1Section of Infectious Disease and International Health,Dartmouth Hitchcock Medical Center,Lebanon,New Hampshire.
2Division of Infectious Diseases,University of California Irvine School of Medicine,Orange,California.
Infect Control Hosp Epidemiol. 2017 Sep;38(9):1091-1097. doi: 10.1017/ice.2017.134. Epub 2017 Jul 31.
OBJECTIVE To assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation METHODS Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency). RESULTS Upon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy. CONCLUSIONS Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation. Infect Control Hosp Epidemiol 2017;38:1091-1097.
目的 通过全州范围的外部验证方法，评估结肠手术后和腹式子宫切除术的医院手术部位感染（SSI）识别和报告情况。
方法 加州公共卫生部（CDPH）的感染预防人员（IP）对自愿参与的医院进行了外科手术部位感染（SSI）的现场验证。验证包括对医院先前报告的 SSI 病例进行病历审查，以及对通过索赔代码标记为疑似 SSI 的患者记录进行审查。我们评估了传统监测的敏感性以及基于索赔的监测的额外益处。我们还评估了基于索赔的监测的阳性预测值（即工作量效率）。
结果 在验证审查中，CDPH IP 在 42 家医院的 239 例结肠手术后和 34 家医院的 76 例腹式子宫切除术后发现了 SSI。对于结肠手术，传统监测的敏感性为 50%（深部切口或器官/空间[DI/OS] SSI 为 47%），而基于索赔的监测的敏感性为 84%（DI/OS SSI 为 88%）。对于腹式子宫切除术，传统监测的敏感性为 68%（DI/OS SSI 为 67%），而基于索赔的监测的敏感性为 74%（DI/OS SSI 为 78%）。基于索赔的监测也是有效的，每 2 例接受腹式子宫切除术和每 2.6 例接受结肠手术的患者中就有 1 例 SSI 被识别。总体而言，CDPH 在进行结肠手术的 74%的验证医院和进行腹式子宫切除术的 35%的验证医院中发现了以前未报告的 SSI。
结论 基于索赔的监测是一种标准化的方法，医院可以使用该方法来补充传统的监测方法，卫生部门可以用于外部验证。感染控制与医院流行病学 2017；38：1091-1097。
