[Registration of postoperative wound complications at a department of vascular surgery]. / Registrering af postoperative sårkomplikationer på en karkirurgisk afdeling.

During the period 1 March 1987 to 31 December 1988, current registration of all vascular surgical operations in the Department of Vascular Surgery RK, Rigshospitalet, was undertaken employing a PC-based programme (DANOP-DATA). A total of 1,898 primary vascular surgical operations were performed on 1,335 patients. During the entire period, 48 (2.5%) patients with wound infection were registered. In half of these, the infection was superficial and in the remainder the infection was deep. Comparison between 1987 and 1988 revealed a non-significant tendency towards a lower incidence of infection in 1988. Significantly more wound infections were found after non-sterile operations (p = 0.005). Significantly more deep infections were found on employing synthetic vascular prostheses (p less than 0.00001) and with inguinal incisions (less than 0.05). No significant connection could be found with age, duration of preoperative hospitalization, duration of operation and the degree of planning of the operation. The authors find that computer-based monitoring of the surgical activity is a good which renders current assessment and analysis of the pattern of complications possible. The authors did not find that DANOP-DATA was sufficient for registration in a special department for vascular surgery and a programmel (KARBASE) has been developed which is more suitable for this purpose.

Modifications of health behaviour in response to air pollution notifications in Copenhagen.

Ambient air quality is a major issue today in large cities all over the world. On the theoretical background of the health belief model and the health locus of control model, we studied the knowledge and beliefs about air pollution and the modifications of health behaviour brought about by information to the public about projected levels of air pollution, with special emphasis on reduction of outdoor activity and avoidance of car driving. Data were collected with a questionnaire among a sample of residents in the Copenhagen area. The respondents were almost universally knowledgeable about the prime emission source and concerned about the possible health effects of the air pollution in the area. Avoidance of outdoor activity was associated with personal experiences of symptoms ascribed to the air pollution, employment status, and with female sex, but not with knowledge or beliefs about the degree or health implications of the air pollution. The willingness to avoid car driving was positively associated with the belief that one can oneself influence one's health and with female sex. Lung diseased respondents were generally more prone to protect themselves than the healthy, both by avoiding outdoor activity and by being less willing to avoid car driving. The present study was conducted in an only moderately polluted city, and it is not clear whether the findings and conclusions can be generalized to more polluted cities. The study partly supported the underlying theories of the determinants of health behaviour, but also indicated a need for a broader theoretical framework, incorporating aspects of the respondents' life situation and personal experience which would be relevant to the specific type of health behaviour under study.

[Discontinuing postoperative wound dressings]. / Seponering af postoperativ sårforbinding.

The influence of postoperative dressings on wound healing was investigated. Clean and potentially contaminated operation wounds were subdivided at random into a group with dressings until the sutures were removed or a group with dressings during the first 24 hours after operation only. No significant differences in the incidences of wound infections were observed in the two groups. The majority of the patients treated with dressings for a brief period only did not desire prolonged periods with dressings after possible future operations.

The effect of incisional plastic drapes and redisinfection of operation site on wound infection following caesarean section.

In a randomized prospective multicentre study of post-caesarean wound infection among 1,340 women in eight hospitals, the effect of redisinfection of the skin around the incision before skin closure and the effect of adhesive skin drapes were investigated. The overall rate of wound infection with pus was 5.0% (range 3.5-8.9%). The study showed a reduction in postoperative wound infection associated with redisinfection (P = 5.5%), while no benefit from adhesive plastic drapes could be demonstrated.

The DANOP-DATA system: a low-cost personal computer based program for monitoring of wound infections in surgical ward.

A low-cost personal computer program to monitor surgical wound infections was developed in parallel to the Danish national guidelines for recording postoperative wound infections. Internationally accepted definitions were used. The program offers three fixed-data entry screens and produces user-specified variations of four standard tables, comprising most of the epidemiological data needed for surveillance and infection control. The program was tested in Danish hospitals and was found to serve well as a simple local tool for the operating staff, offering fast information on infection rates. Results from two hospitals consisting of 3904 operations are presented. Infections occurring after discharge were included. Overall infection rates for clean wounds were 2.3%, clean-contaminated wounds 4.7%, contaminated wounds 4.3% and dirty operations 8.3%. None of the hospitals had used infection surveillance systems before.

[Postoperative wound infections at a mixed surgical department. 1 year's registration employing a PC-based system]. / Postoperative sårinfektioner på en blandet kirurgisk afdeling. Et års registrering ved hjaelp af et PC-baseret system.

