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Grace T Emori - One of the best experts on this subject based on the ideXlab platform.
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cdc definitions of nosocomial Surgical site infections 1992 a modification of cdc definitions of Surgical Wound infections
Infection Control and Hospital Epidemiology, 1992Co-Authors: Teresa C Horan, Robert P Gaynes, William J Martone, William R Jarvis, Grace T EmoriAbstract:In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force, a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of Surgical Wound infection and changed the name to Surgical site infection (SSI).
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cdc definitions of nosocomial Surgical site infections 1992 a modification of cdc definitions of Surgical Wound infections
American Journal of Infection Control, 1992Co-Authors: Teresa C Horan, Robert P Gaynes, William J Martone, William R Jarvis, Grace T EmoriAbstract:In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections.1 However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force,2 a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of Surgical Wound infection and changed the name to Surgical site infection (SSI). The changes were made for two reasons. First, in the 1988 definitions, it was not clear that for deep Surgical Wound infections, specifying the anatomic location of the deep infection was necessary. For example, NNIS System hospitals would report osteomyelitis as the specific site of a deep Surgical Wound infection if it followed an orthopedic operative procedure. Hospitals unfamiliar with this two-level designation might not have gleaned this information from the 1988 definitions. In this revision, we have included a Table listing specific sites. Second, we have removed the term "Wound," because in Surgical terminology, "Wound" connotes only the incision from skin to deep soft tissues. We introduce the term "organ/space" to define any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure. The distinction between this component of the Surgical site and the incision is important in the pathogenesis of SSI following certain operative procedures. The following revised definitions should be used f r surveillance of SSI by hospitals wishing to compare their SSI data with NNIS System SSI data. This article includes some additional considerations when comparing hospital data to NNIS System data.
Kuojen Tsao - One of the best experts on this subject based on the ideXlab platform.
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quality check of a quality measure Surgical Wound classification discrepancies impact risk stratified Surgical site infection rates in pediatric appendicitis
Journal of The American College of Surgeons, 2013Co-Authors: Shauna M Levy, Galit Holzmannpazgal, Kevin P Lally, Koya Davis, Kuojen TsaoAbstract:Background The impact of quality measures in health care and reimbursement is growing. Ensuring the accuracy of quality measures, including any risk-stratification variables, is necessary. Surgical site infection rates, risk stratified by Surgical Wound classification (SWC) among other variables, are increasingly considered as quality measures. We hypothesized that hospital-documented and diagnosis-based SWCs are frequently discordant and that diagnosis-based SWCs better predict Surgical site infection rates. Study Design All pediatric patients (ie, younger than 18 years old) at a single institution who underwent an appendectomy for appendicitis between October 1, 2010 and August 31, 2011 were included. Each chart was reviewed to determine the hospital-documented SWC, which is recorded by the circulating nurse (options included clean, clean-contaminated, contaminated, and dirty); SWC based on the surgeons' postoperative diagnosis, including contaminated (ie, acute nonperforated, nongangrenous appendicitis), dirty (ie, gangrenous and perforated appendicitis), and 30-day postoperative Surgical site infections. Results Of the 312 evaluated appendicitis cases, the diagnosis-based and circulating nurse–based SWCs differed in 288 (92%) cases. The circulating nurse–based and diagnosis-based SWCs differed by more than one SWC in 176 (56%) cases. Surgical site infections were associated with worsening diagnosis-based SWC, but not with circulating nurse–based SWC. Conclusions Significant discordance exists between hospital documentation by the circulating nurse- and surgeon diagnosis-based SWCs. Inconsistency in risk-stratified quality measures can have a significant effect on outcomes measures, which can lead to misdirection of quality-improvement efforts, incorrect inter-hospital rating, reduced reimbursements, and public misperceptions about quality of care.
Teresa C Horan - One of the best experts on this subject based on the ideXlab platform.
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cdc definitions of nosocomial Surgical site infections 1992 a modification of cdc definitions of Surgical Wound infections
Infection Control and Hospital Epidemiology, 1992Co-Authors: Teresa C Horan, Robert P Gaynes, William J Martone, William R Jarvis, Grace T EmoriAbstract:In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force, a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of Surgical Wound infection and changed the name to Surgical site infection (SSI).
