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Nosocomial surgical infections: incidence and cost in a developing country
Abstract:
Eight hundred twenty-nine patients were monitored for nosocomial surgical infections from January to December 1980 at the University Hospital of the West Indies. Two hundred twenty-five patients (27%) had 189 postoperative wound infections (POWI) and 295 other nosocomial infections, with an average of 2.1 infections per infected patient. The incidence of POWI was 22.8%, varying from 7.3% in clean to 82.2% in infected wounds. The most common organisms isolated were gram-negative bacilli and Staphylococcus aureus. The most frequent nosocomial infection other than POWI was urinary tract infection (27.8%). A statistically significant number of urinary tract infections and septicemias were associated with the use of medical devices such as indwelling urethral catheters and central venous pressure lines (p less than 0.001). Septicemia was frequently associated with operations on the lower gastrointestinal and hepatobiliary tracts (p less than 0.001). The postoperative stay of an infected patient was prolonged by an average of 18 days. The total excess cost of hospitalization for the infected patients was U.S. $170,000.
Insights
Nosocomial surgical infections, including postoperative wound infections (POWI), affected 27% of patients. Medical devices and certain surgeries significantly increased infection risk, prolonging hospital stays and increasing costs.
Area of Science:
- Medical Microbiology
- Hospital Epidemiology
- Infectious Diseases
Background:
- Nosocomial infections pose a significant threat to patient safety and healthcare costs.
- Understanding the epidemiology of these infections is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the incidence and types of nosocomial surgical infections at the University Hospital of the West Indies.
- To identify risk factors associated with these infections and their impact on patient outcomes and hospital expenditures.
Main Methods:
- A prospective monitoring study of 829 patients from January to December 1980.
- Data collection on postoperative wound infections (POWI) and other nosocomial infections.
- Analysis of causative organisms, associated medical devices, surgical procedures, and patient outcomes.
Main Results:
- 27% of patients acquired nosocomial infections, with 22.8% experiencing POWI.
- Gram-negative bacilli and Staphylococcus aureus were the most common pathogens.
- Urinary tract infections and septicemias were significantly linked to medical devices (e.g., catheters, central venous pressure lines) and specific surgical sites (gastrointestinal, hepatobiliary).
- Infected patients had an average 18-day longer hospital stay, incurring an excess cost of $170,000.
Conclusions:
- Nosocomial infections, particularly POWI, are a substantial problem in surgical settings.
- The use of medical devices and the type of surgery are significant risk factors for developing infections like UTIs and septicemias.
- Effective infection control measures are essential to reduce patient morbidity, prolonged hospitalization, and healthcare costs.