ABSTRACT
Prospective surveillance programmes to monitor the incidence of surgical-site infection (SSI) in patients who have had orthopaedic implant surgery can be difficult to implement due to limited human and technical resources. In addition, prolonged patient follow-up, up to one year, may be required. Traditional methods of surveillance can be enhanced by using administrative databases to assist in case finding and facilitate overall surveillance activities. The aim of this study was to identify the incidence of SSI in patients who had undergone total hip replacement (THR) or total knee replacement (TKR) surgery in all Western Australian (WA) hospitals during 1999 using the Western Australian Data Linkage System. The WA Data Linkage System links several population-based administrative health datasets within the state, including the Hospital Morbidity Data System (HMDS), containing International Classification of Disease-coded discharge information, and mortality records. A total of 1476 THR and 1875 TKR procedures was identified from 21 WA hospitals during 1999. The incidence of SSI after these procedures was 5% (95% CI 4.3-5.7) [THR (4.86%, 95% CI 3.77-5.95) and TKR (5.15%, 95% CI 4.15-6.15)]. The incidence was 33.72 infections per 1000 person-years. Patients aged over 80 years experienced a significantly higher rate of infection after THR compared with patients aged 80 or less (z-test, z = 2.56, P = 0.015), but not for TKR. No patients with an SSI died during follow-up. The WA Data Linkage System provided a unique opportunity to review the incidence of SSIs in patients undergoing THR or TKR surgery in WA hospitals.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Cross Infection/epidemiology , Medical Record Linkage , Population Surveillance/methods , Surgical Wound Infection/epidemiology , Adult , Aged , Aged, 80 and over , Continuity of Patient Care , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Western Australia/epidemiologyABSTRACT
Many infection control practitioners (ICPs) dedicate a significant amount of time and resources to surveillance of surgical site infections (SSIs). Alternative surveillance methods need to be explored to reflect the changes to the healthcare system and the increasing economic constraints placed on infection control units. This study was undertaken to compare two methods of identifying SSIs in orthopaedic surgery. Surveillance data collected routinely by ICPs was compared with data obtained from the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) coding in the medical record. Concordant results between the two methods were obtained. The use of ICD-9-CM coding, as stored in hospital patient administration system databases, has the ability to enhance routine surgical site surveillance programmes. These systems can be used as the basis for screening large data sets for SSIs and identifying where SSIs resulted in patient re-admission. A reduction in the duplication of data and time spent by the ICP on the collection of information for surveillance purposes can be achieved.
Subject(s)
Forms and Records Control , Orthopedic Procedures/statistics & numerical data , Surgical Wound Infection/epidemiology , Hospital Records , Humans , Infection Control Practitioners , Population Surveillance/methods , Western AustraliaABSTRACT
A questionnaire sent to 40 intensive care units showed that ventilator circuits were changed every 24 h in 62% and every 48 h in 20% of the units. A similar survey in 40 special-care baby units showed that only 9.7% changed circuits daily and the majority were changed weekly (38.7%) or between patients (38.7%). A prospective study of bacterial contamination of circuits in adult patients showed that when water humidification was used, 28/72 samples from inspiratory and 31/72 from expiratory tubing were contaminated with Gram-negative bacilli. None of 48 sets of tubing was contaminated when a heat-moisture exchanger was used and only one expiratory tube was contaminated in tubing from 45 neonates using a water humidifier. Gram-negative bacilli were isolated from the mouths of 21/36 adults and 6/12 neonates, and also from 6/17 hands of staff after changing circuits. It is suggested that circuits with water humidification may be changed every 48 h in adult patients, and between patients or weekly in neonatal units or between patients if a heat-moisture exchanger is used. Handwashing after removal of a circuit is of major importance in the prevention of spread of infection.
