Volume 19 Number 2

April 1991 Abstracts 121

THE BENEFIT OF A RESPIRATORY CARE UNIT IN PREVENT- ING NOSOCO AL VENTILATOR-ASSOCIATED PNEUMONIA IN CHRONIC K NTILATOR-DEPENDENT PATIENTS. M. Nii- vaggi.* RN, MSN. CIC. J. Selva. RN, BS. CIC, A. Toledo, RN, B.S. A. Mamney. RN, MS, S. Forlenza. MD. Nassau County Medical Center, East Meadow, NY.

BACKGROUND: Endotrachcal intobation and ventilator-assisted respiration can lead to nosocomial pneumonia in chronic ventilator-dependent patients (VDPs). Because of the high mortality of ventilator-associated pneumonia (VAP) in VDPs. infection control programs should identify measures which reduce the incidence of nosocomial pneumonias in this predisposed population. Preliminary evaluation of VAPs on a respira- tory care unit (RCU) suggested a trend toward a lower incidence of VAP in the RCU compared with that in VDPs housed on the general medical units (GMUs). We now present a pmspxtive evaluation of the comparative incidence of VAP in VDPs on a RCU with VDPs housed on the GMUs over a 12.month period. STUDY PURPOSE: The purpose of this study was to determine whether the placement of chronic VDPs on a RCU significantly decreases the incidence of VAP in hospitalized VDPs. MATERIALS AND METHODS: National Nosocomial Infection Surveillance criteria were used for the diagnosis of nosocomial pneumonia. The incidence of nosocomial VAP of VDR cohorted on the RCU was compared prospectively with that of the GMUs of this 700~bed teaching hospital. The 14&d RCU provides private rooms, specially trained nursing staff and a satellite Respiratory Therapy Depamnent located on the unit. Patients located on the GMUs are in 2-bed rooms with the regular floor norses pmvid- ing care and received Respiratory Therapy Department treatments inter- mittently. Patient entry criteria included at least 2 weeks of ventilator dependence and similar severity of illness scores.

RESULTS: 36 VAPs occurred over 1740 ventilator days (VDs) on the GMUs compared with 32 VAPs over 4738 VDs on the RCU. giving an incidence of 20.7 verses 6.75 per IDo0 VDs the GMUs and RCU respectively. Using the two-tailed Fisher’s exact test, the difference was statistically significant (significance level 0.0119. p=O.O12 with a 98% confidence level).

CONCLUSION: A signillcant reduction in the incidence of nosocomial VAP in chronic VDPs cohoned on the RCU was documented in this hospital. Potential benefits derived fmm the RCU’s reduction in VAPs include a lower monality, cost reduction due to the decreased utilization of antibiotics and a concomitant delay or prevention of the emergence of antimicrobial-resistant pathogens colonizing or causing infections in these patients.

POST-DISCHARGE SURVEILLANCE OF POST-OPERATIVE WOUND INFECTIONS: AN ASSESSMENT OF PHYSICIAN COM- PLIANCE AND DATA ACCURACY. M. DeCastro,’ RN, BSN. CIC. I. MacDonald. MD, S. Ragans. RN. BSN. M. Poole. MD. E. Votra. RN MPH. Tallahassee Memorial Regional Medical Center, Tallahassee, FL.

The efficacy of post-discharge surveillance for surgical wound infection identification is a controversial issue. The methodology used at our hospital is dependent upon the ability to consistently obtain accurate and complete data from surgeons.

A system to obtain monthly infection data on inpatient clean and clean-contaminated cases after discharge fmm the hospital was insti- tuted in 1988. Three year’s data were- retrospectively reviewed to assess each of tlx 114 surgwn’s compliance with providing infotma- tion. 89% of the surgeons returned >!XtW of the monthly reports. In addition, one year’s data were reviewed to assess accttracy of data 94.7% of the surgeons reported complete and accurate data.

Surgeon-specific compliance rates and data accuracy rates are reported to the surgical staff in an effort to promote their cooperation and interest in generating accurate surgical wound infection rates.

The applicability and feasibility of our methodology may vary depending upon the individual hospital and community characteristics.

EFFECT OF POSTDISCHARGE SURVEILLANCE ON RATES OF INFECXOUS COMPLICATIONS FOLLOWING CESAREAN SEC- TION. L.J. Hulton.* BSN, R.N. Ohnsted, MPH, J. Treston-Autand. RN, MSN. C.P. Craig, MD. Catherine McAuley Health System, Ann Arbor, MI.

Reporting surgeon-specific wound infection rates has been shown to bc an effective method for decreasing post-operative wound infec- tions. To assess accuracy of these rates for infectious complications following delivery by cesarean section (CS), we implemented post- discharge surveillance (F’S) of all patients undergoing CS delivery at our community teaching hospital (4,lXXl annual deliveries). Physician questionnaires listing patient IDS. date of procedure, and whether an infection was identified were used. Response rate to questionnaires was over 90%. During the six months prior to PS the average CS- associated infection rate was 1.8%. After PS. the rate of CS-associated infection has been 6.3% (p=O.tX?). Approximately 70% of infectious complications following CS would have gone undetected at our institu- tion utilizing only inpatient surveillance.

We conclude that PS is necessary for an accurate determination of rates of infectious complications following CS delivery. The need for PS among this patient population reflects a relatively short postpar- tom hospitalization (average LOS=4.24 days, Catherine McAuley Health System) and an emphasis on outpatient management of post- operative complications.

OPEN HEART SURGERY ASSOCIATED INFECTIONS AND THE SIGNIFICANCE OF POST-DISCHARGE FOLLOW-UP. M. Drou- in,* BSN, C. Smith, MD, E. Rubinstien. MD, R.W. Lyons, MD. St. Francis Hospital & Medical Center, Hattford. CT.

A prospective SNdy of 100 consecutive open heart surgery patients (pts) was done in a 650&d university affiliated hospital per- forming about 950 open heart surgeries per year. Pts were followed for 3 months post-operatively to determine the surgery associated infec- tion rate, risk factors, sites of infection and their bacteriology. Infec- tions were defined according to Center for Disease Control guidelines, by post-discharge patient description of wound inflammation/drainage for which antibiotic therapy was prescribed, and by confirmation by surgeon. Post-discharge follow-up (PDF) involved patient telephone contact and completion of follow-up evaluation forms by surgeons.

There were 28 infections in 26 pts. Eight wound infections were found on PDF. These were 7 of 14 saphenous vein donor site infec- tions (SVDSI) and 1 of 3 sternal wound infections (SW]). The other SVDSI and SWI, as well as the 3 urinary tract infections, 4 lower respiratory infections, and the 4 intravascular line infections were diag- nosed prior to discharge.

The infected and non-infected patients had no significant difference in demographics. Comparison of infected vs non-infected pts (meatxtsd) showed pomp time 116i27 min vs KHX32 min (p=O.Dz), operation time 320182 min vs 289f65 min @=0.06) and post-operative length of stay 14f7 days vs 9~k3 days (p=O.ooOl).

SVDSI accounted for half of the infections identified in this study. 28% of the infections and 48% of the wound infections in this study would not have been identified without PDF. Failure to do PDF may lead to gross underestimation of infection rates associated with cardiovascular surgery.