ABSTRACT
An excess rate of mediastinitis complicating cardiac operations occurred in one of two hospitals served by the same surgeons. The rates were 4% at hospital A and 0.48% at hospital B for the same period (P = .002). At hospital A five patients who underwent a thoracic reoperation experienced postoperative pneumonia or bacteremia prior to onset of mediastinitis; these infections were caused by the same bacterial species. This circumstance provided a unique opportunity for comparing infection control practices, in which one hospital served as a control for interventional changes. At hospital A regular and temporary critical care nursing personnel, who took care of both infected and uninfected patients, did not antisepticize their hands before manipulation of percutaneous catheters. After cohorts of nurses were formed and antisepsis of the hands with alcohol was strictly enforced (no diminution in the number of temporary personnel was instituted), the frequency of mediastinitis decreased significantly among patients who underwent reoperations at hospital A (P = .002), but no concurrent change was noted at hospital B. Preventable postoperative remote-site infection may lead to mediastinitis.
Subject(s)
Cardiac Surgical Procedures , Cross Infection/etiology , Infection Control , Mediastinitis/etiology , Postoperative Complications/etiology , Case-Control Studies , Catheters, Indwelling , Cross Infection/prevention & control , Female , Hand Disinfection , Humans , Intensive Care Units/standards , Male , Mediastinitis/prevention & control , Middle Aged , Postoperative Complications/prevention & control , Retrospective Studies , Risk FactorsABSTRACT
A prospective study of women with low-risk cesarean sections was conducted in four community hospitals to determine the frequency of postoperative infections and identify factors predisposing to endometritis and wound infection. Low-risk cesarean section was defined as a scheduled procedure without an urgent indication, with any duration of ruptured membranes being less than or equal to 12 hours. In a cohort of 1863 patients, 26 (1.4%) developed endometritis and 21 (1.1%) had wound infections. Primary cesarean section was associated with endometritis in the cohort (p less than 0.01) and in a retrospective study with the same cases as in the cohort (p = 0.01). Absence of antibiotic prophylaxis was associated with endometritis (p less than or equal to 0.013) or endometritis with wound infection (p less than 0.01) in both studies. Without prophylaxis 37 such infections occurred in 957 (3.7%) women; with prophylaxis eight infections occurred in 906 (0.9%) women. Routine timely antibiotic prophylaxis in low-risk cesarean sections could lead to an annual national savings of approximately $9 million.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cesarean Section/adverse effects , Endometritis/prevention & control , Premedication , Surgical Wound Infection/prevention & control , Adult , Age Factors , Costs and Cost Analysis , Endometritis/etiology , Female , Humans , Pregnancy , Risk Factors , Surgical Wound Infection/etiologySubject(s)
Cross Infection/etiology , Intubation, Intratracheal , Pneumonia/etiology , Emergencies , Humans , Risk FactorsSubject(s)
Communicable Disease Control , Education , Curriculum , Education, Medical , Education, Nursing , Health Education , Humans , SocietiesSubject(s)
Cross Infection/prevention & control , Humans , North America , Societies , Specialties, Nursing , United KingdomABSTRACT
Important aspects and interpretations of JCAH standards on infection control are explained, and approaches to ensuring compliance are discussed.
