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The effect of performance feedback on wound infection rate in abdominal hysterectomy

Abstract number: 1134_04_245

García Rodríguez J.F., Canedo E., Lorenzo M.V., Rivera A., Carballo M.J., Parada C., Ferro J., Martínez Pérez-Mendaña  J.

Objective:  

To ascertain the effect of an infection control program, using performance feedback, on wound infection (WI) rate in abdominal hysterectomy.

Methods:  

All patients with abdominal hysterectomy attended in our Centre between 1999 and 2003 were prospectively followed for 1 month after operation to know WI rate. CDC definitions were used. A complete set of tests including age, underlying illnesses, cancer, diabetes mellitus, immunosuppression therapy, albumin, ASA risk, inpatient preoperative stay, date of intervention, hygiene and preoperative antimicrobial prophylaxis, type of surgical operation, duration of surgery, surgeon, WI, were collected in each case. After data collection for 1999 concluded, we communicated every year surgical WI rates to surgeons (service and surgeon-specific). A logistic-regression analysis was performed to compare the WI rates with the observed in 1999.

Results:  

We recruited 831 females. Mean age, 50.6 ± 10.7 years, range 22–90.25% patients were cancer cases, 5.3% diabetes mellitus, 0.5% immunosuppression therapy, 26.8% ASA 1, 57.5% ASA 2, 14.4% ASA 3 and 1.2% ASA 4. In 7 (0.8%) patients surgery was done urgently and in 824 programmed, 724 in the morning and 100 in the afternoon. There were no differences between the years of study in the surgery with urgency, and in the frequency of risk ASA 3 and 4; the surgery in the afternoon was more frequent in the years 2000 (23.9%) and 2001 (19.1%) than in 1999 (12%), 2002 (6.9%) and no patient in 2003. The mean of days of preoperative stay was 2.6 ± 3.05, range 1–28. The types of surgical operations were total abdominal hysterectomy 752 (90.5%), subtotal hysterectomy 53 (6.4%) and Wertheim in 26 (3.1%). In the multivariate model the factors associated with surgical WI were albumin (OR 0.97; IC 95%: 0.94–0.99) and the antimicrobial prophylaxis (OR 0.13; IC 95%: 0.04–0.43). The mean values of albumin and the number of patients with perioperative antimicrobial prophylaxis fluctuated between years. The surgical wound infection rate improved from 10.7% (IC95% 5.8–15.6) in the year 1999 as far as 6.6% (–38.3%) in 2003.

 19992000200120022003
Albumin3.35 ± 1.43.64 ± 0.93.60 ± 0.73.86 ± 0.33.88 ± 0.3
Prophylaxis53/150 (35.3%)41/163 (25.2%)62/162 (38.3%)33/173 (19.1%)53/183 (29%)
W. Infection16/150 (10.7%)14/163 (8.6%)8/162 (4.9%)17/173 (9.8%)12/183 (6.6%)

Conclusions:  

The effect of performance feedback to individual surgeons can reduce the infection rates of surgical wound infection.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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