Biomedical subjects

C Fanning

Publications and source records attributed to C Fanning.

4 recordsLinked to original sources

PubMed1995

Postdischarge surgical site infection surveillance.

OBJECTIVE: To evaluate three methods for conducting post-discharge surgical site infection (SSI) surveillance. DESIGN: Patients undergoing in-patient and day-patient surgery were prospectively randomized to one of three surveillance methods: group 1, patient questionnaire (mailed back); group 2, surgeon follow-up card; or group 3, patient questionnaire (telephoned by an infection control practitioner [ICP]). There were 200 in-patients and 200 day-patients randomized to each group. Evaluation of SSI was conducted 30 days postoperatively. SETTING: A 760-bed tertiary care teaching hospital. RESULTS: Questionnaires were sent home with 350 patients. Fifteen in-patients and 35 day-patients were excluded; 15 in-patients and 17 day-patients returned questionnaires early (fewer than three weeks postoperation), leaving 54 of 185 in-patients (29.2%) and 25 of 165 day-patients (15.2%) with timely returns. Seven (three in-patients and four day-patients) reported symptoms of SSI. Surgeons received cards for 400 patients; cards were returned for 118 of 203 in-patients (58.1%) and 142 of 197 day-patients (72.1%). Twelve (seven in-patients and five day-patients) were reported to have developed SSI. ICPS telephoned 332 patients; 187 of 196 in-patients (95.4%) and 107 of 126 day-patients (84.9%) were reached in six or fewer attempts. Four in-patients and 74 day-patients were lost due to cancellation of surgery or no surgical incision. Fourteen (10 in-patients and four day-patients) reported symptoms of SSI. For group 1 patients, ICPS spent 17 h distributing questionnaires and instructing staff; for group 2, ICPs spent no time distributing material; and for group 3, ICPS spent at least 8 h completing data forms, 16.5 h on the telephone and 33 h conducting demographic data retrieval from the hospital computer. CONCLUSIONS: In this setting, surgeon follow-up cards were the most efficient and reliable method for conducting postdischarge SSI surveillance. They provided a good rate of return and were time efficient, and wound evaluation was done by trained professionals using standard criteria for diagnosis of postoperative SSI.

Aftercare↗

PubMed1992

Compliance with a nonrecapping needle policy.

Compliance with nonrecapping needle policies is poor. Accidental needlestick injuries account for up to 80% of reported occupational needle exposures, and 45% of needlestick injuries occur at recapping. To determine the degree of compliance with in-house nonrecapping and needle disposal policies, the authors undertook an unannounced survey of needles disposed in designated sharps disposal containers and, via a questionnaire, surveyed attitudes to policies. The results show between 46 and 77% of needles were being recapped with 9 to 20% of bloodstained needles recapped before disposal. Recapping devices were rarely used and two-handed recapping techniques predominated. Highest rates of recapping were seen in intensive care, intermediate care and medical care units. Common reasons for recapping include inability to dispose immediately of needles properly, and sharps containers being too far away. Awareness of the risks of recapping was widespread with over 90% of respondents having been instructed in proper needle disposal techniques. While few health care professionals disagreed with non-recapping and needle disposal policies, many--for various reasons--persist in hazardous needle disposal practices.

Health Knowledge, Attitudes, Practice↗

PubMed1991

Control of endemic nosocomial legionnaires' disease by using sterile potable water for high risk patients.

In a setting where potable water is contaminated with Legionella pneumophila serogroup 1, we performed two case control studies. The first case control study consisted of 17 cases of nosocomial Legionnaires' disease (LD) and 33 control (the patients who were admitted to the ward where the case was admitted immediately before and after the case) subjects. Cases had a higher mortality rate 65% vs 12% (P less than 0.004); were more likely to have received assisted ventilation (P less than 0.00001); to have nasogastric tubes (P less than 0.0004) and to be receiving corticosteroids or other immunosuppressive therapy (P less than 0.0001). Based on the results of this study, sterile water was used to flush nasogastric tubes and to dilute nasogastric feeds. Only 3 cases of nosocomial LD occurred during the next year compared with 12 the previous year (P less than 0.0001). Nine cases subsequently occurred and formed the basis for the second case-control study. Eighteen control subjects were those patients admitted to the same unit where the case developed LD, immediately before and after the case. The mortality rate for the cases was 89% vs 6% for controls (P less than 0.00003). The only other significant difference was that cases were more likely to be receiving corticosteroids or other immunosuppressive therapy 89% vs 39% (less than 0.01). We hypothesized that microaspiration of contaminated potable water by immunocompromised patients was a risk factor for nosocomial Legionnaires' disease. From 17 March 1989 onwards such patients were given only sterile potable water. Only two cases of nosocomial LD occurred from June 1989 to September 1990 and both occurred on units where the sterile water policy was not in effect. We conclude that aspiration of contaminated potable water is a possible route for acquisition of nosocomial LD in our hospital and that provision of sterile potable water to high risk patients (those who are receiving corticosteroids or other immunosuppressive drugs; organ transplant recipients or hospitalized in an intensive care unit) should be mandatory.

Case-Control Studies↗

PubMed1991

Urinary tract infections--a survey.

Urinary tract infections (UTIs) occur frequently in hospitalized patients and are associated with significant morbidity. The infection control department of the Victoria General Hospital in Halifax, Nova Scotia conducted prospective hospital-wide surveillance for one month to evaluate the incidence of UTIs. There were 40 UTIs: 62.5% in patients with indwelling catheters; 20% in patients undergoing intermittent catheterization; and 17.5% in uncatheterized patients, for an attack rate of 19.9 per 1000 patient discharges. Escherichia coli was the most common organism, isolated in 47.5% of the study population. Trimethoprim-sulphamethoxazole was used to treat 57.5% of the UTIs. The findings from this survey are consistent with those of other authors in comparable institutions.

Cross Infection↗