Operation wounds and surgical wound infections (S.W.I.) in the surgical department of Holbaek County Hospital were recorded over a period of one year. This registration was conducted in co-operation with the National Centre for Hospital Hygiene to test a standardised and simplified registration system and edb-programme, the Danop-Data system, developed to record S.W.I. on PC. 1.377 wounds and 45 S.W.I. were recorded. The overall infection rate was 3.3%. This compares favourably with rates reported in more extensive foreign investigations. There were significantly fewer infections during the second six months than during the first six month of the year. This was not due to changed conditions during the period of registration. The registration system and the edb-programme provide a satisfactory method of continuous surveillance of S.W.I. At the same time, the system itself proved very easy to use.

[Registration of postoperative wound infections by ADB. A trial of the Danop program]. / Registrering af postoperative sårinfektioner på edb. En afprøvning af programmet Danop.

The EDB programme, Danop, which was developed in cooperation with Statens Seruminstitut which is the central department for hospital hygeine in Denmark, was employed during the period 1.7.1987-30.6.1988 for consecutive registration of operative interventions and postoperative wound infection. During the period, 1,660 interventions were registered with a total frequency of infection of 3.5%; 2.6% of these in clean cases and 13.8% in infected cases. About one third of the infections were demonstrated by the general practitioners after discharge. In connection with introduction of registration, a considerable decrease in the number of postoperative wound infections occurred. It is decisive for the employability of the system that a reliable procedure for registration and return information is organized. The system is easy to use and functions well and does not require prior knowledge of edb and it provides excellent current control of and review of postoperative wound infections in one or more departments.

Need for surgical wound dressing.

The need for dressings on clean and clean contaminated surgical wounds was investigated. A total of 1202 patients with 1202 clean or clean contaminated surgical wounds were randomized into two groups: 633 wounds were covered by dressings up until the time of suture removal, and 569 wounds were treated without dressings after the first postoperative day. In the group characterized by long dressing time, the rate of postoperative wound infections was 4.9 per cent. The rate was 4.7 per cent in the group represented by short dressing time. Using short dressing time not only reduces the number of nursing hours but also limits the need for costly dressing material. In addition, both wound observation and patients' personal hygiene are made easier.

[The Danop Data System for decentralized postoperative surveillance of wound infections]. / Decentral overvågning af postoperative sårinfektioner med Danop data system.

The Danop Data System is a microcomputer system designed for the local (ward) surveillance of postoperative surgical infections. The system is served by a simply operated microcomputer program capable of tabulating data input in four standard tables providing continuous information sufficient for surveillance purposes. The aim is that, within a five-year period, 50 per cent of all Danish hospitals will adopt this or similar systems. The system is envisaged as a preliminary to more systematic surveillance of all nosocomial infections.

Seal finger--diagnosis, prevention and treatment.

Seal finger is a well described disease as to symptoms and signs, but the etiology is still unknown. The disease may often be prevented and tetracycline has proved effective.

Antibiotic therapy of meningitis caused by ampicillin-resistant Haemophilus influenzae in Denmark and Greenland 1981 to 1987.

A survey was performed in Denmark and Greenland in order to determine whether the current recommendation of ampicillin (400 mg/kg/day) for initial treatment of purulent meningitis is appropriate. Data obtained 1981-1987 in an ongoing nationwide programme for surveillance of ampicillin-resistant Haemophilus species was analysed, and patient records of 21 cases of meningitis caused by ampicillin-resistant Haemophilus influenzae strains (17 in Denmark, 4 in Greenland) reported in the period 1981-1987 were reviewed. In Denmark the overall rate of ampicillin-resistant Haemophilus influenzae was estimated to be approximately 2% for the study period, and the average rate of resistant isolates from spinal fluid was 5.2% (range 0-12.3%). The incidence of meningitis caused by ampicillin-resistant Haemophilus influenzae strains remained low in the Danish population (around 0.05/100,000/year) except for a peak in 1985. The overall mortality rate of Haemophilus influenzae meningitis for the study period was 2.4%, which was the same as before 1980. In Greenland the actual number of cases of meningitis caused by ampicillin-resistant Haemophilus influenzae was small, but the incidence was at least 40 to 80 times higher than in Denmark with a high mortality rate (50%). These observations prompted revision of the antibiotic regimen in Greenland, whereas the regimen was considered appropriate in Denmark.