[Ten-year surveillance of nosocomial surgical site infections in an orthopedic surgery department].
OBJECTIVE
Surveillance of nosocomial surgical site infections was instituted in our department in June 1991. We report our first nine years experience.


METHODS
This study concerned the first 9 years (June 1991-June 2000) of a surveillance program designed to monitor nosocomial surgical site infections in our orthopedic surgery department. During this period 9,696 patients underwent surgery, including 2745 for hip replacements and 1016 for knee replacements. The diagnosis of infection was based on the Centers of Disease Control criteria. Beginning in 1997, the program was widened to include all indications for prophylactic antibiotics, being limited before that time to indications for arthroplasty and spinal surgery.


RESULTS
The overall rate of infection was 1.25%; 0.55% for hip arthroplasty and 1.77% for knee arthroplasty. The rate of infection among hip surgery patients over the last 5 years was much higher for prosthesis revision (2.37%) than for first-intention implantations (0.16%). The majority of the isolated strains were Gram-positive (84%) including Staphylococcus sp. found in 65% of the cases. Multiple-strains were found in 23% of the infections. The rate of infection improved very significantly over the last five years both for knee arthroplasty and spinal surgery. The rate remained unchanged for hip arthroplasty.


CONCLUSIONS
This 10-year survey enabled us to analyze the difficulties encountered and pinpoint errors or insufficiencies in data recording. We were also able to identify measures to be taken concerning patient follow-up. The improvement in the rate of infection over time appears to be multifactorial, undoubtedly related to wider use of prophylactic antibiotics, progress in hygiene and sterilization methods with institution of a quality assurance program, and team awareness.


CONCLUSIONS
Surveillance of nosocomial infections is a recommended practice. We have found that the information provided can be beneficial if the data is statistically sound, pointing out the need for progress in patient follow-up.
Service de Chirurgie Orthopédique, Hôpital Renée-Sabran, boulevard Edouard-Herriot, Giens, 83400 Hyères.
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F
Lecuire
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Gontier
J
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Carrere
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N
Giordano
J
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Rubini
M
M
Basso
D019643:Arthroplasty, Replacement; D003196:Computer Graphics; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D009985:Orthopedics; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control