Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

2005 ◽  
Vol 26 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Piret Mitt ◽  
Katrin Lang ◽  
Aira Peri ◽  
Matti Maimets
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Fetal Monitoring ◽  
University Hospital ◽  
Cross Sectional Survey ◽  
Increased Risk ◽  
Multi Method Approach ◽  
Method Approach

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

Risk Factors for Surgical-Site Infections Following Cesarean Section

2001 ◽  
Vol 22 (10) ◽  
pp. 613-617 ◽  
Author(s):  
Carol A. Killian ◽  
Eileen M. Graffunder ◽  
Timothy J. Vinciguerra ◽  
Richard A. Venezia
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Multiple Logistic Regression Analysis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Cesarean Sections ◽  
Increased Risk ◽  
Active Labor ◽  
Prenatal Visits

AbstractObjective:To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.Design:Prospective cohort study.Setting:High-risk obstetrics and neonatal tertiary-care center in upstate New York.Patients:Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.Methods:Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by read-mission to the hospital or by a postdischarge survey.Results:Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6; P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02; P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15; P=.001); and hours of ruptured membranes (OR, 1.02; CI95,1.01-1.03; P=.04).Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (F=02), whether or not active labor or ruptured membranes were present.Conclusion:Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.

scholarly journals 754. Prevalence of Latent Tuberculosis Infection Among Healthcare Workers at a Tertiary Care University Hospital

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S271-S271
Author(s):  
Eun Ju Choo ◽  
Se Yoon Park
Keyword(s):  
Risk Factors ◽  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Tertiary Care ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
University Hospital ◽  
Increased Risk ◽  
High Prevalence ◽  
Univariate Analyses

Abstract Background We investigated the prevalence of latent tuberculosis infection (LTBI) among healthcare workers (HCWs) and analyzed its risk factors in a tertiary care university hospital in South Korea in a population with intermediate tuberculosis (TB) burden. Methods A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant. QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay and chest radiography were performed to investigate the rate of LTBI. Results A total of 1,429 participants, 213 (14.9%) doctors and 988 (69.1%) nurses and 228 (16.0%) others were enrolled. The mean age of the subjects was 33.0 years old, and 1,175 (82.2%) were female. Of the participants, 94.5% had received BCG vaccine. QFT-GIT assays were positive for 156 subjects (10.9%). Of the 213 doctors, 28 (13.1%) were positive by QFT-GIT, and among the 988 nurses, 94 (9.5%) had positive QFT-GIT results. Experience of working in hospital was significantly associated with positive LTBI test results by QFT-GIT assay. Gender and duration of employment as an HCW were significantly associated with having a positive QFT-GIT result in univariate analyses. In multivariate analyses, duration of employment as an HCW (&gt;15 years) (odds ratio, 1.98; 95% confidence interval, 1.14–3.43) was independently associated with increased risk of a positive QFT-GIT result. Conclusion A high prevalence of LTBI was found among our HCWs. Considering the association between the experience of working in hospital and high risk of LTBI. The risk for tuberculosis infection among HCWs was higher than general population, which suggests that stricter preventive strategies against nosocomial tuberculosis infection should be implemented. Disclosures All authors: No reported disclosures.

scholarly journals Duration of Methicillin-ResistantStaphylococcus aureusCarriage, According to Risk Factors for Acquisition

2006 ◽  
Vol 27 (11) ◽  
pp. 1206-1212 ◽  
Author(s):  
Jonas Marschall ◽  
Kathrin Mühlemann
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
University Hospital ◽  
Modifiable Risk Factor ◽  
Lower Probability ◽  
Increased Risk ◽  
Antibiotics Use ◽  
Definition Of

Objective.To examine the duration of methicillin-resistant Staphylococcus aureus (MRSA) carriage and its determinants and the influence of eradication regimens.Design.Retrospective cohort study.Setting.A 1,033-bed tertiary care university hospital in Bern, Switzerland, in which the prevalence of methicillin resistance amongS. aureusisolates is less than 5%.Patients.A total of 116 patients with first-time MRSA detection identified at University Hospital Bern between January 1, 2000, and December 31, 2003, were followed up for a mean duration of 16.2 months.Results.Sixty-eight patients (58.6%) cleared colonization, with a median time to clearance of 7.4 months. Independent determinants for shorter carriage duration were the absence of any modifiable risk factor (receipt of antibiotics, use of an indwelling device, or presence of a skin lesion) (hazard ratio [HR], 0.20 [95% confidence interval {CI}, 0.09-0.42]), absence of immunosuppressive therapy (HR, 0.49 [95% CI, 0.23-1.02]), and hemodialysis (HR, 0.08 [95% CI, 0.01-0.66]) at the time MRSA was first MRSA detected and the administration of decolonization regimen in the absence of a modifiable risk factor (HR, 2.22 [95% CI, 1.36-3.64]). Failure of decolonization treatment was associated with the presence of risk factors at the time of treatment (P= .01). Intermittent screenings that were negative for MRSA were frequent (26% of patients), occurred early after first detection of MRSA (median, 31.5 days), and were associated with a lower probability of clearing colonization (HR, 0.34 [95% CI, 0.17-0.67]) and an increased risk of MRSA infection during follow-up.Conclusions.Risk factors for MRSA acquisition should be carefully assessed in all MRSA carriers and should be included in infection control policies, such as the timing of decolonization treatment, the definition of MRSA clearance, and the decision of when to suspend isolation measures.

