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Vol 14, No 2 (2008)
Research paper
Published online: 2008-04-30

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Hospital infections and postdischarge surveillance in selected vascular surgery procedures

Jadwiga Wójkowska-Mach, Małgorzata Bulanda, Andrzej Cencora, Arkadiusz Jawień, Anna Szczypta, Dorota Romaniszyn, Piotr. B. Heczko
Acta Angiologica 2008;14(2):56-65.

Abstract


Background. Nosocomial infections are an unwanted complication present in almost every hospital. Among patients of highly specialized departments, including vascular surgery wards, the most prevalent form of clinical infection are Surgical Site Infections (SSIs). SSIs significantly extend the patient's stay in the hospital, increase costs and above all can be the direct cause of death after vascular procedures.
Material and methods. This paper presents the results of studies on infection epidemiology in vascular surgery in the years 2002-2006 (9,573 surgical procedures) as well as a targeted study which included 413 patients of two highly specialized wards in the year 2005. The registration of infections was based on definitions formulated on the basis of CDC guidelines, and included postdischarge cases.
Results. Within the Active Surveillance System, 207 cases of SSI have been identified (incidence 2.2%) and 99 cases of hospital acquired pneumonia (incidence 1.0%); other forms of infection accounted for 21 cases. The overall incidence among patients undergoing surgical procedures (vascular surgery) was 3.4%. The targeted study allowed for a detailed analysis of SSI incidence with consideration of the SSI standardized infection ratio. The cumulated incidence rate of SSIs was 2.6% in site I and 5.6% in site II. Among the etiological factors isolated from materials taken from patients with symptoms of SSI, staphylococci were in the majority, among them Stapylococcus aureus. In the targeted study, almost half of the isolated S. aureus strains (40%) manifested a resistance to methicillin (MRSA) as well as macrolides, lincosamides and streptogramin B (MLSβ).
Conclusions. The Active Infection Surveillance System confirmed that in the patients of the studied population the most prevalent form of infection was SSI; however, a high incidence of hospital acquired pneumonia was also noticed. In the targeted study, the SSI incidence in site no. I was within the expected values. The possibility of performing postdischarge registration of infections was confirmed as well as the purposefulness of systematic infection control conducted by experienced personnel. The study showed the need for an improvement in microbiological surveillance in infection control, as well as the necessity of performing further detailed studies regarding the relationship of the operating team experience to the incidence of SSIs within Polish vascular surgery wards. We claim that in certain cases the division, together with the later reconstruction, of the left renal vein may facilitate the course of reconstructive operation of the abdominal aorta and decreases the risk of haemo-rrhage complications. Moreover, this manoeuvre does not influence postoperative renal function.

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