Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-15T01:38:11.946Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Surgical-Wound Infection in General Surgery A Prospective Study

Published online by Cambridge University Press:  02 January 2015

Maxima Lizán-García ,
Juan García-Caballero  and
Angel Asensio-Vegas
Maxima Lizán-García*
Affiliation:
Unidad de Medicina Preventiva, Hospital General de Albacete, Spain
Juan García-Caballero
Affiliation:
Servicio de Medicina Preventiva, Hospital La Paz de Madrid, Spain
Angel Asensio-Vegas
Affiliation:
Servicio de Medicina Preventiva, Hospital Ramóny Cajal de Madrid, Spain
*
Unidad de Medicina Preventiva, Hospital General, C) Hermanos Falco s/n, 02006 Albacete, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To quantify surgical-infection rate, to assess adherence with the antibiotic prophylaxis protocol, and to identify independent factors associated with surgical-wound infection (SWI).

Methods:

We carried out a prospective study of a cohort of 2,237 general surgery patients with postsurgery stays of more than 48 hours. Odds ratios (OR) were estimated using unconditional multiple logistic regression.

Setting:

A 1,300-bed, university-affiliated, tertiarycare hospital in Madrid, Spain.

Results:

254 patients developed SWI. The rate of adherence to the antibiotic prophylaxis protocol was 63.5%. Eight factors were independently associated with risk of SWI: age (OR=1.2 for every 10 years of age); wound classification (clean-contaminated, OR=6.4; contaminated, OR=3.7; dirty or infected, OR=9.3); antimicrobial prophylaxis (OR=0.5); stay prior to surgery (OR=1.1 for every 3 days); duration of operation (OR=1.5 for every 60 minutes); malignant neoplasm (OR=1.7); emergency procedure (OR=1.99); intensive-care unit stay prior to surgery (OR=2.6); and antimicrobial prophylaxis administered 2 or more hours before operation (OR=5.3).

Conclusion:

