Risk factors for surgical site infection in spinal surgery.

Object: The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion.

Methods: The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients.

Ambulatory care-sensitive conditions: clinical outcomes and impact on intensive care unit resource use.

Background: We identified risk factors and clinical outcomes associated with ambulatory care-sensitive conditions requiring intensive care unit (ICU) admission.

Methods: This prospective cohort study included 4,144 patients admitted to the medical ICU of an urban teaching hospital during a 3-year period.

Results: A total of 627 patients were classified as having ambulatory care-sensitive conditions (ie, potentially preventable ICU admissions).

Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients.

Study Objective: To determine the sensitivity, specificity, and positive and negative predictive values of blood cultures obtained through a central vein catheter compared with peripheral venipuncture.

Design: Prospective cohort study.

Setting: A medical ICU (19 beds) from a university-affiliated urban teaching hospital.

Patients' and physicians' attitudes regarding the disclosure of medical errors.

Context: Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed.

Objective: To determine patients' and physicians' attitudes about error disclosure.

Surgical site infections after arthroscopy: Outbreak investigation and case control study.

Purpose: The goal of this study was to determine the causes of increased post-arthroscopy surgical site infections (SSIs) and to define risk factors for infection.

Type Of Study: Outbreak investigation and case control study at a university-affiliated community hospital from 1994 to 1996, with surveillance through 1999.

Methods: Demographic, clinical, and microbiological data were collected on 27 post-arthroscopy SSIs from 1994 through 1999.

Risk factors for spinal surgical-site infections in a community hospital: a case-control study.

Objective: To characterize risk factors for surgical-site infection after spinal surgery.

Design: A case-control study.

Setting: A 113-bed community hospital.

Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia.

Objective: The purpose of the study was to determine whether an education initiative could decrease the hospital rate of ventilator-associated pneumonia.

Design: Pre- and postintervention observational study.

Setting: Five intensive care units in Barnes-Jewish Hospital, an urban teaching hospital.

Factors associated with the treatment of latent tuberculosis infection among health-care workers at a midwestern teaching hospital.

Study Objective: To assess factors associated with initiating therapy and compliance with treatment for latent tuberculosis infection among health-care workers with positive tuberculin skin test results.

Design: Prospective cohort study.

Setting: An urban midwestern teaching hospital in St.

Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients.

Objective: The objective of this study was to determine the rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit (PICU) patients.

Design: Prospective cohort study.

Settings: This study was performed at St Louis Children's Hospital, a 235-bed academic tertiary care center with a combined 22-bed medical and surgical PICU.

Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia.

Study Objectives: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP).

Setting: Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated urban teaching hospital.

The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different.

Objective: We sought to determine risk factors for deep and superficial chest wound infections after coronary artery bypass graft surgery to develop predictive models.

Methods: We retrospectively analyzed data collected on 1980 consecutive patients undergoing coronary artery bypass surgery at our institution between January 1, 1996, and June 30, 1999, by using the Society of Thoracic Surgery database. Independent risk factors for surgical-site infection were identified with multivariate logistic regression.

Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial.

Background: This study sought to compare 2 strategies for the administration of enteral feeding to mechanically ventilated medical patients.

Methods: The prospective, controlled, clinical trial was carried out in a medical intensive care unit (19 beds) in a university-affiliated, urban teaching hospital. Between May 1999 and December 2000, 150 patients were enrolled.

Nonrandom selection and the attributable cost of surgical-site infections.

Objective: To study the extent to which selection bias poses problems for estimating the attributable cost of deep chest surgical-site infection (SSI) following coronary artery bypass graft (CABG) surgery.

Design: Reanalysis of a prospective case-control study.

Setting: A large, Midwestern community medical center.

Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes.

Objectives: To determine the rates, risk factors, and outcomes of ventilator-associated pneumonia in pediatric intensive care unit (PICU) patients.

Methods: A prospective cohort study was conducted at the St Louis Children's Hospital PICU on all patients who were admitted to the PICU from September 1, 1999, to May 31, 2000, except those who died within 24 hours, were > or =18 years of age, or were neonatal intensive care unit patients on extracorporeal membrane oxygenation. The primary outcome measured was the development of ventilator-associated pneumonia.

The business of health care epidemiology: creating a vision for service excellence.

To achieve service excellence in infection control in an era of fiscal constraint requires infection control specialists to demonstrate the value of their department in business terms to their health care administrators. Models for achieving service excellence in infection control based on cost-effective interventions found effective in our organization are described, including development and maintenance of effective teams, guidelines for structuring and implementing interventions, and establishment of business standards for excellence in health care.

Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit.

Objective: The purpose of the study was to determine whether an education initiative aimed at improving central venous catheter insertion and care could decrease the rate of primary bloodstream infections.

Design: Pre- and postintervention observational study.

Setting: Eighteen-bed surgical/burn/trauma intensive care unit (ICU) in an urban teaching hospital.

Postarthroscopy surgical site infections: review of the literature.

The use of arthroscopy for both diagnosis and operative intervention has been increasing steadily since its introduction in the 1970s. It is generally associated with fewer complications and shorter times to mobilization than are open procedures. Overall reported rates of complications are low (0.