Annalisa Castella

Surgical Site Infection Surveillance: Analysis of Adherence to Recommendations for Routine Infection Control Practices

OBJECTIVE To evaluate the application of surgical site infection control procedures in general surgery departments in hospitals in the Piemonte region of Italy. DESIGN The descriptive study entailed 1 week of observation in the general surgery departments and 1 week of observation in the operating rooms of 49 hospitals in Piemonte; the survey was conducted in 2003. METHODS Data collection forms were designed to record information about presurgical patient preparation (form 1) and infection control practices routinely used by surgical teams (form 2). RESULTS A total of 856 patients were observed; 88% of operations were surgical wound class I or II; 70.6% of patients had hair removed, 28.8% showered the day before the operation; antimicrobial prophylaxis was administered in 63.3% of cases (68.4% on induction of anesthesia and 26% on the day of the operation) and was continued into the postoperative period in 43% of cases. A total of 799 operations were observed; the mean number of healthcare personnel in the operating room was 6; doors were opened an average of 12 times during an operation; 88% of the surgical team members wore a cap/hood and mask correctly; 25% of surgeons and 41% of instrument nurses wore an eye shield; preoperative hand and forearm scrubbing technique was correct in 78% of cases (surgeons, 74.6%; instrument nurses, 86.6%; and anesthesiologists, 73%). CONCLUSIONS A comparison between the survey data and the international recommendations for SSI prevention highlighted practices that could be improved with corrective interventions. The study provided an opportunity for sharing feedback on appropriate data with healthcare personnel and was an effective instrument to audit infection control practices.

Incidence of surgical-site infections in orthopaedic surgery: a northern Italian experience.

SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.

Mumps: A current epidemiologic pattern as a necessary background for the choice of a vaccination strategy

Before the measles–mumps–rubella (MMR) vaccination was widely offered, the epidemiologic data about mumps (morbidity, immunization level, vaccine coverage) were analyzed in Piedmont region (Italy). The disease had a 3- to 5-year epidemic recurrence with morbidity rate between 40 and 150/100,000; the surveillance conducted by ‘sentinel’ pediatricians showed that the notifications underestimated the real data by about 5- to 7-fold. The 12-year-old subjects showed an immunization level (reached by the disease or the vaccination) of about 50% and their parents tended to refuse the MMR vaccination. Only 54% of the 3- to 5-year-old children received the MMR vaccine in the second year of life and the frequency of the vaccination failure was about 10%. The strategy of vaccination should take into account this epidemiologic pattern, to program an offer adequate to reach mumps control/elimination; the strategy of our region should include the active offer in the second year of life to reach higher coverage, a second offer at 4–6 and/or 12 years of life, when other vaccinations are given and the choice of a highly efficacious vaccine. The improvement of the notification system could also allow a more sensitive surveillance of epidemiologic patterns.

Valutazione economica della vaccinazione antimorbillo-parotite-rosolia in relazione al livello di copertura

AbstractObjectives: To evaluate the cost-benefit ratio of measles-mumps-rubella vaccination in two Italian areas with different immunisation coverages. Design: On the basis of the epidemiologic patterns of the three diseases in Piemonte and Puglia, the direct and indirect costs of the diseases and vaccination were estimated. A hypothetical 5-year vaccination program for children between 2 and 6 years of age was designed for the two regions. Setting: Piemonte and Puglia regions from 1995 to 1999, with a MMR immunization coverage of 60% and 40%, respectively. Main outcome measures and results: The variation of the cost-benefit ratio of vaccination was related to immunization coverage (and residual morbidity), cost of the disease (especially indirect costs), efficacy of the vaccine. The ratio was > 1 when coverage was moderate (40%) with high morbidity and low costs of the disease; with a 60% coverage a ratio of 0.70–0.90 was achieved. Conclusions: The analysis showed that the cost-benefit ratio is affected by several factors that can vary within the regional situations. While the cost of a prevented case can be low, public health strategies should also consider the cost of residual cases, which can be high when immunisation coverage or vaccine efficacy is low.

Surgical site infections surveillance in northern Italy.