In general, antimicrobial prophylaxis protects against SWI (OR=0.5); however, administration 2 hours or more before the operation increases the risk of SWI by a factor of 5.3. Therefore, measures should be taken to ensure the correct timing of antimicrobial prophylaxis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 5 , May 1997 , pp. 310 - 315
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nichols, RL. Postoperative wound infection. N Engl J Med 1982;307:1701–1702.CrossRefGoogle ScholarPubMed
2. Haley, RW, Culver, DH, White, JW, Emori, TG. The national nosocomial infection rate. A new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle Scholar
3. Saez González, MC, Rodrigo Sanchez, N, Gutierrez Fisac, JL, Valero Juan, L, Nuñez Mateos, JC, Melendez Marugán, D. Incidencia de Infección Hospitalaria en un Hospital Universitario. Med Clin (Barc) 1989;92:213–216.Google Scholar
4. Pittet, D, Ducel, G. Infectious risk factors related to operating rooms. Infect Control Hosp Epidemiol 1994;15:456–462.CrossRefGoogle ScholarPubMed
5. Asensio Vegas, A, Monge Jodrá, V, Soriano, C, López, R, Gil, A, Lizán García, M. Infección de la herida quirúrgica: factores de riesgoy modelo predictivo. Med Clin (Barc) 1993;100:521–525.Google Scholar
6. Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264–268.CrossRefGoogle ScholarPubMed
7. Green, MS, Rubistein, E, Amit, P. Estimating the effects of nosocomial infections on the length of hospitalization. J Infect Dis 1982;145:667–672.CrossRefGoogle ScholarPubMed
8. Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, JE. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248–257.CrossRefGoogle ScholarPubMed
9. Nichols, RL. Techniques known to prevent postoperative wound infection. Arch Surg 1982;3:34–37.Google Scholar
10. Polk, HC, Simpson, CJ, Simmons, BP, Alexander, W. Guidelines for prevention of surgical wound infection. Arch Surg 1983;M8:213–217.Google Scholar
11. Naessens, A, Lauwers, S. Prophylactic antibiotics in surgery. Acta Anaesthesiol Belg 1983;3:163–171.Google Scholar
12. DiPiro, JT, Cheung, RPF, Bowden, TA, Mansberger, JA. Single dose systemic antibiotic prophylaxis of surgical wound infections. Am J Surg 1986;152:552–559.CrossRefGoogle ScholarPubMed
13. Bohnen, J. Surgical infection and prophylaxis. Current Opinion in Infectious Diseases 1991;4:520–524.CrossRefGoogle Scholar
14. Martin, C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. Infect Control Hosp Epidemiol 1994;15:463–471.CrossRefGoogle Scholar
15. Altemeier, WA, Burket, F, Pruitt, BA, Sandersky, WP. Definitions and classification of surgical infections. In: Manual on Control of Infection in Surgical Patients. 2nd ed. Philadelphia, PA: Lippincott; 1984:19–30.Google Scholar
16. Comisión Clínica de Infecciones de la Paz. Guia Para la Prevencióny Control de la Infección Hospitalaria. Madrid, Spain: Hospital La Paz; 1988.Google Scholar
17. Ministerio de Sanidady Consumo. Instituto Nacional de la Salud. Clasification Internacional de Enfermedades. 9a Revisión (CIE-9). Modificación Clínica, Vol 2. Lista Tabular de Procedimientos. Madrid, 1989.Google Scholar
18. Garner, JS, Jarvis, W, Emori, G, Horan, TC, Hughes, J. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
19. Cruse, P, Foord, R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.CrossRefGoogle ScholarPubMed
20. Leigh, DA. An eight-year study of postoperative wound infection in two district general hospitals. J Hosp Infect 1981;2:207–217.CrossRefGoogle ScholarPubMed
21. Haley, RW, Schaberg, DR, Crossley, KB, von Allmen, SD, McGowan, JE. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:51–58.CrossRefGoogle ScholarPubMed
22. Culver, D, Horan, T, Gaynes, R, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152–157.CrossRefGoogle ScholarPubMed
23. Haley, RW. Nosocomial infection in surgical patients: developing valid measures of intrinsic patient risk. Am J Med 1991;91(suppl 3B):145–151.CrossRefGoogle ScholarPubMed
24. Haley, RW, Culver, D, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infection in our hospital. Am J Epidemiol 1985;121:83–205.CrossRefGoogle Scholar
25. Bremmelgaard, A, Raahave, D, Beier-Holgersen, R, Pedersen, JV, Andersen, S, Sorensen, AI. Computer-aided surveillance of surgical infections and identification of risk factors. J Hosp Infect 1989;13:1–18.CrossRefGoogle ScholarPubMed
26. Mishriki, SF, Law, DJ, Jeffery, PJ. Factors affecting the incidence of postoperative wound infection. J Hosp Infect 1990;16:223–230.CrossRefGoogle ScholarPubMed
27. Centers for Disease Control. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609–621.CrossRefGoogle Scholar
28. Hierholzer, W, Zervos, M. Nosocomial bacterial infections. In: Evans, A, Brachman, P, eds. Bacterial Infections of Humans. New York & London: Plenum Book Company; 1991:467–497.CrossRefGoogle Scholar
29. Saviter, SM, Samsa, GP, Rutala, WA. Nosocomial infections in the elderly. Increased risk per hospital day. Am J Med 1988;84:661–666.CrossRefGoogle Scholar
30. Cruse, PJE, Foord, R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206–210.CrossRefGoogle ScholarPubMed
31. Brachman, PS, Dan, BB, Haley, RW, Hooton, TM, Garner, JS, Allen, JR. Nosocomial surgical infections: incidence and cost. Surg Clin Am 1980;60:15–25.CrossRefGoogle ScholarPubMed
32. Courte, C, Lecoz, A, Jaume, C, Mazue, MC. Preparation of the surgical patient. From theory to daily usage. Soins 1988;512:22–32.Google Scholar
33. Garibaldi, RA, Skolnick, D, Lerer, T, et al. The impact of preoperative skin disinfection on preventing intraoperative wound contamination. Infect Control Hosp Epidemiol 1988;9:109–113.CrossRefGoogle ScholarPubMed
34. Delgado-Rodríguez, M, Cueto Espinar, A, Rodríguez Contreras, R, Gálvez Vargas, R. Quantification of risk factor in hospital infection at a surgical service. Eur J Epidemiol 1988;4:235–241.CrossRefGoogle Scholar
35. Chiodo, F, Falasca, P, Finci, G. The role of antiseptics and disinfectants in the control of the nosocomial infections. J Chemother 1989;1(suppl):25–27.CrossRefGoogle ScholarPubMed
36. Delgado-Rodríguez, M, Bueno-Cavanillas, A, López-Gigoso, R, et al. Hospital stay length as an effect modifier of other risk factors for nosocomial infection. Eur J Epidemiol 1990;6:34–39.CrossRefGoogle ScholarPubMed
37. Maki, DG. Risk factors for nosocomial infection in intensive care. ‘Devices vs Nature’ and goals for the next decade. Arch Intern Med 1989;149:30–35.CrossRefGoogle ScholarPubMed
38. Jarvis, W, Edwards, J, Culver, D, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):185–244.CrossRefGoogle ScholarPubMed
39. Weinstein, RA. Epidemiology of nosocomial infections in adult intensive care units. Am J Med 1991;91(suppl 3B):179–184.CrossRefGoogle ScholarPubMed
40. Sherertz, RJ, Garibaldi, RA, Maroski, RD, et al. Consensus paper on the surveillance of surgical wound infection. Am J Infect Control 1992;20:263–270.Google Scholar
41. Garibaldi, RA, Cushing, D, Lerer, T. Risk factor for postoperative infection. Am J Med 1991;91(suppl 3B):158–163.CrossRefGoogle ScholarPubMed
42. Classen, D, Scott, R, Stanley, L, et al. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med 1992;326:281–286.CrossRefGoogle ScholarPubMed
43. Shapiro, M, Shimon, D, Freund, U, Sacks, T. A decisive period in the antibiotic prohylaxis of cutaneous lesions caused by bacteroides fragilis in guinea pigs. J Infect Dis 1980;1:532–541.CrossRefGoogle Scholar
44. Richet, HM, Chidiac, C, Prat, A, et al. Analysis of risk factor for surgical wound infections following vascular surgery. Am J Med 1991;91(suppl 3B):170–178.CrossRefGoogle ScholarPubMed