Surgical wound infections occurring in day surgery patients

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India

Background:

Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.

Aims and Objectives:

This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.

Materials and Methods:

In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.

Results:

Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.

Conclusions:

DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

Fast-track care for pertrochanteric hip fracture: What impact on function and autonomy after discharge?

INTRODUCTION

Fast-track treatment of pertrochanteric fracture is being developed in traumatology. The present study hypothesis was that fast-track treatment of pertrochanteric fracture does not jeopardize patient autonomy.

MATERIAL AND METHOD

A single-center prospective comparative observational study, conducted from 2014 to 2016 in the University Hospital of Angers, France, included patients presenting with isolated A1 or A2 pertrochanteric fracture on the AO classification, managed by intramedullary nailing and requiring transfer to Post-acute Recovery (PAR). The fast-track exposure group were transferred directly on postoperative day 1, while the non-exposure group received postoperative care in the surgery department before transfer to PAR. The main endpoint was difference in Parker score between admission and discharge. Secondary endpoints comprised type of walking aid at discharge and destination of discharge from PAR.

RESULTS

109 patients were initially included, with 54 patients (27 pairs) after matching. There was a significant difference in reduction in Parker score in favor of fast-track: -1.27 (95% CI: -2.27; -0.32) (p=0.012). There were no differences in amount or type of aid at discharge or discharge destination, although there was a trend toward greater discharge to the initial place of residence with fast-track.

DISCUSSION

Orthopedics is heading to the fast-track. Previous studies reported shorter hospital stay, comparable survival and complications rates, and significant cost-saving. The present study addressed progression: fast-track patients showed significantly less loss of walking autonomy.

CONCLUSION

Fast-track management of pertrochanteric fracture significantly reduced loss of walking autonomy, without significant impact on discharge destination or walking aids.

LEVEL OF EVIDENCE

IIB, exposure/non-exposure cohort.

Fast track care for pertrochanteric hip fractures: How does it impact length of stay and complications?

INTRODUCTION

The medical and economic impact of treating pertrochanteric hip fractures is growing. We hypothesized that fast track surgery of pertrochanteric fractures would reduce the length of stay (LOS) without compromising the quality of care.

MATERIALS AND METHODS

This was a prospective, observational, single-center cohort study conducted between 2014 and 2016 at the Angers Teaching Hospital in France. The enrolled patients had an isolated A1 or A2 proximal femur fracture (AO classification) that was treated surgically by intramedullary nailing and required post-acute rehabilitation (PAR) care. The exposed FT cohort was transferred into the PAR pathway on postoperative day 1. The non-exposed (control) group was provided with postoperative care in the surgery unit before transfer to PAR. The primary outcome was the total LOS (LOS in surgery+LOS in PAR). The secondary objectives were to determine the immediate survival, 1-year survival, postoperative complications and average cost of hospitalization.

RESULTS

The study enrolled 109 patients initially, with 54 patients eligible for analysis after matching (27 pairs). The LOS in PAR and total LOS were 45.85±19.24 days and 48.56±19.36 days in the FT group (n=27), and 68.41±48.77 days and 77.85±48.80 days in the control group (n=27). Thus the LOS in PAR and total LOS were significantly lower in the FT group (p=0.022, p=0.003). There was no significant difference in the number of early deaths, complications, and 1-year survival without rehospitalization between cohorts. The mean cost per patient was lower in the FT cohort.

DISCUSSION

The FT pathway has already been adopted in orthopedics. For patient who suffer a hip fracture, it contributes to reducing the total LOS without negatively impacting the quality of care. Early health economics studies support this care pathway.

CONCLUSION

The FT approach to treating pertrochanteric fractures reduces total LOS without increasing mortality or complication rates. The 1-year survival is comparable.

LEVEL OF EVIDENCE

IIB, Exposed/Unexposed cohort.

Outpatient Latarjet surgery for gleno-humeral instability: Prospective comparative assessment of feasibility and safety

BACKGROUND

Some surgical procedures are rarely done on an outpatient basis. The primary objective of this study was to assess the safety of outpatient surgical shoulder stabilisation using the Latarjet procedure.

HYPOTHESIS

The Latarjet procedure is safe when performed on an outpatient basis provided the patients are managed according to a specifically designed programme starting at the decision to undergo surgery and ending at the end of the early postoperative period.

