RESUMO
OBJECTIVE: To evaluate different strategies for detecting surgical site infections (SSIs) using different sources (notification by the surgeon, bacteriological results, antibiotic prescription, and discharge diagnosis codes). BACKGROUND: Surveillance plays a role in reducing the risks of SSIs but the performance of case reports by surgeons is insufficient. Indirect methods of SSI detection are an alternative to increase the quality of surveillance. METHODS: A retrospective cohort study of 446 patients operated consecutively during the first half of 2007 was set up in a 56-bed general surgery unit in Lyon University Hospital, France. Patients were followed up 30 days after intervention. Different methods of detection were established by combining different data sources. The sensitivity and specificity of these methods were calculated by using, as reference method, the manual review of the medical records. RESULTS: The sensitivity and specificity of SSI detection were, respectively, 18.4% (95% confidence interval [CI]: 7.9-31.6) and 100% for surgeon notification; 63.2% (95% CI: 47.3-78.9) and 95.1% (95% CI: 92.9-97.1) for detection based on positive cultures; 68.4% (95% CI: 52.6-81.6) and 87.5% (95% CI: 84.3-90.7) using antibiotic prescription; 26.3% (95% CI: 13.2-42.1) and 99.5% (95% CI: 98.8-100) using discharge diagnosis codes. By combining the latter 3 sources, the sensitivity increased at 86.8% (95% CI: 76.3-97.4) and the specificity was lowered at 85.5% (95% CI: 82.1-89.0). CONCLUSIONS: SSI detection based on the combination of data extracted automatically from the hospital information system performed well. This strategy has been implemented gradually in Lyon University Hospital.
Assuntos
Sistemas de Informação Hospitalar , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Idoso , Feminino , França , Hospitais Universitários , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
BACKGROUND: The incidence of ventilator-associated pneumonia (VAP) within the first 48 hours of intensive care unit (ICU) stay has been poorly investigated. The objective was to estimate early-onset VAP occurrence in ICUs within 48 hours after admission. METHODS: We analyzed data from prospective surveillance between 01/01/2001 and 31/12/2009 in 11 ICUs of Lyon hospitals (France). The inclusion criteria were: first ICU admission, not hospitalized before admission, invasive mechanical ventilation during first ICU day, free of antibiotics at admission, and ICU stay ≥ 48 hours. VAP was defined according to a national protocol. Its incidence was the number of events per 1,000 invasive mechanical ventilation-days. The Poisson regression model was fitted from day 2 (D2) to D8 to incident VAP to estimate the expected VAP incidence from D0 to D1 of ICU stay. RESULTS: Totally, 367 (10.8%) of 3,387 patients in 45,760 patient-days developed VAP within the first 9 days. The predicted cumulative VAP incidence at D0 and D1 was 5.3 (2.6-9.8) and 8.3 (6.1-11.1), respectively. The predicted cumulative VAP incidence was 23.0 (20.8-25.3) at D8. The proportion of missed VAP within 48 hours from admission was 11% (9%-17%). CONCLUSIONS: Our study indicates underestimation of early-onset VAP incidence in ICUs, if only VAP occurring ≥ 48 hours are considered to be hospital-acquired. Clinicians should be encouraged to develop a strategy for early detection after ICU admission.
Assuntos
Pneumonia Associada à Ventilação Mecânica/epidemiologia , Adulto , Idoso , França/epidemiologia , Humanos , Incidência , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos ProspectivosRESUMO
The decision-making bodies of the University Claude Bernard Lyon 1 (UCBL) established a Health Observatory - OSPEL (Observatory of Health Personnel, University of Lyon 1) whose mission is to report epidemiological results on the health of university staff. An initial study had the following objectives: 1 / identify and collect the health issues and themes that staff wanted to see addressed by OSPEL and 2 / test the survey methodology through self-administered questionnaire via Internet from a representative sample of UCBL staff. In December 2008, a sample of 15% of the professional population of the university (n = 694) was invited by e-mail to answer a self-administered questionnaire available on the Internet. A sample of 607 people received this e-mail and 242 staff responded (39.9% rate of participation). A weight was factored in and applied to responses to redress the sample base of respondents and render it representative of the professional population at UCBL. Respondents chose three priority themes, "Quality of Life - Overall Health ? Well-being, "Mental Health-Stress" and "Occupational Risks" as the primary topics to be addressed by OSPEL. Respondents were predominantly women (63.5%), administrative and technical staff (56.8%), as well as professors (77.3%). The interest of this study is centered on the reactivity and the ubiquity of the Internet / Intranet methodology which facilitated the targeted collection of the health expectations of university staff. This survey is a first step in the development of more focused epidemiological investigations in line with the expectations of UCBL staff. Future surveys should consider the physical and temporal constraints suggested in this study.
Assuntos
Atitude Frente a Saúde , Docentes , Pessoal de Saúde , Nível de Saúde , Epidemiologia/normas , Feminino , França , Humanos , Internet , Masculino , Qualidade de Vida , Fatores de Risco , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , UniversidadesRESUMO
BACKGROUND: The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. OBJECTIVE: To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. SETTING: Eleven ICUs of a French university hospital. DESIGN: We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. RESULTS: Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. CONCLUSIONS: ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
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Infecção Hospitalar/mortalidade , Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos de Casos e Controles , Causas de Morte , Estado Terminal , Infecção Hospitalar/epidemiologia , França , Hospitais Universitários , Humanos , Incidência , Tempo de Internação , Vigilância da População/métodos , RiscoRESUMO
PURPOSE: To compare risk factors of early- (E) and late-onset (L) ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: An epidemiological survey based on a nosocomial infection surveillance program of 11 intensive care units (ICUs) of university teaching hospitals in Lyon, France, was conducted. A total of 7236 consecutive ventilated patients, older than 18 years and hospitalized in ICUs for at least 48 hours, were studied between 1996 and 2002. Data during ICU stay, patient-dependent risk factors, device exposure, nosocomial infections occurrence, and outcome were collected. The cutoff point definition between E-VAP (
Assuntos
Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Distribuição de Qui-Quadrado , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Estatísticas não ParamétricasAssuntos
Álcoois/administração & dosagem , Infecção Hospitalar/prevenção & controle , Desinfetantes/administração & dosagem , Desinfecção das Mãos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos em Hospital , Administração Cutânea , Atitude do Pessoal de Saúde , França , Fidelidade a Diretrizes/normas , Humanos , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/psicologia , Guias de Prática Clínica como Assunto , Soluções , Inquéritos e QuestionáriosRESUMO
Commonly used methods for identifying the training needs of general practitioners do not enable the real needs felt during interviews with patients during office visits to be detected. In this study, the authors evaluate how physicians' use of a personal-office-visit diary affects the level of specificity of their expressed training needs. In 1999, the authors carried out a controlled intervention trial using a random sample of 1,038 general practitioners from a region of France, randomized to intervention and control groups. The practitioners in the intervention group were asked to identify their training needs using a personal-office-visit diary. The level of specificity for their expressed needs was compared with that of the expressed needs of the practitioners in the control group. The use of the diary was associated with a significantly higher level of specificity in the training needs identified by the general practitioners who participated. Independent of the intervention, practitioners under 40 years of age, those in urban practice, and those who were members of a continuing medical education (CME) association expressed their training needs with higher specificity. The personal-office-visit diary would seem to be a simple, inexpensive, and useful tool for more specifically identifying training needs, which could help establish more appropriate and better-targeted training programs. However, it should be assessed further by those involved in CME for general practitioners.