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Incidence of Surgical-Site Infections and the Validity of the National Nosocomial Infections Surveillance System Risk Index in a General Surgical Ward in Santa Cruz, Bolivia

Published online by Cambridge University Press:  02 January 2015

Lorena Soleto ,
Marianne Pirard ,
Marleen Boelaert ,
Remberto Peredo ,
Reinerio Vargas ,
Alberto Gianella  and
Patrick Van der Stuyft
Lorena Soleto
Affiliation:
Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia
Marianne Pirard
Affiliation:
Belgian Technical Co-operation, Santa Cruz, Bolivia
Marleen Boelaert
Affiliation:
Institute of Tropical Medicine, Epidemiology Unit, Antwerpen, Belgium
Remberto Peredo
Affiliation:
Hospital San Juan de Dios, Santa Cruz, Bolivia
Reinerio Vargas
Affiliation:
Hospital San Juan de Dios, Santa Cruz, Bolivia
Alberto Gianella
Affiliation:
Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia
Patrick Van der Stuyft*
Affiliation:
Institute of Tropical Medicine, Epidemiology Unit, Antwerpen, Belgium
*
Institute of Tropical Medicine, Epidemiology Unit, Nationale Straat 155, 2000 Antwerpen, Belgium
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Abstract

Objectives:

To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.

Design:

A prospective study with patient follow-up until the 30th postoperative day.

Setting:

A general surgical ward of a public hospital in Santa Cruz, Bolivia.

Patients:

Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed.

Results:

Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a “local” risk index constructed with the above cut-off points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3.

Conclusions:

SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 26 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. lnfect Control Hosp Epidemiol 1999;20:250–280.Google ScholarPubMed
2.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 2000;20:725–730.CrossRefGoogle Scholar
3.Haley, RW, 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;121:182–205.CrossRefGoogle ScholarPubMed
4.The Society for Hospital Epidemiology of America, The Association for Practitioners in Infection Control, The Centers for Disease Control, The Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599–605.CrossRefGoogle Scholar
5.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.CrossRefGoogle ScholarPubMed
6.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S.CrossRefGoogle ScholarPubMed
7.Roy, MC, Herwaldt, LA, Embrey, R, Kuhns, K, Wenzel, RP, Perl, TM. Does the Centers for Disease Control's NNIS System risk index stratify patients undergoing cardiothoracic operations by their risk of surgical-site infection? Infect Control Hosp Epidemiol 2000;21:186–190.CrossRefGoogle ScholarPubMed
8.Gaynes, RP. Surgical-site infections and the NNIS SSI risk index: room for improvement. Infect Control Hosp Epidemiol 2000;21:184–185.CrossRefGoogle ScholarPubMed
9.Delgado-Rodriguez, M, Medina Cuadros, M, Martinez Gallego, G, Sillero Arenas, M. The usefulness of intrinsic risk factors of infection of the surgical site as predictors of other infections and death [in Spanish]. Enferm Infecc Microbiol Clin 1998;16:2–8.Google ScholarPubMed
10.Geubbels, E, Mintjes-de Groot, AJ, van den Berg, JM, de Boer, AS. An operating surveillance system of surgical-site infections in the Netherlands: results of the PREZIES National Surveillance Network. Infect Control Hosp Epidemiol 2000;21:311–318.CrossRefGoogle ScholarPubMed
11.Gaynes, RP. Surveillance of surgical-site infections: the world coming together? Infect Control Hosp Epidemiol 2000;21:309–310.CrossRefGoogle ScholarPubMed
12.Hall, A. Nosocomial infection in developing countries: time to learn. Trop Med Int Health 1998;3:517–517.CrossRefGoogle Scholar
13.Pannuti, CS, Grinbaum, RS. An overview of nosocomial infection control in Brazil. Infect Control Hosp Epidemiol 1995;16:170–174.CrossRefGoogle ScholarPubMed
14.Wey, SB. Infection control in a country with annual inflation of 3.600%. Infect Control Hosp Epidemiol 1995;16:175–178.CrossRefGoogle Scholar
15.Ponce De Leon Rosales, S. Intrahospital infections and quality of medical care: is it possible to save in health? [in Spanish]. Salud Publica Mex 1991;33:3–8.Google ScholarPubMed
16.Ponce De Leon Rosales, S, Romero Oliveros, MC, Sandoval Gomez, MN, Ruiz Palacios, G. Efficacy of a program for the control of nosocomial infections: a real possibility for improving the quality of medical care [in Spanish]. Salud Publica Mex 1986;28:593–598.Google ScholarPubMed
17.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
18.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, Approved Standard, 6th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997.Google Scholar
19.Simmons, BP. CDC guidelines on infection control. Infect Control 1982;3:187–196.CrossRefGoogle ScholarPubMed
20.Owens, WD, Felts, JA, Spitznagel, ELJ. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–243.CrossRefGoogle ScholarPubMed
21.Kleinbaum, DG, Kupper, LL, Muller, KE, Nizam, A. Applied Regression Analysis and Multivariable Methods, 3rd ed. Pacific Grove, CA: Duxbury Press; 1998.Google Scholar
22.Dean, AG, Dean, JA, Coulombier, D, et al. Epi-Info, Version 6: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention; 1994.Google Scholar
23.Burns, SJ, Dippe, SE. Postoperative wound infections detected during hospitalization and after discharge in a community hospital. Am J Infect Control 1982;10:60–65.CrossRefGoogle Scholar
24.Medina-Cuadros, M, Sillero-Arenas, M, Martinez-Gallego, G, Delgado-Rodriguez, M. Surgical wound infections diagnosed after discharge from hospital: epidemiologic differences with in-hospital infections. Am J Infect Control 1996;24:421–428.CrossRefGoogle ScholarPubMed
25.Santos, KR, Fonseca, LS, Bravo Neto, GP, Gontijo Filho, PP. Surgical site infection: rates, etiology and resistance patterns to antimicrobials among strains isolated at Rio de Janeiro University Hospital. Infection 1997;25:217–220.CrossRefGoogle Scholar
26.Dierssen, T, Vicente, P, Seco, JL, Rodrigo, I, Delgado-Rodriguez, M. Risk factors associated with the development of surgical wound infection in a general surgery service [in Spanish]. Enferm Infecc Microbiol Clin 1996;14:240–244.Google Scholar
27.Wolff, MJ. Use and misuse of antibiotics in Latin America. Clin Infect Dis 1993;17(suppl 2):S346–S351.CrossRefGoogle ScholarPubMed
28.Salemi, C, Anderson, D, Flores, D. American Society of Anesthesiology scoring discrepancies affecting the National Nosocomial Infection Surveillance System: surgical-site-infection risk index rates. Infect Control Hosp Epidemiol 1997;18:246–247.CrossRefGoogle ScholarPubMed
29.Freitas, PF, Campos, ML, Cipriano, ZM. Suitability of the NNISS risk index to predict the incidence of surgical site infection on a university hospital in Florianopolis, South Brazil [in Portuguese]. Rev Assoc Med Bras 2000;46:359–362.CrossRefGoogle ScholarPubMed
30.Roy, MC, Perl, TM. Basics of surgical-site infection surveillance. Infed Control Hosp Epidemiol 1997;18:659–668.CrossRefGoogle ScholarPubMed
31.Zaidi, M. Nosocomial infection control in Latin America. Infect Control Hosp Epidemiol 1993;14:617–618.CrossRefGoogle ScholarPubMed