THE SCIENTIFIC BASIS FOR USING SURVEILLANCE AND RISK FACTOR DATA TO REDUCE NOSOCOMIAL INFECTION-RATES

Research over the past 20 years has demonstrated that an active progra mme of surveillance with feedback of surgical wound infection rates to surgeons can reduce subsequent rates by 30-40%. For surveillance data and feedback to be meaningful and influential, however, certain rigor ous methodological principles must be observed. First, surveillance da ta must be collected in an accurate, efficient and confidential manner . This requires written definitions of infection, regular clinical cas e-finding, post-discharge follow up for short-staying patients, and co mputer storage, analysis and reporting of the data in coded form that does not publicly identify individuals. Second, the variation in intri nsic risk of the patients of the various surgeons must be controlled f or by stratifying the final infection rates on a multivariate risk ind ex, which combines the traditional classes of wound contamination with measures of intrinsic patient susceptibility. This can be accomplishe d with a relatively small commitment of time by the Infection Control Nurse with the aid of sophisticated computer software that is now avai lable.