POSTDISCHARGE SURVEILLANCE AND INFECTION-RATES IN OBSTETRIC PATIENTS

Objective: To study the impact of post-discharge surveillance on the d etection of nosocomial surgical site infection (SSI) after cesarean se ction and vaginal delivery. Methods: During a 21-month period, all pat ients attending the obstetrics service in labor were recruited for a o bservational study on the incidence of SSI. Examinations to detect SSI were performed daily during the hospitalization period and up to 30 d ays after hospital discharge in an outpatient clinic supervised by the Infection Control Committee.The stratification of risk-factors and th e criteria for the diagnosis of SSI were done in accordance with the m ethods described by the Centers for Disease Control and Prevention. Th e rates of surgical site infection detected during the hospitalization period were compared with those reported by the Centers for Disease C ontrol and Prevention's National (United States) Nosocomial Infection Surveillance System (CDCNNIS) 'benchmarks'. The incidence of SSI detec ted by post-discharge outpatient surveillance was compared with that f rom in-hospital surveillance, for both cesarean section and vaginal de livery. Results: A total of 4463 deliveries were performed during the study period, 2431 (54.5%) by the vaginal route and 2032 (45.5%) by ce sarean section. In-hospital surveillance was done on all patients. Pos t-discharge examinations were done on 951 (46.8%) of the 2032 cesarean section patients. The incidence of SSI in cesarean section detected b y in-hospital surveillance was 1.6% (32 cases) and lower than the 3.6% mean rate reported by the CDCNNIS. When SSIs detected by post-dischar ge surveillance were included, the total number of SSI was 196 cases ( 9.6%), a value much higher than that for the SSI detected by in-hospit al surveillance alone. Only 5 cases (0.21%) of SSI were detected among the 2431 vaginal deliveries. Conclusions: The results of our study de monstrate that most of SSI following cesarean section were detected on ly after patient's discharge from the hospital and seems to indicate t hat failing to do follow-up evaluation of these patients could result in a substantial mis-calculation of the authentic SSIs rates. Therefor e data on post-discharge surveillance should be included to realistica lly estimate the true rates of SSI in obstetric patients and to allow the implementation of measures to reduce post-partum infection. (C) 19 98 International Federation of Gynecology and Obstetrics.