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Prevention of Nosocomial Infections through Surveillance. Pilot study on surveillance of wound infections after heart surgery

PREventie van ZIEkenhuisinfecties door Surveillance. Component wondinfecties na hartchirurgie, pilotstudie 2001-2002

Synopsis

Yearly, about 14,000 patients undergo open heart surgery at one of the 13 specialized heart centres in the Netherlands. Since surgical site infections can occur as a complication, surveillance of these infections is an important tool for prevention. In 2001/2002 a pilot study was carried out in seven Dutch heart centres to test a standardized registration method for wound infections after heart surgery. Additionally, the study was to assess which risk factors should be adjusted for to allow comparison of infection rates among the centres. A definitive protocol for the surveillance of wound infections after heart surgery has now been established on the basis of the results of this pilot study. For the study the heart centres collected information on 1612 open heart operations and on the infection prevention policy for open heart surgery. Twenty-one deep sternal wound infections (incidence 1.3%) and 24 superficial sternal wound infections (incidence 1.5%) occurred. Of the 1013 patients with a leg graft, 43 contracted a wound infection at the harvest site (incidence 4.2%). About 50% of the sternal wound infections and 84% of the donor wound infections were contracted after discharge from the heart centre. Patients with a longer follow-up period after the operation were more often recognized as having a wound infection. The most important risk factors for contracting an infection were higher age, being female, higher body mass index, having insulin-dependent diabetes, longer perfusion time, higher lowest body temperature during the operation, and undergoing an emergency operation or a resternotomy after the original operation. These risk factors can be used to generate reference data for wound infections after heart surgery, which are adjusted for the most important confounding factors.
 

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