WOUND INFECTIONS AFTER HYSTERECTOMY - OPPORTUNITIES FOR PRACTICE IMPROVEMENT

Background: This study was designed to determine the frequency of surg ical site infection development after discharge from the hospital afte r abdominal or vaginal hysterectomy and the frequency of use of antimi crobial prophylaxis in this patient group. Methods: A prospective coho rt study was performed on patients undergoing abdominal or vaginal hys terectomy between February 1 and December 31, 1995. Surgeons were cont acted 1 month after the operations to determine which patients had acq uired surgical site infections. Surgical site infection rates were cal culated according to procedure, surgeon, and National Nosocomial Infec tion Surveillance system risk categories. A retrospective pharmacy rec ord review was conducted to determine antimicrobial prophylaxis use ac cording to procedure and surgeon. Results: A total of 763 cases were s urveyed; 55 (7.2%) met criteria for postoperative surgical cal site in fection (7.7% abdominal and 4.5% vaginal hysterectomy). National Nosoc omial Infection Surveillance system moderate-risk patients had signifi cantly higher infection rates than did low-risk patients for both abdo minal (p = 0.045) and vaginal (p = 0.05) procedures. Most patients (71 .1%) were not given antimicrobial prophylaxis. There was a wide range of antimicrobial prophylaxis use by surgeon (3.6% to 94.4% of patients , p < 0.01). Conclusion: Despite long-standing and widespread recommen dations for antimicrobial prophylaxis before hysterectomy, most of our patients were operated on without such prophylaxis. Surveillance prog rams permit detailed review of patient care practices that may reveal opportunities for improvement.