[The effect of changing some patient care practices on the incidence of surgical wound infections following "clean" interventions. PRINOS group of study].
OBJECTIVE
To evaluate the changes in patient care practices following an intervention program in general surgery and their impact on surgical wound infections (SWI) associated with clean operations.


METHODS
A "before-after" study design was used. Active surveillance was implemented in each ward; the intervention consisted of an educational program, whose effectiveness was evaluated comparing SWI rates before and after its implementation.


RESULTS
A total of 799 patients undergoing clean operations from three general surgical wards were included in the study: 606 before and 193 after the intervention program. The observed reduction in the SWI incidence was 79.2%; the most striking change in patient care practices observed after the intervention was the substitution of open surgical drains with closed drains. High risk operations (RR 8.4), length of operation greater than 2 hours (RR 11.2), and open surgical drains lasting more than three days (RR 5.1) significantly increased the risk of SWIs in the preintervention phase, according to the logistic regression analysis. Of the observed pre-intervention SWIs, 46.2% was attributable to exposure to open drains.


CONCLUSIONS
Many postoperative infections can be prevented in environments where patient care practices fall well below the accepted standards. More efforts should be placed on the prevention of the risk associated with modifiable risk factors, such as open surgical drains.
Moro
M L
ML
Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Roma.
Carrieri
M P
MP
Tozzi
A E
AE
Lana
S
S
Greco
D
D
D000328:Adult; D000985:Antisepsis; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D007318:Inservice Training; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012306:Risk; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*
Impatto del cambiamento di alcune pratiche assistenziali sull'incidenza di infezioni della ferita chirurgica in seguito a interventi puliti. Gruppo di Studio PRINOS.