Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation.
Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation.
复制标题
全州范围内验证中结肠手术和腹部子宫切除术后手术部位感染的可变病例检测和许多未报告的病例。
DOI：
10.1017/ice.2017.134
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发表时间：
2017
影响因子：
4.5
通讯作者：
Janssen,Lynn
中科院分区：
文献类型：
--
作者：
Calderwood,MichaelS;Huang,SusanS;Keller,Vicki;Bruce,ChristinaB;Kazerouni,NNeely;Janssen,Lynn
目的 通过全州范围的外部验证来评估结肠手术和腹部子宫切除术后医院手术部位感染 (SSI) 的识别和报告方法来自加州公共卫生部 (CDPH) 的感染预防人员 (IP) 对自愿参与的医院进行的手术进行了现场 SSI 验证。验证包括对医院之前报告的 SSI 病例进行图表审查，以及对通过暗示 SSI 的索赔代码标记供审查的患者记录进行审查。我们评估了传统监测的敏感性以及基于索赔的监测的额外好处。我们还评估了基于索赔的监测的阳性预测价值（即工作量效率）。 结果经过验证审查，CDPH IPs 在 42 家医院的结肠手术后发现了 239 例 SSI，在 34 家医院的腹部子宫切除术后发现了 76 例 SSI。对于结肠手术，传统监测的敏感性为 50%（深切口或器官/间隙 [DI/OS] SSI 为 47%），而基于索赔的监测为 84%（DI/OS SSI 为 88%）。对于腹部子宫切除术，传统监测的敏感性为 68%（DI/OS SSI 为 67%），而基于索赔的监测为 74%（DI/OS SSI 为 78%）。基于索赔的监测也很有效，每 2 名接受过腹部子宫切除术的患者和每 2.6 名接受结肠手术的患者被标记为需要审查的患者，就会发现 1 个 SSI。总体而言，CDPH 在 74% 进行结肠手术的验证医院和 35% 进行腹部子宫切除术的验证医院中发现了以前未报告的 SSI。结论基于索赔的监测是一种标准化方法，医院可用于增强传统监测方法，卫生部门可用于外部验证。感染控制医院流行病学 2017 年；38:1091–1097
OBJECTIVETo assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validationMETHODSInfection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency).RESULTSUpon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy.CONCLUSIONSClaims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.Infect Control Hosp Epidemiol 2017;38:1091–1097