PATIENTS AND METHODS

Consecutive patients with unidirectional anterior shoulder instability managed in 2013-2014 by primary open, minimally invasive surgery involving coracoid process transfer as described by Latarjet was included prospectively. One of the surgeons routinely offered outpatient surgery to patients who met none of the usual exclusion criteria (age>60years, ASA 3-4, and long distance from home to hospital). Standardised protocols were applied for anaesthesia and analgesia. The primary evaluation criterion was failure of the admission modality, defined as inpatient admission of a patient after outpatient surgery either without prior discharge or within 1week after discharge. Secondary evaluation criteria were early postoperative symptoms and functional outcomes after at least 1year. All self-reported criteria were entered online by the patients.

RESULTS

Of 46 included patients, 17 had outpatient surgery and 29 inpatient surgery. There were 41 males and 5 females, with a mean age of 25.3±6.4years. No significant baseline differences were found between the two groups. None of the outpatients required inpatient admission or readmission. No postoperative complications were recorded. After a mean follow-up of 18.5±5.2months, the two groups showed no significant differences for return to sports, apprehension, avoidance behaviours, or functional outcomes. Most patients were satisfied with their management and outcomes.

CONCLUSION

No serious adverse events were recorded in this first French prospective evaluation of the safety of open, minimally invasive shoulder stabilisation by the Latarjet procedure performed on an outpatient basis. Thus, in selected patients, the risks of outpatient surgery are similar to those of inpatient surgery.

LEVEL OF EVIDENCE

III, prospective, comparative, non-randomised study.

Monitoring patient safety in health care: building the case for surrogate measures

BACKGROUND

Objective measurements are notably lacking for many adverse events in health care. A new approach to monitoring such events is based on the experience in measuring hospital-associated infections.

DEVELOPING OBJECTIVE AND UNIVERSAL MEASURES

An essential tenet of the current goal of surveillance-focusing only on rigorously confirmed adverse events-is neither necessary nor achievable across the entire health care system. Efforts should be directed instead to creating objective measures of quality of care and of outcomes that can be used by all health care facilities. Adopting objective measures would be easier if health care was open to surrogate measures of important outcomes. Surrogate measures of interest for infection surveillance are used to identify objective, readily ascertained events that are sufficiently correlated with infections to provide useful information about organizations' infection rates. For example, the surgical site infection rate following coronary artery bypass appears to correlate closely enough with the proportion of patients who receive extended courses of inpatient antibiotics to be a useful indicator of a hospital's outcomes for the procedure.

CONCLUSION

Developing clinically relevant process or surrogate measures that clinicians would use to improve patient outcomes is essential. These measures could be relevant not only to hospital-acquired infections but other health care-related adverse events that are relatively common yet require substantial resources to identify.

A study of telephone screening and direct observation of surgical wound infections after discharge from hospital

Post-discharge surveillance of surgical site infection is necessary if accurate rates of infection following surgery are to be available. We undertook a prospective study of 376 knee and hip replacements in 366 patients in order to estimate the rate of orthopaedic surgical site infection in the community. The inpatient infection was 3.1% and the post-discharge infection rate was 2.1%. We concluded that the use of telephone interviews of patients to identify the group at highest risk of having a surgical site infection (those who think they have an infection) with rapid follow-up by a professional trained to diagnose infection according to agreed criteria is an effective method of identifying infection after discharge from hospital.

Risk factors for surgical site infections in a free-standing outpatient setting

BACKGROUND

More information about risk factors for surgical site infections in outpatient settings is necessary for creation of surveillance systems in this field.

OBJECTIVE

The aim of this study was to determine the incidence of surgical site infections (SSI) in an outpatient setting and to investigate whether the risk index of the National Nosocomial Infections Surveillance (NNIS) System is appropriate for outpatient settings.

METHODS

A retrospective cohort design was used to investigate SSI following all hernia repairs and varicose veins operations over a 9-year period in a freestanding outpatient setting. The exposure variables studied were age, sex, and American Society of Anesthesiologists (ASA) score of the patient; duration of operation; performing surgeon's name; type of operation; type of anesthesia; and follow-up period. An univariable and a multivariable analysis were performed to determine risk factors for SSI.

