Likelihood Of Surgical Site Infection Research Articles

The Effect of American Society of Anesthesiologists Score and Operative Time on Surgical Site Infection Rates in Major Abdominal Surgeries.

The objective of this study was to evaluate the influence of two crucial variables, the American Society of Anesthesiologists (ASA) score and operative time, on the occurrence of surgical site infections (SSIs) in the context of major abdominal surgical procedures. A cross-sectional research study involved patients undergoing various gastrointestinal surgical procedures. Surgical details, procedure duration, and ASA score were meticulously documented. Patients were observed for surgical site infections (SSIs) during their inpatient stay until discharge. Following their discharge, patients were monitored in the outpatient department for a minimum of 30 days post-surgery, and those who underwent mesh procedures were observed for one year. In the overall study population, surgical site infections were identified in 42 cases, constituting 6.7%. There was a significant association between ASA grade and the incidence of surgical site infections (p=0.001), indicating a higher prevalence of infections in cases with elevated ASA grades. Furthermore, a statistically significant association exists between the average duration of surgery and the occurrence of surgical site infections (p=0.001). The meansurgery duration for cases with infections is reported as 206.33 min, with a standard deviation of 103.73, while for cases without infections, the mean duration is 99.72 min, with a standard deviation of 79.71. In the multivariate analysis, it was found that an ASA score of 3 or higher and operative time exceeding 90 min were identified as independent factors for predicting the likelihood of surgical site infections. The significant associations identified between the American Society of Anesthesiologists (ASA) grade, average surgery duration, and SSIs underscore the importance of comprehensive preoperative assessment and procedural management in infection prevention.

Antibiotic treatment of hand wounds in children: Contribution of a decision tree

BackgroundThe need for prophylactic antibiotic treatment of hand wounds in children requiring emergency surgical exploration is still controversial. Our starting hypothesis was that the absence of prophylactic antibiotic treatment in this setting (as specified by a decision tree) does not increase the likelihood of surgical site infection. MethodsA decision tree for antibiotic prescription was developed by a working group in compliance with the guidelines issued by the French High Authority for Health, as part of a clinical pathway. One injection of intravenous antibiotics was prescribed for bite injuries, open joint injuries, injuries left untreated for more than 24 h, and suspected contaminated wounds. All children admitted for surgical treatment of a hand wound between July 2018 and March 2023 were included. Demographic data, antibiotic prescription and onset of postoperative surgical site infection were recorded. ResultsThe 238 children included had a mean age of 8 ± 4.8 years; 102 received antibiotics and 136 did not. Eleven children (4.6%) had superficial surgical site infection requiring no revision surgery or antibiotic therapy. 206 children (86.5%) were treated following the decision tree. Ten had superficial surgical site infection: 3 received antibiotics (3.7% of the 80 who were treated) and 7 did not (5.5% of the 126 not treated) (p = 0.74). Thirty-two patients (13.5%) were off-protocol, only 1 of whom received antibiotics for superficial surgical site infection. DiscussionApplying the decision tree standardized the prescription of antibiotics in hand wounds, was not associated with a significantly greater rate of surgical site infection, and avoided exposure to antibiotics for 61.1% of the children, thus limiting potential adverse events. Level of evidenceIII.

Impact of penicillin allergy labels on surgical site infections in a large UK cohort of gastrointestinal surgery patients.

