Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-09T13:15:03.993Z Has data issue: false hasContentIssue false

Surgeon-Specific Wound Surveillance: The Family or the Bean Counters?

Published online by Cambridge University Press:  21 June 2016

Charles S. Bryan*
Affiliation:
Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
*
5 Richmond Medical, ACZ2, Area R, Columbia, SC 29203

Extract

I generally associate the “product commentary” section of this journal with such things as urethral catheters, vascular access devices and antiseptic solutions. Hence, the invitation to write about surgical wound surveillance seemed at first inappropriate. However, the gathering storm over who will supervise wound surveillance involves our own unique product: infection control data. My task is to address concerns common to all business enterprises:

▪ What is the demand?

▪ What does the consumer want?

▪ Who should be the chief executive officer?

▪ What should be our current strategy?

More than 70 years ago, it was shown that making surgeons aware of infection rates can lower their incidence.’ It is now customary to cite a series of studies suggesting that surgeon-specific rate reporting lowers the incidence of postoperative wound infection. First, Cruse and Foord correlated this practice with a lowering of the infection rate from 2.6% to 0.6%. Next, Condon et al. and then Olson et al. reported similar successes. Finally, data from the Centers for Disease Control's SENIC project indicated that two factors clearly correlated with reduced wound infection rates: 1) strong surveillance and control programs; and 2) the presence of an effective infection control physician.” Having both elements in place reduced the infection rate by 41% or 35% for low-risk or high-risk patients, respectively. Having surveillance alone reduced the infection rate by 19% for low-risk patients and 20% for high-risk patients. These findings made the case for wound surveillance seem ironclad.

Type
Special Sections
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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. Brewer, GE: Studies in aseptic technique. JAMA 1915; 64:13691372.10.1001/jama.1915.02570430001001Google Scholar
2. Guise, PJE, Foord, R: The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980; 60:2740.Google Scholar
3. Condon, RE, Schulte, WJ, Malgoni, MA, et al: Effectiveness of a surgical wound surveillance program. Arch Surg 1983; 118:303307.10.1001/archsurg.1983.01390030035006Google Scholar
4. Olson, M, O'Connor, M, Schwartz, ML.: Surgical wound infections: A five-year prospective study of 20.193 wounds al the Minneanolis VA Medical Center. Ami Surg 1984; 188:253299.Google Scholar
5. Haley, KW, 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; 121:182205.10.1093/oxfordjournals.aje.a113990CrossRefGoogle ScholarPubMed
6. Haley, RW: Who will generate surgeon-specific rates? The gauntlet is down (letter). Infect Control Hasp Epidemiol 1988; 9:475476.10.2307/30145167CrossRefGoogle Scholar
7. Scheckler, WE: Surgeon-specific wound infection rates—A potentially dangerons and misleading strategy (perspective). Infect Control Hasp Epidemiol 1988; 9:145146.10.2307/30145420Google Scholar
8. Platt, R, Munoz, A, Stella, J, et al: Antibiotic prophylaxis for cardiovascular surgery: Efficacy with coronary artery bypass. Ann Intern Med 1984; 103:770774.10.7326/0003-4819-101-6-770Google Scholar
9. Condon, RE, Haley, RW, Lee, JT, et al: Does injection control control infection? Arch Surg 1988; 123:250256.10.1001/archsurg.1988.01400260138019Google Scholar
10. Penin, GB. Ehrenkranz, NJ: Priorities for surveillante and cost-effective control of postoperative infection. Arch Surg 1988; 123:13051308.10.1001/archsurg.1988.01400350019001Google Scholar
11 Fry, DE: Discussion of Penin E, Ehrenkranz NJ: Priorities for surveillance and cost-effective control of postoperative infection. Arch Surg 1988; 123:13051308.Google Scholar
12. Garner, JS, Jarvis, WR, Emori, TG, et al: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128140.10.1016/0196-6553(88)90053-3Google Scholar
13. Alexander, JW: The contributions of infection control to a century of surgical progress. Ann Surg 1985; 201:423428.10.1097/00000658-198504000-00004Google Scholar
14. Bryan, CS: Of soap and Semmelweis (editorial). Infect Control 1986; 7:445447.10.1017/S0195941700064924Google Scholar