 3 , March 1999 , pp. 208 - 212
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
2. Scheckler, WE. Continuous quality improvement in a hospital system: implications for hospital epidemiology. Infect Control Hosp Epidemiol 1992;13:288–292.Google Scholar
3. Freeman, J, McGowan, JE Jr. Methodologie issues in hospital epidemiology, I: rates, cases-finding and interpretation. Rev Infect Dis 1981;3:658–667.CrossRefGoogle Scholar
4. Thompson, RL. Surveillance and reporting of nosocomial infections. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1987:70–82.Google Scholar
5. Rhame, FS, Sudderth, WD. Incidence and prevalence as used in the analysis of the ocurrence of nosocomial infections. Am J Epidemiol 1981;113:1–11.Google Scholar
6. Delgado-Rodríguez, M, Cueto Espinar, A, Rodríguez-Contreras Pelayo, R, Gálvez Vargas, R. Usefulness of Rhame and Sudderth's formula on nosocomial infection surveillance. Rév Epidemiol Santé Publique 1987;35: 482–487.Google Scholar
7. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
8. Horan, TC, Gaynes, RP, Marrone, WJ, Jarvis, WR, Emori, TG. Centers for Diseases Control (CDC) definitions for nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:60fr608.Google Scholar
9. Medina-Cuadros, M, Sillero-Arenas, M, Martínez Gallego, G, Delgado-Rodríguez, M. Surgical wound infections diagnosed after discharge from hospital. Epidemiological differences with in-hospital infections. Am J Infect Control 1996:24:421–428.Google Scholar
10. Wenzel, RP, Osterman, CA, Hunting, KJ, Gwaltney, JM Jr. Hospital-acquired infections, I: surveillance in a university hospital. Am J Epidemiol 1976;103:251–260.CrossRefGoogle ScholarPubMed
11. Haley, RW, Schaberg, DR, McClish, DK, Quade, D, Crossley, KB, Culver, DH, et al. The accuracy of retrospective chart review in measuring nosocomial infection rates. Am J Epidemiol 1980;111:516–533.Google Scholar
12. Wenzel, RP, Osterman, CA, Townsend, TR, Veazey, JM Jr, Servis, KH, Miller, LS, et al. Development of a statewide program for surveillance and reporting of hospital-acquired infections. J Infect Dis 1979;140: 741–746.Google Scholar
13. Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologie Research. Belmont, CA: Lifetime Learning Publications; 1982.Google Scholar