Charles P. Craig

Effect of postdischarge surveillance on rates of infectious complications after cesarean section

Decreases in length of stay for surgical procedures and increased outpatient surgery affect accuracy of surgical wound infection rates. To assess accuracy of rates for infectious complications after delivery by cesarean section, we implemented postdischarge surveillance at our hospital (4800 annual deliveries). Physician questionnaires were used. Response rate was greater than 90%. During the 5 months before postdischarge surveillance the overall infection rate was 1.6%; afterward the rate increased to 6.3% (p = 0.0003). Approximately 59% of infectious complications would have gone undetected with only inpatient surveillance. We conclude that postdischarge surveillance is necessary for an accurate determination of rates of infectious complications. The need among this population reflects relatively short postpartum hospitalization and emphasis on outpatient management of postoperative complications.

Bacillus cereus Endocarditis in an Addict

Excerpt To the editor: Except forBacillus anthracis, bacilli are not usually considered pathogenic. Despite the increasing role of saprophytes in bacteremic infections, reports of systemic infectio...

Preparation of the skin for surgery.

The history of topical care of wounds is long and illustrious, dating back to at least as early as the Egyptians of the pharoahs. Among other materials employed for prevention of infection in wounds, the Egyptians recommended honey, and such practices still enjoy significant popularity, particularly among certain gynecologists. The effectiveness of honey was based upon the presence in it of an antibacterial substance called inhibine, a secretory product of the salivary glands of bees. Like the contemporary manufacturers representative trying to sell a topical antiseptic, those who provided honey to the Egyptians faced serious hazards, since bees were not raised domestically and the harvesting of honey was done from hives of wild bees. Progressing through the use of certain dye substances, particularly the triphenylmethane dye, malachite green, by the Egyptians, through wine which had significant antibacterial activity based upon the presence of certain phenolics, to carbolic acid in the days of Lister, treatment of wounds to control infections enjoyed great popularity. However, it became apparent that the prophylactic use of carbolic acid on the skin of the patient to be operated and the hands of the surgeon could significantly reduce postoperative wound infections. Today there are a battery of topical agents which are proposed to be effective materials in preparing a skin site for subsequent surgery. All are significantly less toxic than carbolic acid and all enjoy some virtues.

Risk of hepatitis B among phlebotomists

Because of their frequent exposure to blood from patients with possible undetected chronic hepatitis, phlebotomists are at risk of acquiring hepatitis B. The relative risk of phlebotomists was assessed by comparing the incidence of development of circulating hepatitis B surface antigen or antibody to the antigen in a 6-month period with the incidence in a group of hospital secretaries. Phlebotomists from 13 hospitals were surveyed for a total of 270 personnel months and secretaries for 94 personnel months. Phlebotomists had twice the incidence of seropositivity as secretaries at the outset, but during the study they developed antibody or antigenemia with the same relative frequency as secretaries. Both had a decreasing frequency during the 6-month period of time, demonstrating the effect of the study on personnel practices. Although the development of hepatitis among phlebotomists seems somewhat higher than that among personnel who were not blood handlers, this study fails to confirm this fact, since under the stimulus of a research study the rate of development of disease over 270 personnel months was no different than that of a group of secretaries from the same institutions.