Studies in the USA, Canada and France have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). Here, we investigate the association between PALs and SSI in the UK, a country with distinct epidemiology of infecting pathogens and range of antimicrobial regimens in routine use. Electronic health records and national SSI surveillance data were collated for a retrospective cohort of gastrointestinal surgery patients at Cambridge University Hospitals NHS Foundation Trust from 1 January 2015 to 31 December 2021. Univariable and multivariable logistic regression were used to examine the effects of PALs and the use of non-β-lactam-based prophylaxis on likelihood of SSI, 30 day post-operative mortality, 7 day post-operative acute kidney injury and 60 day post-operative infection/colonization with antimicrobial-resistant bacteria or Clostridioides difficile. Our data comprised 3644 patients and 4085 operations; 461 were undertaken in the presence of PALs (11.3%). SSI was detected after 435/4085 (10.7%) operations. Neither the presence of PALs, nor the use of non-β-lactam-based prophylaxis were found to be associated with SSI: adjusted OR (aOR) 0.90 (95% CI 0.65-1.25) and 1.20 (0.88-1.62), respectively. PALs were independently associated with increased odds of newly identified MRSA infection/colonization in the 60 days after surgery: aOR 2.71 (95% CI 1.13-6.49). Negative association was observed for newly identified infection/colonization with third-generation cephalosporin-resistant Gram-negative bacteria: aOR 0.38 (95% CI 0.16-0.89). No evidence was found for an association between PALs and the likelihood of SSI in this large UK cohort, suggesting significant international variation in the impact of PALs on surgical patients.

Study to determine the factors related to patient and surgical procedures influencing the rate of postoperative surgical wound infections

Wound infections continue to be a substantial contributor to postoperative morbidity, responsible for around one-fourth of all nosocomial infections. The human bacteria from the endogenous organ microflora and the extrinsic environment continue to have a role in the development of wound infections. The development of postoperative wound infection has been linked to several different perioperative variables that have been studied in detail. Numerous studies have shown that several surgical procedures are more susceptible to postoperative infection complications because of individual risk factors. The majority of patient- and procedure-related variables have been identified to influence the likelihood of surgical site infections in univariate or multivariate analysis. Preexisting infection, older age, and other dangerous pathogens, smoking, and diabetes is also possible patient-related variables. Procedure-related variables include the length of the surgery, the quality of preoperative skin preparation and poor surgical skill. The goal of this study was to recognize the incidence of postoperative surgical wound infections, which is influenced by patient and surgical technique parameters.

Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery.

Limited contemporary data has compared similarities and differences between total laparoscopic (LDP), hand-assisted (HALDP), and open distal pancreatectomy (ODP). This study aimed to examine similarities and differences in outcomes between these three approaches in a contemporary cohort. Methods: Patients undergoing elective LDP, HALDP, and ODP in the NSQIP dataset (2014−2019) were included. Descriptive statistics and multivariate regression analyses were employed to compare postoperative outcomes. Results: Among 5636 patients, 33.9% underwent LDP, 13.1% HALDP, and 52.9% ODP. Compared with the LDP approach, surgical site infections were more frequent in HALDP and ODP approaches (1.2% vs. 2.6% vs. 2.8%, respectively, p < 0.01). After adjustment, the LDP approach was associated with a significantly lower likelihood of surgical site infection (OR 0.25, p = 0.03) when compared to ODP. There was no difference in the likelihood of surgical site infection when HALDP was compared to ODP (OR 0.59, p = 0.40). Unadjusted operative times were similar between approaches (LDP = 192 min, HALDP = 193 min, ODP = 191 min, p = 0.59). After adjustment, the LDP approach had a longer operative time (+10.3 min, p = 0.04) compared to ODP. There was no difference in the adjusted operative time between HALDP and ODP approaches (+5.4 min, p = 0.80). Conclusions: Compared to ODP, LDP was associated with improved surgical site infection rates and slightly longer operative times. There was no difference in surgical site infection rates between ODP and HALDP. Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients.

Hospital-Acquired Conditions: A Review of Classical and Novel Risk Factors Following Total Hip and Knee Arthroplasties.

In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $41,000 per patient per HAC. In the settings of total hip arthroplasty (THA) and total knee arthroplasty (TKA), increased age, a body mass index of >35 kg/m2, male sex, diabetes mellitus, electrolyte disturbances, and a history of anemia increase the likelihood of surgical site infections. Institution-specific (surgical) risk factors such as increased tourniquet time, an operative time of >130 minutes, bilateral procedures, a femoral nerve block, and general anesthesia increase the risk of HACs in the settings of THA and TKA.

Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study of Rates, Risk Factors, and Pathogens.

A retrospective multicenter study. To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity. There have been no extensive investigations of the risk factors for SSI in Japan. Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline. The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718). The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.

Artificial Neural Networks Applied to Prediction to Assess the Likelihood of Surgical Site Infection in Different Surgeries

Background: Based on data obtained from hospitals in the city of Belo Horizonte (population ~3,000,000), we evaluated relevant factors such as death, age, duration of surgery, potential for contamination and surgical site infection, plastic surgery, and craniotomy. The possibility of predicting surgical site infection (SSI) was then analyzed using pattern recognition algorithms based on MLP (multilayer perceptron). Methods: Data were collected by the hospital infection control committees (CCIHs) in hospitals in Belo Horizonte between 2016 and 2018. The noisy records were filtered, and the occurrences were analyzed. Finally, the predictive power of SSI of 5 types MLP was evaluated experimentally: momentum, backpropagation standard, weight decay, resilient propagation, and quick propagation. The model used 3, 5, 7, and 10 neurons in the occult layer and with resamples varied the number of records for testing (65% and 75%) and for validation (35% and 25%). Comparisons were made by measuring the AUC (area under the curve (range, 0–1). Results: From 1,096 records of craniotomy, 289 were usable for analysis. Moreover, 16% died; averaged age was 56 years (range, 40–65); mean time of surgery was 186 minutes (range, 95–250 minutes); the number of hospitalizations ranged from 1 (90.6%) to 8 (0.3%). Contamination among these cases was rated as follows: 2.7% contaminated, 23.5% potentially contaminated, 72.3% clean. The SSI rate reached 4%. The prediction process in AUCs ranged from 0.7 to 0.994. In plastic surgery, from 3,693 records, 1,099 were intact, with only 1 case of SSI and no deaths. The average age for plastic surgery was 41 years (range, 16–91); the average time of surgery was 218.5 minutes (range, 19–580 minutes); the number of hospitalizations ranged from 1 (77.4%) to 6 times (0.001%). Contamination among these cases was rated as follows: 27.90% potential contamination, 1.67% contaminated, and 0.84% infected. The prediction process ranged in AUCs from 0.2 to 0.4. Conclusions: We identified a high noise index in both surgeries due to subjectivity at the time of data collection. The profiles of each surgery in the statistical analyses were different, which was reflected in the analyzed structures. The MLP for craniotomy surgery demonstrated relevant predictive power and can guide intelligent monitoring software (available in www.sacihweb.com). However, for plastic surgeries, MLPs need more SSI samples to optimize outcomes. To optimize data collection and to enable other hospitals to use the SSI prediction tool, a mobile application was developed.Disclosures: NoneFunding: None

Compliance Rate of Surgical Antimicrobial Prophylaxis and its Association with Knowledge of Guidelines Among Surgical Residents in a Tertiary Care Public Hospital of a Developing Country.

IntroductionSurgical antimicrobial prophylaxis (SAP) means the administration of antibiotics in surgical practice, and it reduces the likelihood of surgical site infections (SSIs). Inappropriate SAP practice regarding the prescription, timing, and duration of antibiotic use prolongs the hospital stay of patients, increases patient morbidity (by exposing them to the adverse effects of antibiotics), promotes bacterial resistance, and puts an economic burden on health care.While developed countries regularly monitor and revise their SAP protocols, there are only a few such researches in developing countries, which is a major setback to proper surgical care.Objectives of the studyThis study aims to compare the practice of SAP in a tertiary health care hospital of a developing country Pakistan, with internationally recommended protocols and evaluate the impact of knowledge of international guidelines on SAP practice. The results of the study will highlight important shortcomings in prophylactic practice in the hospital and help develop recommendations to improve SAP practice and ensure better surgical care for patients.Materials and methodsAn observational, cross-sectional study was conducted in the general surgery unit of Holy Family Hospital (HFH), Rawalpindi, Pakistan, from March 2017 to November 2017 during which antimicrobial prophylaxis of 150 general surgery procedures was documented on the basis of six international SAP criteria, which were “indication for use of prophylaxis, timing of preoperative dose, choice of drug, route of administration, duration of postoperative prophylaxis, and the assessment of beta-lactam allergy.” The compliance rate (number of procedures following all the six criteria) was calculated for each operating surgical resident.A questionnaire was formulated that assessed the knowledge of 33 surgical residents working at that time regarding the above- mentioned six variables of SAP by six close-ended questions. Their responses were then compared to their compliance rate by chi-square analysis and binary logistic regression in SPSS version 23 (IBM Corp, Armonk, NY, US). A p-value of less than or equal to 0.05 was considered significant.The required ethical approval was obtained from the departmental heads as well as institutional research forum.ResultsSeventy-four of 150 observed procedures followed all the six international criteria of SAP, giving a compliance rate of 49.33%. Seventeen out of 33 (51%) surgical residents were aware of the guidelines. A chi-square analysis revealed a highly significant association between the awareness of guidelines and the number of compliant procedures performed by a resident (p<0.000). Forty-five out of 74 compliant procedures were performed by residents who were aware of the guidelines (61% of compliant procedures). The odds ratio for awareness and correct prophylaxis was 4.064 (p<0.000).ConclusionsThe study indicates an overall low compliance rate of 49.33% regarding surgical antimicrobial prophylaxis (SAP) practice in a public health care hospital of a developing country. The most common cause of non-compliance was prolonged postoperative prophylaxis. This study also shows that the knowledge of international guidelines significantly improves the prophylaxis practice by about four times. Hence, proper SAP compliance rate can be increased by actively educating and monitoring surgical residents.

