title: Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.
abstract: OBJECTIVE
  To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.
  
  
  METHODS
  A prospective study with patient follow-up until the 30th postoperative day.
  
  
  METHODS
  A general surgical ward of a public hospital in Santa Cruz, Bolivia.
  
  
  METHODS
  Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed.
  
  
  RESULTS
  Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a "local" risk index constructed with the above cutoff points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3.
  
  
  CONCLUSIONS
  SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.
authors.affiliation: Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia.
authors.forename: Lorena
authors.initials: L
authors.lastname: Soleto
authors.forename: Marianne
authors.initials: M
authors.lastname: Pirard
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Remberto
authors.initials: R
authors.lastname: Peredo
authors.forename: Reinerio
authors.initials: R
authors.lastname: Vargas
authors.forename: Alberto
authors.initials: A
authors.lastname: Gianella
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D000328:Adult; D000368:Aged; D001838:Bolivia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology*