Crabtree Traves D, Pelletier Shawn J, Raymond Daniel P, Antevil Jared T, Gleason Thomas G, Pruett Timothy L, Sawyer Robert G
Department of Surgery, University of Virginia School of Medicine, Charlottesville 22908-0709, USA.
Shock. 2002 Apr;17(4):258-62. doi: 10.1097/00024382-200204000-00003.
The practice of surgery is being performed increasingly on an outpatient basis. How these changes have influenced the nosocomial infection rate and the ability of standard, Center for Disease Control (CDC)-designed surveillance techniques to detect these infections is unknown. The goal of this study was to determine whether recent changes in surgical care have led to an increased nosocomial infection rate based on number of discharges and whether current surveillance techniques are adequate to detect these complications. Data were collected prospectively on all nosocomial infections over a 1-year period on the general surgery, trauma, and transplant units at a university hospital, as independently observed by both the study team [surgical auditors (SA)] and CDC-trained infection control practitioners (ICP). The patient study group had a high acuity of illness (for 516 episodes of infection, mean APACHE II score of 15.4, 45% intensive care unit-bound, mortality of 16%). The overall infection rate per 100 discharges was 23.8 for SA and 12.2 for ICP (P < 0.001 by chi2), higher than historical reports. SA detected significantly more surgical site infections, pneumonias, and non-Clostridium difficile-related gastrointestinal infections. These relative rates of detection, however, were similar to those described previously in prior studies using similar methodologies. The nosocomial infection rate in surgical patients, based on number of discharges, appears to be increasing, perhaps due to increased inpatient acuity of illness. Current epidemiological methods provide estimates of infection rates with effectiveness similar to that reported in previous epidemiological studies but fail to recognize many infections otherwise identified by surgeons dedicated to infection control.
外科手术越来越多地在门诊基础上进行。这些变化如何影响医院感染率以及疾病控制中心（CDC）设计的标准监测技术检测这些感染的能力尚不清楚。本研究的目的是确定近期外科护理的变化是否导致基于出院人数的医院感染率增加，以及当前的监测技术是否足以检测这些并发症。在一所大学医院的普通外科、创伤科和移植科，研究团队[外科审计员（SA）]和接受CDC培训的感染控制从业人员（ICP）独立观察，前瞻性收集了为期1年的所有医院感染数据。患者研究组病情严重程度高（516例感染发作，平均急性生理与慢性健康状况评分系统II（APACHE II）评分为15.4，45%入住重症监护病房，死亡率为16%）。SA每100例出院患者的总体感染率为23.8，ICP为12.2（卡方检验P<0.001），高于历史报告。SA检测到的手术部位感染、肺炎和非艰难梭菌相关的胃肠道感染明显更多。然而，这些相对检测率与之前使用类似方法的研究中描述的相似。基于出院人数的外科患者医院感染率似乎在上升，这可能是由于住院患者病情严重程度增加所致。当前的流行病学方法提供的感染率估计值与之前流行病学研究报告的有效性相似，但未能识别许多外科医生专门致力于感染控制而发现的感染。
