Efficacy of surveillance in nosocomial infection control in a surgical service

Objective: The purpose of this study was to assess the efficacy of surveill ance of nosocomial infection in infection control at a service of general s urgery. Design: A surveillance study that included 1483 patients with a prospective identification of nosocomial infection was carried out. Its results were d iscussed with the staff, and a program on nosocomial infection control was implemented. One year after the preintervention study, a similar study that included 1506 patients was done. The main outcome measure was nosocomial i nfection. Incidence rates, incidence rate ratios, crude and multiple-risk f actor adjusted for by Poisson regression analysis, and their 95% confidence interval rates were estimated. Results: The characteristics of the patients enrolled in both studies were compared. After the intervention, the trend was to attend patients with mor e severe conditions: higher frequency of liver failure, chronic obstructive lung disease, higher proportion of dirty surgical wounds, and higher score s of both Study on the Efficacy of Nosocomial Infection Control (SENIC) and National Nosocomial Infections Surveillance indices. There were no signifi cant differences in emergency surgery, duration of surgery, age, and sex. A fter the intervention, unnecessary chemoprophylaxis was drastically reduced , and a significant reduction in preoperative stay was observed. The nosoco mial incidence rate fell from 18.4 to 14 per 1000 patient-days. This reduct ion yielded an incidence rate ratio of 0.56 (95% confidence interval, 0.43% -0.74%) adjusted for several variables (SENIC index, serum creatinine level , serum albumin level, antihistamine H2 level, surgical wound, body mass in dex, chemoprophylaxis, and community-acquired infection). Significant reduc tions in surgical site infection and urinary tract infection were observed, but the rate of respiratory tract infection remained unchanged. Conclusions: Surveillance was effective in reducing nosocomial infection.