Noy Denise, Creedy Debra
West Moreton Health District, Ipswich Hospital, Queensland, Australia.
Am J Infect Control. 2002 Nov;30(7):417-24. doi: 10.1067/mic.2002.123393.
Surveillance of surgical site infections (SSIs) is an important clinical indicator of quality patient care, yet an increasing number of SSIs manifest after discharge and are not detected through standard surveillance methods.
This study evaluated a multimethod approach to postdischarge surveillance of SSIs with use of a cesarean section procedure as a case study.
A postdischarge questionnaire was sent on day 30 to women (n = 277) who had undergone cesarean section. A follow-up telephone interview was conducted if the questionnaire had not been returned within 2 weeks, a diagnosis of infection could not be clearly determined from the responses given, or to confirm the diagnosis of infection. If follow-up could not be made, a chart audit was undertaken.
A total response rate of 89% (247/277) was obtained. Twenty-one women with SSI were identified through questionnaire responses. Additional strategies of telephone follow-up and chart review of patients with possible infection and of nonresponders identified more postdischarge infections (33%, 14/42). The overall infection rate was 17% (42/247) compared with 2.8% (7/247) at discharge.
Postdischarge surveillance approaches need to achieve the best possible response rate, reflect follow-up health care delivery patterns, be cost-effective, gather data from both patients and treating physicians, and use standard definitions to facilitate benchmarking with other health care facilities and surveillance systems. The inclusion of contacting nonresponders in any method of postdischarge surveillance is recommended to determine the most accurate infection rate.
手术部位感染（SSI）监测是衡量患者优质医疗护理的一项重要临床指标，但越来越多的SSI在出院后才出现，且无法通过标准监测方法检测到。
本研究以剖宫产手术为例，评估了一种用于出院后SSI监测的多方法途径。
在术后第30天向接受剖宫产手术的女性（n = 277）发送出院后调查问卷。如果调查问卷在2周内未返回，或者根据所给回复无法明确确定感染诊断，或者为了确诊感染，则进行后续电话访谈。如果无法进行随访，则进行病历审核。
总回复率为89%（247/277）。通过调查问卷回复确定了21例SSI女性患者。对可能感染的患者和未回复者进行电话随访和病历审查等额外策略，发现了更多出院后感染病例（33%，14/42）。总体感染率为17%（42/247），而出院时为2.8%（7/247）。
出院后监测方法需要实现尽可能高的回复率，反映后续医疗保健服务模式，具有成本效益，从患者和治疗医生双方收集数据，并使用标准定义以便与其他医疗保健机构和监测系统进行基准比较。建议在任何出院后监测方法中纳入联系未回复者，以确定最准确的感染率。