A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before–after, cohort study

Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa. We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders. Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8·0% (95% CI 6·8-9·5; n=129) to 3·8% (3·0-4·8; n=70; p<0·0001), and this decrease persisted in the sustainability period (3·9%, 2·8-5·4; n=35). A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods. The likelihood of SSI during follow-up was significantly lower than pre-intervention (odds ratio [OR] 0·40, 95% CI 0·29-0·54; p<0·0001), but the likelihood of death was not significantly reduced (0·72, 0·42-1·24; p=0·2360). Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes. US Agency for Healthcare Research and Quality, WHO.

Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery.

The purpose of this study was to evaluate the efficacy of topically applied vancomycin powder in reducing the rate of surgical site infections (SSIs) in patients with diabetes mellitus (DM) undergoing foot and ankle surgery. Eighty-one patients with DM who underwent reconstructive surgery of a foot and/or ankle deformity and/or trauma and who received topically applied vancomycin were matched to 81 patients with DM who did not receive topically applied vancomycin. The mean age was 60.6 years in the vancomycin group and 59.4 years in the control group (P < .05). The 2 groups were similar with regard to gender, body mass index, duration of DM, short-term and longer term glycemic control, and length of surgery. The overall likelihood of SSI was decreased by 73% in patients who received topically applied vancomycin (odds ratio [OR], 0.267; 95% CI, 0.089-0.803; P = .0188). The rate of superficial infection was not significantly different between the 2 groups (OR, 0.400; 95% CI, 0.078-2.062; P = .2734); however, deep infections were 80% less likely in patients who received vancomycin powder (OR, 0.200; 95% CI, 0.044-0.913; P = .0377). High-risk diabetic patients undergoing foot and ankle surgery were notably less likely to develop an SSI with the use of topically applied vancomycin powder in the surgical wound, particularly with regard to deep infections. Topically applied vancomycin was associated with a very low rate of complications and was inexpensive ($5 per 1000 mg). Based on this study, foot and ankle surgeons may consider applying 500 to 1000 mg of vancomycin powder prior to skin closure in diabetic patients who are not allergic to vancomycin. Level III, retrospective case control series.

Predictive model for surgical site infection risk after surgery for high-energy lower-extremity fractures

Current infection risk scores are not designed to predict the likelihood of surgical site infection after orthopedic fracture surgery. We hypothesized that the National Nosocomial Infections Surveillance (NNIS) System and the Study on the Efficacy of Nosocomial Infection Control (SENIC) scores are not predictive of infection after orthopedic fracture surgery and that risk factors for infection can be identified and a new score created (Emerg Infect Dis. 2003;9:196-203). We conducted a secondary analysis of data from a trial involving internal fixation of 235 tibial plateau, pilon, and calcaneus fractures treated between 2007 and 2010 at a Level I trauma center. The predictive value of the NNIS System and SENIC scores was evaluated based on areas under the receiver operating characteristic (ROC) curve. Bivariate and multiple logistic regression analyses were used to build an improved prediction model, creating the Risk of Infection in Orthopedic Trauma Surgery (RIOTS) score. The predictive value of the RIOTS score was evaluated via the ROC curve. NNIS System and SENIC scores were not predictive of surgical site infection after orthopedic fracture surgery. In our final regression model, the relative odds of infection among patients with AO [Arbeitsgemeinschaft für Osteosynthesefragen] type C3 or Sanders type 4 fractures compared with fractures of lower classification was 5.40. American Society of Anesthesiologists class 3 or higher and body mass index less than 30 were also predictive of infection, with odds ratios of 2.87 and 3.49, respectively. The area under the ROC curve for the RIOTS score was 0.75, significantly higher than the areas for the NNIS System and SENIC scores. The NNIS System and SENIC scores were not useful in predicting the risk of infection after fixation of fractures. We propose a new score that incorporates fracture classification, American Society of Anesthesiologists classification, and body mass index as predictors of infection. Prognostic study, level II.

Effect of Stoma Location on the Incidence of Surgical Site Infections in Colorectal Surgery Patients

The purpose of this study was to investigate the association between ostomy location and the incidence of surgical site infections (SSIs) in colorectal surgery patients. Prospective comparison cohort study. The study sample comprised 25 adult inpatients with colorectal cancer managed surgically. All participants underwent stoma site marking before surgery. Persons undergoing emergency stoma creation and those requiring reconstruction of stomas were excluded. Subjects were recruited by WOC nurses at 6 facilities with outpatient clinics operated by WOC nurses and infection control nurses. All facilities were located in Japan. Six WOC nurses and 6 infection control nurses collected data including participant demographics, types of surgery, and occurrence of SSIs. Participants were prospectively observed for 30 days following surgery. Surgical site infections occurred in 9 out of 25 study participants (36%). Specifically, infections were reported at a rate of 43.8% (n = 7) and 36% (n = 2) with colon and rectal surgery, respectively. Inferential statistical analysis revealed no association between the likelihood of SSI and the distance between abdominal incision and the newly created intestinal ostomy. Based on these findings, we concluded that the distance between the location of stoma and the abdominal midline incision is not a significant risk factor for development of an SSI among postcolorectal surgery patients.

Comparing a combination of penicillin G and gentamicin to a combination of clindamycin and amikacin as prophylactic antibiotic regimens in prevention of clean contaminated wound infections in cancer surgery

Background and aimAppropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery. Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost. Patients and methodsTwo hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group A received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously. The demographic data of patients were collected, and they were observed for wound infections. ResultsInfected wounds occurred in 19 patients with a rate of 9.5%. Highest incidence of SSI was among bladder cancer patients (14.2%); p=0.044. The rate of SSI was 11% in group A, and 8% in group B, p=0.469. The cost of PA administered in group A was significantly less than that of group B (21.96±3.22LE versus 117.05±12.74LE, respectively; p<0.001). SSI tended to be higher among those who had longer time for antibiotic and incision (⩾30min) than those who had shorter time interval (<30min), (13% vs. 6.5%, respectively). ConclusionBoth penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.

Pre-operative skin preparation practices: results of the 2007 French national assessment

Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P<0.001). Compliance with hair removal procedures was observed in 91.5% of cases (95% CI 91.2-91.8), and compliance with surgical site disinfection recommendations was observed in 25,529 cases (62.0%, 95% CI 61.5-62.5). The following documentary evidence was found: information given to patient, 35.6% of cases; pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties.

Building a data warehouse for infection control

Recently, the convergence of several themes in health care has stimulated interest in exploiting data collected during clinical encounters to monitor and improve the quality of health care. Infection control departments can be supported by assembling previously collected electronic data into a data warehouse to monitor infections, report communicable diseases, and detect clusters of organisms. I present the rationale for constructing a data warehouse and describe the steps and challenges of developing a data warehouse to support infection control activities.