Abstract
Measuring the frequency of a defined outcome flaw for a series of patients undergoing
operative procedures generates information for performance evaluation. Such data influence
decisions to improve care if used responsibly. Wound infection (WI), bacterial invasion
of the incision, is the most common infectious complication of surgical care and WI
prevention has value because the complication affects economic, patient satisfaction,
and patient functional status outcomes. WI frequency, one kind of surgical outcome
flaw rate, is traditionally used to judge one aspect of surgical care quality. At
the author's institution, global WI surveillance was conducted without interruption
for 20 years. Results for 85 260 consecutive inpatient operations performed during
the period showed that secular changes in infection rates occurred but were not necessarily
caused by surgical care quality decrements.
Zusammenfassung
Mithilfe der Bestimmung von definierten Ergebnisfehlern ist es möglich, eine Leistungsstatistik
für Patienten, die einem chirurgischen Eingriff unterworfen werden, zu erstellen.
Die Daten erlauben Entscheidungen, die Behandlungsqualität zu verbessern. Die häufigste
infektiöse Komplikation nach chirurgischer Therapie stellt die Wundinfektion dar,
definiert als eine bakterielle Invasion der Inzision. Die Wichtigkeit der Verhinderung
der Wundinfektion ergibt sich aus ökonomischen Gründen sowie aufgrund der Patientenzufriedenheit
und des Funktionsstatus bei Entlassung. Die Häufigkeit der Wundinfektion wird traditionell
als Maß für einen Ergebnisfehler angegeben, um so die chirurgische Behandlungsqualität
zu bewerten. In der Institution des Autors wurde eine globale Wundinfektionsüberwachung
ohne Unterbrechung für 20 Jahre durchgeführt. Die Ergebnisse bei konsekutiver Verfolgung
von 85 260 stationären Operationen zeigten zeitliche Schwankungen der Infektionsraten,
die nicht zwangsweise durch eine abnehmende Qualität verursacht waren.
Key words
Surgical wound infection - surgical care improvement - incisional infection - quality
improvement - surgical infection surveillance
Schlüsselwörter
Chirurgische Wundinfektion - Verbesserung der Behandlungsqualität - Infektion der
Inzision - Überwachungsprogramm
References
- 1
Benneyan J C.
Statistical quality control methods in infection control and hospital epidemiology,
Part I: Introduction and basic theory.
Infec Cont Hosp Epidemiol.
1998;
19
194-214
- 2
Benneyan J C.
Statistical quality control methods in infection control and hospital epidemiology,
Part II: Chart use, statistical properties, and research issues.
Infec Cont Hosp Epidemiol.
1998;
19
265-283
- 3
Christou N V, Johr C S, Meakins J L.
Assessing operative site infection in surgical patients.
Arch Surg.
1987;
122
165-169
- 4
Classen D C, Evans R S, Pestotnik S L, Horn S D. et al .
The timing of prophylactic administration of antibiotics and the risk of surgical
wound infections.
New Engl J Med.
1992;
326
281-286
- 5
Culver D H, Horan T C, Gaynes R P. et al .
Surgical wound infection rates by wound class, operative procedure, and patient risk
index.
Amer J Med.
1991;
91 (Suppl 3 B)
152-157
- 6
Daley J, Khuri S F, Henderson W, Hur K. et al .
Risk adjustment of the postoperative morbidity rate for the comparative assessment
of the quality of surgical care: Results of the national Veterans Affairs surgical
risk study.
J Amer Coll Surg.
1997;
185
328-340
- 7
Dellinger E P, Gross P A, Barrett T L, Krause P J. et al .
Quality standard for antimicrobial prophylaxis in surgical procedurs.
Clin Infec Dis.
1994;
18
422-427
- 8
Gross P A.
The potential for clinical guidelines to impact appropriate antimicrobial agent use.
Infec Dis Clin N Amer.
1997;
11
803-812
- 9
Grover F L, Johnson R R, Shrover A L. et al .
The Veterans Affairs continuous improvement in cardiac surgery study.
Ann Thor Surg.
1994;
58
1845-1851
- 10
Haley R W.
Nosocomial infections in surgical patients: Developing valid measures of intrinsic
patient risk.
Amer J Med.
1991;
91 (Suppl 3 B)
145-151
- 11
Haley R W, Crossly K B, Von Allman S D, McGowen J E.
Extra charges and prolongation of stay attributable to nosocomial infections: A prospective
interhospital comparison.
Amer J Med.
1981;
70
51-58
- 12
Haley R W, Culver D H, Morgan W M. et al .
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
- 13
Horan T C, Gaynes R P, Martone W J. et al .
CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC
definitions of surgical wound infections.
Infec Cont Hosp Epidemiol.
1992;
13
606-608
- 14
Howard J M, Barker W F, Culbertson W R. et al .
Postoperative wound infections: The influence of ultraviolet irradiation of the operating
room and of various other factors.
Ann Surg.
1964;
160 (Suppl)
1-192
- 15 Howard R J, Lee J T. Surgical wound infection: Epidemiology, Surveillance, and
Clinical Management. In: Howard RJ, Simmons RL (eds). Surgical Infectious Diseases.
Third Edition. Appleton & Lange, Norwalk 1994; pp 401-411
- 16
Hunt T K, Hopf H W.
Wound healing and wound infection: What surgeons and anesthesiologists can do.
Surg Clin N Amer.
1997;
77
587-606
- 17
Jonsson K, Hunt T K, Mathes S G.
Oxygen as an isolated variable influences resistance to infection.
Ann Surg.
1988;
208
783-787
- 18
Jorgensen J H.
Laboratory issues in the detection and reporting of antibacterial resistance.
Infec Dis Clin N Amer.
1997;
11
785-802
- 19
Kluytmans J A, Mouton J W, VandenBergh M F Q. et al .
Reduction of surgical site infections in cardiothoracic surgery by elimination of
nasal carriage of Staphlylococcus aureus as a major risk factor for wound infections
after cardiac surgery.
Infec Cont Hosp Epidemiol.
1996;
17
780-785
- 20
Knighton D, Halliday B, Hunt T K.
Oxygen as an antibiotic: The effect of inspired oxygen on infection.
Arch Surg.
1984;
119
199-204
- 21
Lee J T.
Contemporary wound infection surveillance issues.
New Horizons: The Science and Practice of Acute Medicine.
1998;
6 (Suppl)
20-29
- 22
Lee J T.
Operative complications and quality improvement.
Amer J Surg.
1996;
171
545-548
- 23 Lee J T. Surgical wound infections: Surveillance for quality improvement. In: Fry
DE (ed). Surgical Infections. New York, Little, Brown 1995; 145-159
- 24
Lee J T.
Wound infection surveilllance.
Infec Dis Clin North Amer.
1992;
6
643-656
- 25 Mangrum A, Horan TC Jarvis W R. et al .Guideline for the prevention of surgical
site infection. Centers for Disease Control and Prevention, Atlanta GA 1999
- 26
Miholic J, Judec M, Domanig E, Hiertz H. et al .
Risk factors for severe bacterial infections after valve replacement and aortocoronary
bypass operations: Analysis of 246 cases by logistic regression.
Ann Thor Surg.
1985;
40
224-228
- 27
Nagachinta T, Stephens M, Reitz B, Polk B.
Risk factors for surgical wound infection following cardiac surgery.
J Infec Dis.
1987;
156
967-973
- 28
Olson M M, Lee J T.
Continuous, 10-year wound infection surveillance: Results, advantages, and unanswered
questions.
Arch Surg.
1990;
125
794-803
- 29
Page C P, Bohnen J M, Fletcher J R. et al .
Antimicrobial prophylaxis for surgical wounds: Guidelines for clinical care.
Arch Surg.
1993;
128
79-88
- 30
Richet H M, Craven P C, Brown J M. et al .
A cluster of Rhodococcus (Gordona) bronchialis sternal wound infections after coronary
artery bypass surgery.
New Engl J Med.
1991;
324
104-109
- 31
Roy M C.
Surgical site infections after coronary artery bypass graft surgery: Discriminating
site-specific risk factors to improve prevention efforts.
Infec Cont Hosp Epidemiol.
1998;
19
229-233
- 32
Roy M C, Perl T M.
Basics of surgical-site infection surveillance.
Infec Cont Hosp Epidemiol.
1997;
18
659-668
- 33
Slaughter M S, Olson M M, Lee J T. et al .
A fifteen-year wound surveillance study after coronary artery bypass.
Ann Thor Surg.
1993;
56
1063-1068
- 34
Wenger P N, Brown J M, McNeil M M, Jarvis W R.
Nocardia farcinica sternotomy site infections in patients following open heart surgery.
J Infec Dis.
1998;
178
1539-1543
- 35 Wong E S. Surgical site infections. In: Mayhall CG (ed). Hospital Epidemiology
and Infection Control. Williams-Wilkins, Baltimore 1996; pp 154-175
James T. LeeMD, PhD, Consultant, Specialty Care
Dept of Veterans Affairs Medical Center
Minneapolis MN
250 East Sixth Street
Suite 808
St Paul MN 55101
USA