RESULTS

A total of 1095 operations were performed: 714 on varicose veins and 381 on hernia repairs. The median follow-up period was 43 days. The crude SSI rate was 1.2% (varicose veins operations, 1.5%; hernia repair operations, 0.5%). According to the results of the logistic regression model, only 1 factor remained significant: Patients with spinal anesthesia were 11 times as likely to develop a SSI as patients with any other type of anesthesia (95% CI, 2.15-200.5).

CONCLUSION

The NNIS risk index was not suitable for assessing SSI rates in this outpatient setting and for these specific procedures.

[Ambulatory and day surgery]

Ambulatory surgical care is intended to save healthcare expenditure from the economical viewpoint. From the patients point of view significant advantages as well as specific disadvantages of ambulatory surgery are known. The increase in the volume and complexity of procedures provided in an ambulatory setting are driven by improvements in anesthesia and surgical technique as well as by changes in financing and reimbursement. Therefore careful quality control and scientific evidence for the safety of increasingly used complex surgical procedures for higher risk patients is essential. Reducing the surgical trauma by minimally invasive surgical techniques and very good controllability by modern anesthesia concepts is making the management of the postoperative period crucial for successful ambulatory surgery. Most of the complications and common problems during the postoperative period, such as pain, nausea and vomiting, are not specific for ambulatory surgery, but management places an increasing burden of responsibility not only on general and specialised physicians, but also on other health professionals, patients, and family members.

Wound infection in day-surgery

To determine the surgical wound infection rate associated with day-surgery and to assess whether infection was related to patient factors, a prospective study of all electively operated adult day-cases was carried out during a 6 month period between January and June 1996. The study included gastroenterological orthopaedic, vascular, plastic and urological surgery. No operations involving obviously infected patients were performed in the unit. Strict criteria for diagnosis of infection were used. All patients were examined on the 7th and 30th post-operative day. A total of 642 (98.8%) patients were included (316 females 334 males). Infection developed in 22 of the 642 patients (3.5%), only three were diagnosed before the 7th day visit. Orthopaedic procedures accounted for more than 40% of the surgery, but only 22.7% of the wound infections. Gastroenterology made up nearly 36% of the procedures and accounted for 36.4% of the infections. Vascular procedures were 5.7% of the total but accounted for 18% of the infections. No correlation was found between age, gender, operation time or ASA-group and the infection rate. The study is to small to quantify with statistical significance risk-factors associated with wound infection in ambulatory surgery. Our data may suggest that the type of surgery as well as individual factors associated with surgeons may influence the wound infection rate.

Surgical site infections in ambulatory surgery: a 5-year experience

OBJECTIVES

To evaluate the ambulatory surgical site infection rate and risk factors associated with surgical site infection.

METHODS

We conducted a case-control analysis of all ambulatory surgeries between January 1, 1993, and December 31, 1997. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis.

SETTING

A 140-bed tertiary-care teaching hospital for adult patients with cancer.

RESULTS

The study followed 1350 outpatient surgeries. Thirty-eight patients had a surgical site infection (rate per 100 surgeries: 2.8). The risk factors statistically associated with surgical site infection were postoperative antibiotics (OR = 7.5; 95% CI, 2.5-23.0), and surgical time >35 minutes (OR = 2.4; 95% CI, 1.1-5.5).

CONCLUSIONS

The surgical site infection rate for same-day surgery at our hospital is within the limits reported in the literature and below the rates reported previously for inpatient surgeries at our hospital. Full review of medical records and microbiology reports at day 30 allowed us to identify infections that otherwise would have been missed. Postoperative antibiotics may increase the risk of infection.

The importance of definitions and methods in surgical wound infection audit

We investigated the value of a full-time audit nurse personally following up every patient from admission to 30 days postoperatively in order to obtain accurate surgical wound infection rates. Our results show that this type of audit is an effective, although time-consuming, way of collecting accurate data on wound infection rates. It enabled the early identification of problem areas in practice and facilitated the adoption of evidence based practice. As a result of the audit there was a significant reduction in the clean wound infection rate from 13.9% in November 1995 to 7.9% in March 1998 (P= 0.05).