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cdc definitions of nosocomial Surgical site infections 1992 a modification of cdc definitions of Surgical Wound infections
American Journal of Infection Control, 1992Co-Authors: Teresa C Horan, Robert P Gaynes, William J Martone, William R Jarvis, Grace T EmoriAbstract:In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections.1 However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force,2 a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of Surgical Wound infection and changed the name to Surgical site infection (SSI). The changes were made for two reasons. First, in the 1988 definitions, it was not clear that for deep Surgical Wound infections, specifying the anatomic location of the deep infection was necessary. For example, NNIS System hospitals would report osteomyelitis as the specific site of a deep Surgical Wound infection if it followed an orthopedic operative procedure. Hospitals unfamiliar with this two-level designation might not have gleaned this information from the 1988 definitions. In this revision, we have included a Table listing specific sites. Second, we have removed the term "Wound," because in Surgical terminology, "Wound" connotes only the incision from skin to deep soft tissues. We introduce the term "organ/space" to define any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure. The distinction between this component of the Surgical site and the incision is important in the pathogenesis of SSI following certain operative procedures. The following revised definitions should be used f r surveillance of SSI by hospitals wishing to compare their SSI data with NNIS System SSI data. This article includes some additional considerations when comparing hospital data to NNIS System data.
Shauna M Levy - One of the best experts on this subject based on the ideXlab platform.
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quality check of a quality measure Surgical Wound classification discrepancies impact risk stratified Surgical site infection rates in pediatric appendicitis
Journal of The American College of Surgeons, 2013Co-Authors: Shauna M Levy, Galit Holzmannpazgal, Kevin P Lally, Koya Davis, Kuojen TsaoAbstract:Background The impact of quality measures in health care and reimbursement is growing. Ensuring the accuracy of quality measures, including any risk-stratification variables, is necessary. Surgical site infection rates, risk stratified by Surgical Wound classification (SWC) among other variables, are increasingly considered as quality measures. We hypothesized that hospital-documented and diagnosis-based SWCs are frequently discordant and that diagnosis-based SWCs better predict Surgical site infection rates. Study Design All pediatric patients (ie, younger than 18 years old) at a single institution who underwent an appendectomy for appendicitis between October 1, 2010 and August 31, 2011 were included. Each chart was reviewed to determine the hospital-documented SWC, which is recorded by the circulating nurse (options included clean, clean-contaminated, contaminated, and dirty); SWC based on the surgeons' postoperative diagnosis, including contaminated (ie, acute nonperforated, nongangrenous appendicitis), dirty (ie, gangrenous and perforated appendicitis), and 30-day postoperative Surgical site infections. Results Of the 312 evaluated appendicitis cases, the diagnosis-based and circulating nurse–based SWCs differed in 288 (92%) cases. The circulating nurse–based and diagnosis-based SWCs differed by more than one SWC in 176 (56%) cases. Surgical site infections were associated with worsening diagnosis-based SWC, but not with circulating nurse–based SWC. Conclusions Significant discordance exists between hospital documentation by the circulating nurse- and surgeon diagnosis-based SWCs. Inconsistency in risk-stratified quality measures can have a significant effect on outcomes measures, which can lead to misdirection of quality-improvement efforts, incorrect inter-hospital rating, reduced reimbursements, and public misperceptions about quality of care.
Andrea Kurz - One of the best experts on this subject based on the ideXlab platform.
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nitrous oxide and risk of Surgical Wound infection a randomised trial
The Lancet, 2005Co-Authors: Edith Fleischmann, Rainer Lenhardt, Béla Fülesdi, Robert Greif, F Herbst, Daniel I Sessler, Andrea Kurz, Ozan AkcaAbstract:Summary Background Nitrous oxide inactivates vitamin B12 and methionine synthase, thereby impairing DNA formation and, consequently, new cell formation. The gas also inhibits methionine production, which can reduce scar formation and depresses chemotactic migration by monocytes. Therefore, we assessed whether nitrous oxide increases the incidence of Surgical Wound infection. Methods We recruited 418 patients aged 18–80 years, scheduled for colon resection that was expected to last more than 2 h, at three hospitals in Austria and Hungary. Patients were randomly assigned 65% intraoperative nitrous oxide (n=208) or nitrogen (n=206), with remifentanil and isoflurane. The primary outcome was the incidence of clinical postoperative Wound infection, analysed by intention to treat. Findings 206 patients in the nitrous oxide group and 202 in the nitrogen group were included in the final analysis. Duration of surgery was longer in the nitrogen group (3·4 h [1·5]) than in the nitrous oxide group (3·0 h [SD 1·3]) and arterial pressure (84 mm Hg [10] vs 81 mm Hg [9]), bispectral index values (53 [9] vs 44 [8]), and end-tidal isoflurane concentration (0·64% [0·14] vs 0·56% [0·13]) were greater in patients given nitrogen than in those given nitrous oxide. Infection rate was 15% (31/206) in patients given nitrous oxide and 20% (40/202) in those given nitrogen (p=0·205). Additionally, the ASEPSIS Wound healing score, Wound collagen deposition, number of patients admitted to critical care unit, time to first food ingestion, duration of hospital stay, and mortality did not differ between treatment groups. Interpretation Nitrous oxide does not increase the incidence of Surgical Wound infection.
