title: [Effect of surveillance on surgical site infection rate in knee and hip arthroplasty].
abstract: OBJECTIVE
  To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery.
  
  
  METHODS
  Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced.
  
  
  RESULTS
  A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods.
  
  
  CONCLUSIONS
  Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.
authors.affiliation: Servicio de Medicina Preventiva, Complejo Hospitalario Materno-Insular, Las Palmas de Gran Canaria, Spain. jmolcab@gobiernodecanarias.org
authors.forename: J
authors.initials: J
authors.lastname: Molina-Cabrillana
authors.forename: A
authors.initials: A
authors.lastname: Chirino Cabrera
authors.forename: J P
authors.initials: JP
authors.lastname: Rodríguez-Alvarez
authors.forename: R
authors.initials: R
authors.lastname: Navarro-Navarro
authors.forename: I
authors.initials: I
authors.lastname: López-Carrió
authors.forename: I
authors.initials: I
authors.lastname: Ojeda-García
authors.forename: M
authors.initials: M
authors.lastname: Bolaños-Rivero
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*