Evaluation of two retrospective active surveillance methods for the detection of nosocomial infection in surgical patients

OBJECTIVE

To compare the sensitivity and specificity of two retrospective active surveillance methods based on review of the medical record and review of the discharge form in identfying nosocomial infection, taking the prospective surveillance method as the reference standard.

DESIGN

Blind comparison of three active nosocomial infection surveillance methods.

SETTING

Department of General Surgery of a tertiary-care hospital with a referral population of 266,000 people.

METHODS

All operated patients admitted to the Department of Surgery for more than 24 hours and discharged from January 1, 1994, to December 31, 1994, were included. Prospective surveillance consisted of daily review of the patient's record during hospitalization. Retrospective surveillance consisted of review of the medical record and the discharge form. Sensitivity and specificity of both retrospective methods were calculated.

RESULTS

Of the 1,514 patients included in the study, 1,476 (97.5%) were reviewed by means of the retrospective surveillance system. A total of 20, 8, and 4 hours per week was needed for the active prospective system, review of the medical record, and review of the hospital discharge form, respectively. The documented cumulative incidence of nosocomial infection was 21.8% for the prospective system, 19.6% for review of the medical record, and 12.6% for review of the discharge form. The overall sensitivity of review of the medical record was 88% and of the discharge form 56%, with a specificity of 99%. For review of the medical record, the highest sensitivity was 93%, for urinary tract infections; for review of the discharge form, the highest was 57%, for surgical-wound infection.

CONCLUSIONS

The retrospective method of review of the medical record was the most efficient active surveillance strategy in detecting nosocomial infection in surgical patients.

Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee

EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care. Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures. Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy). Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activitie

The effect of surveillance on surgical wound infection rates

The clean wound infection rate is the most valuable reflection of surgical care in any hospital. Wound infection rates are seen as indicators of quality in terms of negative outcome measures. A nurse was appointed by Hairmyres and Stonehouse Hospitals NHS Trust for the purpose of surveillance of the clean surgical wound infection rate. The surveillance is based on a previous study in the USA showing that feedback of infection rates to surgeons can lead to a reduction in these rates. The specifications for surveillance were that all clean surgery would be followed up for 30 days post-operatively and that wounds with implants, i.e. vascular grafts, would be followed up for 1 year post-operatively to produce infection rates for the surgeons, wards, theatres and the infection control team. Data collection commenced in October 1995 and so far 1851 clean surgical cases have been followed up for 30 days post-operatively. All patients were monitored until discharge, then at 30 days post-operatively, and the wound scored for signs of infection. Day cases were seen within week 1 and at day 30. General practitioner and district nurse liaison enabled detection of problems at other times. The patients were given a telephone number they could use to report problems after surgery. The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It has enabled the early identification of problem areas in practice. The audit has also been used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the extrinsic risk factors for wound infection. As a result of the surveillance, there has been a significant reduction (P < 0.05) in the clean wound infection rate.

Outcomes of a postdischarge surveillance system for surgical site infections at a Midwestern regional referral center hospital

BACKGROUND

Postdischarge surveillance has been reported in the literature as one method for detecting surgical site infections (SSIs) that more traditional methods of surveillance (review of readmission data, monitoring of microbiology, radiology, pharmacy antibiotic usage reports, and medical record review) fail to include.

METHODS

This article describes a postdischarge surveillance program that used surgeon questionnaires and was implemented at a 225-bed Midwestern regional referral center hospital. Evaluation of the postdischarge program was accomplished by review of infection control program data for calendar years 1995 through 1997.

RESULTS

Implementation of the postdischarge program resulted in an almost fourfold increase (in both 1995 and 1996) in SSI rates over the reported SSI rates if only traditional surveillance methods had been used. A majority of surgeons (79% in 1995 and 83% in 1996) had individual response rates of 80% or greater. In addition, implementation of the postdischarge program required only 3.5 to 4 additional hours per month.

CONCLUSIONS

Results suggest that the postdischarge surveillance program identified SSIs missed by traditional surveillance methods, resulted in higher reported rates of SSI, was moderately to well accepted by surgeons, and was implemented with a minimum of organizational resources.

Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.

Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

Infection control in ambulatory care

This article provides a structured review of the English literature focusing on areas that theoretically pose the greatest risk for nosocomial infections in ambulatory care. The review describes variations in methods of surveillance and a general paucity of studies that provide reliable estimates of the risk for infections in the ambulatory environment.

Postoperative wound infections

A prospective study of postoperative wound infection was carried out over a two year period in Cumhuriyet University Medicine Faculty Hospital in Sivas, Turkey. Examination of wounds, with cultures of all suspicious wounds using standard bacteriological methods was performed. Of a total of 4146 surgical wounds, 188 (4.53%), became infected. High infection rates were noted after colon resection (32.1%), gastric and oesophageal operations (21.1%), cholesystectomy (17.2%), and splenectomy (10.2%). Low infection rates were noted after thyroidectomy, mastectomy, caesarean section and abdominal hysterectomy. The commonest causative organisms were coagulase-negative staphylococci 21.7%, Staphylococcus aureus 19.7%, Escherichia coli 19.7%, Enterobacter spp. 17.6%, and Pseudomonas spp. 10.7%.

Underestimation of surgical site infection rates in obstetrics and gynecology

BACKGROUND

With the increasing volume of same-day operations and shortened hospital stays, it becomes more likely that a significant percentage of surgical site infections will occur after these patients' discharges.

METHODS

To document the true incidence of postdischarge surgical site infection, surveillance was undertaken in a group of obstetric and gynecologic patients. The study consisted of two parts. (1) A questionnaire was mailed to each surgeon, inquiring about clinical evidence of infection. The infection control service continued to do surveillance of wound infection in the usual manner, and the results of the two methods were compared. (2) A questionnaire was provided to patients undergoing operation, inquiring about signs and symptoms of wound infection.

RESULTS

A total of 469 surgical procedures were included, with a total of 24 infections detected (5.2%). Of these, 14 infections (58.3%) were detected by the usual surveillance method. An additional 10 infections (41.7%) were detected after patient discharge by the physician questionnaire. Only two of the 24 infections were detected by the patient questionnaire.

CONCLUSIONS

Failure to include postdischarge surgical site surveillance results in a substantial underestimation of the true surgical site infection rate. Physician input and strong support have prompted a regular biannual postdischarge surgical site surveillance program in this patient population.

Wound infection rates: the importance of definition and post-discharge wound surveillance

The importance of definition and post-discharge wound surveillance on reported wound infection rates have been studied, using data taken from a prospective, randomized, placebo-controlled, double-blind trial of the effect of whole body disinfection on postoperative wound infection rates. All patients admitted for an elective clean or potentially contaminated surgical procedure over a 32-month period were recruited into the study. Of the 3733 patients recruited, 3466 completed the study. Wound infection (which is defined for this study) is the main outcome that was examined. The effect of careful post-discharge follow-up of patients to look for wound infections was analysed for age, wound type and presence or absence of a drain. Sixty percent of postoperative wound infections occurred after discharge. A rising wound infection rate with increasing age was observed in the in-hospital cohort whereas the incidence of outpatient wound infections declined with age. This finding is attributed to the longer in-hospital stay encountered in patients above 50 years old (median, 3 vs. 5 days, P < 0.00001). Although clean operations had a significantly lower in-hospital infection rate, potentially contaminated procedures had a lower outpatient infection rate. A similar picture was observed in other subgroups of operations including horizontal versus vertical wounds and use of drains. When assessing reported wound infection rates, the definition of wound infection used and the extent of follow-up must be known to enable accurate assessment of the results.

Postdischarge surveillance for nosocomial wound infection: a brief review and commentary

Escalating medical care costs during the last decade have resulted in shorter hospital stays and higher volumes of outpatients surgical procedures. As a result, the proportion of nosocomial surgical wound infections manifesting after discharge will increase. We performed a literature review to assess the current state of the art of postdischarge surveillance for nosocomial wound infection. From 20% to 70% of postoperative surgical site infections do not become apparent until after the patient's discharge, resulting in serious underreporting of true rates. Infections in outpatients are not being identified efficiently. Institutions using self-reporting methods report a low validity for these methods. The Centers for Disease Control and the Joint Commission for the Accreditation of Healthcare Organizations currently have no strong guidelines on the subject. Since valid postdischarge surveillance may become a necessity for a quality infection control program, new national recommendations are needed.