scholarly journals Perioperative Metoprolol and Risk of Stroke after Noncardiac Surgery

2013 ◽  
Vol 119 (6) ◽  
pp. 1340-1346 ◽  
Author(s):  
George A. Mashour ◽  
Milad Sharifpour ◽  
Robert E. Freundlich ◽  
Kevin K. Tremper ◽  
Amy Shanks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Model ◽  
Tertiary Care ◽  
Fold Increase ◽  
Perioperative Period ◽  
Noncardiac Surgery ◽  
University Hospital ◽  
Perioperative Stroke ◽  
Entire Cohort ◽  
Increased Risk

Abstract Background: Numerous risk factors have been identified for perioperative stroke, but there are conflicting data regarding the role of β adrenergic receptor blockade in general and metoprolol in particular. Methods: The authors retrospectively screened 57,218 consecutive patients for radiologic evidence of stroke within 30 days after noncardiac procedures at a tertiary care university hospital. Incidence of perioperative stroke within 30 days of surgery and associated risk factors were assessed. Patients taking either metoprolol or atenolol were matched based on a number of risk factors for stroke. Parsimonious logistic regression was used to generate a preoperative risk model for perioperative stroke in the unmatched cohort. Results: The incidence of perioperative stroke was 55 of 57,218 (0.09%). Preoperative metoprolol was associated with an approximately 4.2-fold increase in perioperative stroke (P &lt; 0.001; 95% CI, 2.2–8.1). Analysis of matched cohorts revealed a significantly higher incidence of stroke in patients taking preoperative metoprolol compared with atenolol (P = 0.016). However, preoperative metoprolol was not an independent predictor of stroke in the entire cohort, which included patients who were not taking β blockers. The use of intraoperative metoprolol was associated with a 3.3-fold increase in perioperative stroke (P = 0.003; 95% CI, 1.4–7.8); no association was found for intraoperative esmolol or labetalol. Conclusions: Routine use of preoperative metoprolol, but not atenolol, is associated with stroke after noncardiac surgery, even after adjusting for comorbidities. Intraoperative metoprolol but not esmolol or labetalol, is associated with increased risk of perioperative stroke. Drugs other than metoprolol should be considered during the perioperative period if β blockade is required.

scholarly journals LOWER SEGMENT CESAREAN SECTION (LSCS);

2013 ◽  
Vol 20 (06) ◽  
pp. 916-923
Author(s):  
NAZIA MUSSARAT ◽  
SAIMA QURASHI ◽  
MAHNAZ ROOHI
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
University Hospital ◽  
Breech Delivery ◽  
Lower Segment Cesarean Section ◽  
Increased Risk

Introduction: Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one ofthe oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in thedeveloped countries. As primary caesarean deliveries contributed most to the overall caesarean section rate (CSR). So this is clear thatprimary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery.Objectives: To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperativecomplications of LSCS at tertiary care centre. Material And Methods: All caesarean sections performed at Obstetrics andGynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information wasobtained from operation theater and labor ward records. Results: During the study period 100 patients undergone caesarean section. Outof 100 patients, 58(58%) had emergency and 42(42%) had elective caesarean section. The leading maternal indications were previouscaesarean section 34 (34%), severe pre- eclampsia 6(6%),post date& failed induction of labor6 (6%), placenta previa 6(6%), and failureof progression of labor 5(5%), PROM3(3%), Pre-PROM3(3%)and cephalopelvic disproportion2 (2%).Major fetal indications include fetaldistress9 (9%), malpresentation 6(6%), cord prolapse 3(3%),IUGR 5(5%) and pregnancy complicated by multiple fetuses 7 (7%). Intraoperativesurgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Conclusions: Majority of cesarean sectionare done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to controlCS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection,selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral intime is the key factor in decreasing the cesarean section rate and complications.

scholarly journals Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

2008 ◽  
Vol 29 (6) ◽  
pp. 477-484 ◽  
Author(s):  
Margaret A. Olsen ◽  
Anne M. Butler ◽  
Denise M. Willers ◽  
Preetishma Devkota ◽  
Gilad A. Gross ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Tertiary Care ◽  
University Teaching ◽  
Skin Closure ◽  
Care Hospital ◽  
Site Infection ◽  
Increased Risk ◽  
Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

scholarly journals Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1064
Author(s):  
Gitana Scozzari ◽  
Cristina Costa ◽  
Enrica Migliore ◽  
Maurizio Coggiola ◽  
Giovannino Ciccone ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Multivariable Analysis ◽  
Northern Italy ◽  
University Hospital ◽  
Care Workers ◽  
Increased Risk ◽  
Never Smokers ◽  
The University ◽  
Job Profile ◽  
Pandemic Wave

This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March–April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76–2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12–6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48–0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48–0.76).

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Sang Hoon Han ◽  
Bum Sik Chin ◽  
Han Sung Lee ◽  
Su Jin Jeong ◽  
Hee Kyung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Cell Contact ◽  
Patient Risk ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

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