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nitrous oxide and risk of Surgical Wound infection a randomised trial
The Lancet, 2005Co-Authors: Edith Fleischmann, Rainer Lenhardt, Béla Fülesdi, Robert Greif, F Herbst, Daniel I Sessler, Andrea Kurz, Ozan AkcaAbstract:Summary Background Nitrous oxide inactivates vitamin B12 and methionine synthase, thereby impairing DNA formation and, consequently, new cell formation. The gas also inhibits methionine production, which can reduce scar formation and depresses chemotactic migration by monocytes. Therefore, we assessed whether nitrous oxide increases the incidence of Surgical Wound infection. Methods We recruited 418 patients aged 18–80 years, scheduled for colon resection that was expected to last more than 2 h, at three hospitals in Austria and Hungary. Patients were randomly assigned 65% intraoperative nitrous oxide (n=208) or nitrogen (n=206), with remifentanil and isoflurane. The primary outcome was the incidence of clinical postoperative Wound infection, analysed by intention to treat. Findings 206 patients in the nitrous oxide group and 202 in the nitrogen group were included in the final analysis. Duration of surgery was longer in the nitrogen group (3·4 h [1·5]) than in the nitrous oxide group (3·0 h [SD 1·3]) and arterial pressure (84 mm Hg [10] vs 81 mm Hg [9]), bispectral index values (53 [9] vs 44 [8]), and end-tidal isoflurane concentration (0·64% [0·14] vs 0·56% [0·13]) were greater in patients given nitrogen than in those given nitrous oxide. Infection rate was 15% (31/206) in patients given nitrous oxide and 20% (40/202) in those given nitrogen (p=0·205). Additionally, the ASEPSIS Wound healing score, Wound collagen deposition, number of patients admitted to critical care unit, time to first food ingestion, duration of hospital stay, and mortality did not differ between treatment groups. Interpretation Nitrous oxide does not increase the incidence of Surgical Wound infection.
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perioperative normothermia to reduce the incidence of Surgical Wound infection and shorten hospitalization
The New England Journal of Medicine, 1996Co-Authors: Andrea Kurz, Daniel I Sessler, Rainer LenhardtAbstract:Background Mild perioperative hypothermia, which is common during major surgery, may promote Surgical-Wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing Wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to Surgical-Wound infection and lengthens hospitalization. Methods Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patients' anesthetic care was standardized, and they were all given cefamandole and metronidazole. In a double-blind protocol, their Wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; Wounds containing culture-positive pu...
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perioperative normothermia to reduce the incidence of Surgical Wound infection and shorten hospitalization
The New England Journal of Medicine, 1996Co-Authors: Andrea Kurz, Daniel I Sessler, Rainer LenhardtAbstract:BACKGROUND: Mild perioperative hypothermia, which is common during major surgery, may promote Surgical-Wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing Wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to Surgical-Wound infection and lengthens hospitalization. METHODS: Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patient's anesthetic care was standardized, and they were all given cefamandole and metronidazole. In a double-blind protocol, their Wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; Wounds containing culture-positive pus were considered infected. The patients' surgeons remained unaware of the patients' group assignments. RESULTS: The mean (+/- SD) final intraoperative core temperature was 34.7 +/- 0.6 degrees C in the hypothermia group and 36.6 +/- 0.5 degrees C in the normothermia group (P < 0.001) Surgical-Wound infections were found in 18 of 96 patients assigned to hypothermia (19 percent) but in only 6 of 104 patients assigned to normothermia (6 percent, P = 0.009). The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia (P = 0.002), and the duration of hospitalization was prolonged by 2.6 days (approximately 20 percent) in hypothermia group (P = 0.01). CONCLUSIONS: Hypothermia itself may delay healing and predispose patients to Wound infections. Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations.
