Implantación de un sistema de vigilancia de infección de la herida quirúrgica al alta en herniorrafia y mastectomía / Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures

INTRODUCCIÓN: La vigilancia tradicional de la infección de localización quirúrgica (ILQ) que se realiza durante el ingreso hospitalario puede infraestimar su incidencia, al ser cada vez más corta la estancia hospitalaria. El objetivo de este trabajo es conocer las tasas reales de ILQ prolongando la vigilancia después del alta. MÉTODOS: Se incluyó a todos los pacientes sometidos a los procedimientos de herniorrafia y mastectomía en el Hospital Universitario Ramón y Cajal entre el 1 de enero y el 31 de diciembre de 2011. Los datos de ILQ se recogieron prospectivamente según el sistema de vigilancia de infección nosocomial de Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC). La vigilancia postalta (VPA) se realizó mediante encuesta telefónica. RESULTADOS: Se incluyeron 409pacientes en el estudio: 299herniorrafias y 110mastectomías. En herniorrafia la tasa de infección antes del alta era del 6,02%, incrementándose tras VPA al 7,69%. En mastectomía la tasa de infección antes del alta era del 1,8%, incrementándose tras VPA al 3,6%. Del total de infecciones se detectaron tras VPA el 50% en mastectomía y el 21,7% en herniorrafia. CONCLUSIONES: La VPA incrementó la incidencia de ILQ en los procedimientos estudiados; La VPA es útil para analizar la tendencia real de ILQ y evaluar posibles acciones de mejora. Es necesario estandarizar los protocolos de VPA

INTRODUCTION: Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. METHODS: All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. RESULTS: A total of 409 patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). CONCLUSIONS: Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised

Surgical wound infection rates in Spain: data summary, January 1997 through June 2012.

BACKGROUND: The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. METHODS: INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. RESULTS: This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). CONCLUSIONS: Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system.

[Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures]. / Implantación de un sistema de vigilancia de infección de la herida quirúrgica al alta en herniorrafia y mastectomía.

INTRODUCTION: Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. METHODS: All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. RESULTS: A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). CONCLUSIONS: Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised.

[Trends in the prevalence of extended-spectrum beta-lactamase-producing gram-negative bacilli in a teaching hospital in Madrid, Spain]. / Tendencia de la prevalencia de bacilos gramnegativos productores de betalactamasas de espectro extendido en un hospital universitario de Madrid.

BACKGROUND AND OBJECTIVE: The pprevalence of extended-spectrum beta-lactamase (ESBL) producing gram-negative bacilli has increased in recent years. The aim of this study is to estimate the prevalence of infection/colonization due to theses microorganisms per 100 admissions and its trend during the period 2007-2010. PATIENTS AND METHODS: Prospective observational study of all patients admitted from January 2007 to December 2010 infected or colonized with ESBL-producing gram-negative bacilli at Hospital Universitario Ramón y Cajal. The prevalence of infection/colonization of ESBL-producing gram-negative rods was calculated according to the recommendations for metrics for multidrug-resistant organisms in healthcare settings of The Society for Healthcare Epidemiology of America and the Healthcare Infection Control Practices Advisory Committee. To analyse trends, Poisson regression was used (Joinpoint Regression Program Version 3.4.3, U.S. National Institutes of Health). RESULTS: Through the study period there was an upward trend of prevalence of all the ESBL-producing gram-negative bacilli. The Poisson trend analysis indentified a significant inflection point in August 2009 (p=0.014). CONCLUSION: The inflection point in the prevalence of the ESBL-producing gram-negative bacilli trend can be explained by a slowdown in the prevalence of some microorganisms such as ESBL-producing Klebsiella pneumoniae.

Preparación prequirúrgica, profilaxis antibiótica y vigilancia de infección de herida quirúrgica en cirugía de mama / Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery

Introducción El impacto de la infección de herida quirúrgica (IHQ) en salud pública justifica su vigilancia y prevención. Nuestros objetivos fueron estimar la incidencia de IHQ en cirugía de mama y evaluar sus protocolos de profilaxis antibiótica y preparación prequirúrgica. Métodos Estudio de cohortes prospectivo multicéntrico de incidencia de IHQ. Se evaluó la incidencia de IHQ, se estratificó por índice de riesgo NNIS y se calculó la razón estandarizada de incidencia (REI). La REI se comparó con las tasas nacionales y americanas. Se evaluó el cumplimiento y adhesión del protocolo de profilaxis antibiótica y de preparación prequirúrgica y su influencia en la IHQ con el riesgo relativo. Resultados Se estudiaron 592 intervenciones de mama procedentes de 10 hospitales de la Comunidad de Madrid. La incidencia de IHQ acumulada fue de 3,89% (IC 95%: 2,3-5,5). La REI fue de 1,82 sobre la tasa nacional y de 2,16 sobre la americana. Se administraron el 97,81% de las profilaxis antibióticas indicadas con una adhesión global al protocolo del 75%. La preparación prequirúrgica fue correcta en el 53,8%. No se encontró asociación de la infección con la adhesión a la profilaxis antibiótica ni con el cumplimiento de la preparación prequirúgica (p>0,05). Conclusión Nuestra incidencia ha sido algo superior a la de los programas nacionales de vigilancia. Hay que mejorar la adhesión de la profilaxis antibiótica y el registro de los datos de preparación prequirúrgica (AU)

Introduction: The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Methods: Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates andU.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Results: Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P > .05). Conclusion: Our incidence is with in those seen in the literature although it is some what higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data (AU)

[Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery]. / Preparación prequirúrgica, profilaxis antibiótica y vigilancia de infección de herida quirúrgica en cirugía de mama.

INTRODUCTION: The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. METHODS: Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. RESULTS: Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). CONCLUSION: Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data.