Surgical site infection (SSI) surveillance programs vary across Europe. Since 1996, some 100 hospitals in the UK have participated in a general surveillance of operations, with particular focus on vascular, gynecological, and orthopedic surgeries [1,2]. The minimum duration of participation in the study is 3 months, and the program does not include 30 days post-discharge (PD) follow-up. Since 1998, French hospitals using a common national surgical protocol have been taking part in a surveillance program managed by five coordinating centers aimed at fighting nosocomial infection (C-CLIN). Surveillance is carried out 3 months a year and includes a 30-day follow-up. Since 2004, the incidence of SSI is an indicator of ‘‘composite indicator’’ in the ICALIN project [3]. Active SSI surveillance in Belgium involves the participation of hospitals for a 6-month period with a 30-day follow-up; data for a 2-year period from 2001 to 2002 are available [4]. The European HELICS (Hospitals in Europe Link for Infection Control through Surveillance) project, a network for the collection, analysis, and dissemination of nosocomial infection data, involved 11 countries and a total of 600 hospitals. Six different types of surgical interventions were surveyed, and the length of PD surveillance depended on the type of surveillance program the particular country operated [5, 6]. In the USA, the NNIS (National Nosocomial Infections Surveillance System), a hospital-based reporting system, has routinely collected the SSI data, although information on PD surveillance is not overall available [7]. In Italy, the incidence of SSI in surgical patients is 5%–6%, and the mean prolonged length of hospital stay (LOS) is 7–10 days [8]. One of the objectives of the recent INF-OSS project, supported by CCM (Centro Nazionale per la Prevenzione e il Controllo delle Malattie), is the elaboration and execution of pilot study on a national protocol for the surveillance of SSI, as in the HELICS model. In 2000, a study group on nosocomial infections in Piemonte (Northern Italy, 550,000 admissions/year, 28,000 health care workers) conducted a regional prevalence study. The analysis of the data showed a low rate of SSI, and the modalities of administration of the antimicrobial prophylaxis did not always agree with the criteria for the correct and efficacious use of these agents [9]. A survey was conducted in 2003 to evaluate the application of procedures recommended for SSI prevention, specifically the Centers for Disease Control (CDC) Category IA and IB recommendations [10]. The aim of this study was to determine SSI incidence and to test a standardized surveillance method at a local level. To this end, we conducted an active SSI surveillance survey comprising PD follow-up with telephone interviews (30 days) in 36 of the 61 public hospitals (only primary care and two teaching hospitals) in Piemonte and Valle d’Aosta, Italy, between September 2004 and May 2005. The participation in the study was voluntary. Hernia repair and colorectal surgery were surveyed. These are the most commonly interventions surveyed elsewhere in Europe, and our choice of these two areas allows us to generalize and compare our results with European data. The study population comprised patients of any age (one children’s hospital participated in the study) who were operated on during the study period in a service of general surgery. Interventions were grouped according to the International Classification of Diseases (ICD)-9-CM (Table 1). The following were excluded from the study: all reinterventions at the same site due to complications from prior operations, whether or not infectious, that had occurred within 30 days. Based on the incidence reported by the NNIS system and expected case series in our region, an 8-month surveillance period was set up to obtain significant data at the regional level [7]. The expected regional rate was 115 infections per 10,583 hernia repairs, assuming an inci-

Modeling the risk: Innovative approaches to understand and quantify the risk of severe FB injury

OBJECTIVES The entry of a small item into the respiratory or digestive tract is still one of the leading causes of injuries in children up to 14 years old. The aim of the paper is to provide a quantitative risk assessment analysis for identifying consumer product features which contribute to increase the risk of sustaining a severe injury. METHODS Data on foreign body injuries were collected in 28 European countries and one Pakistani hospital. A total of 7296 cases were classified according to ICD-9CM 931-935. Information about injuries included age and gender of the injured child, circumstances of the accident and foreign body features. A classification tree was set up in order to analyze the impact of the item features like volume shape and rigidity on the severity of the injury. RESULTS Males are involved in severe injuries more often than females. Most severe injuries when the foreign body is localized in the ears were due to objects with volume lesser than 49 mm(3). Volume cut-off is slightly higher for foreign bodies that have been found in the nose (55 mm(3)). Objects with conforming rigidity pose children to higher risk of severe injury. CONCLUSIONS The presence and supervision of an adult is crucial in reducing the risk for severe injuries both in pharynx and laryhnx and in mouth.