Surveillance of selected post-caesarean infections based on electronic registries: validation study including post-discharge infections
Introduction
Surveillance of hospital-acquired infections (HAIs) with feedback to the clinical staff has in previous studies been shown to be associated with reduced rates of wound infections of 25–55%.1, 2, 3 Several countries have implemented nosocomial infection surveillance systems, often as regularly conducted prevalence studies.4, 5, 6 Prevalence studies are, however, time-consuming and may, despite clear definitions of infection, be subjective with some interobserver variability.7, 8 The increasing amount of medical data stored in electronic databases may be used as data source in surveillance systems. A number of studies have validated the use of such electronically stored information in different patient groups or types of infections.9, 10, 11, 12, 13 In none of these studies were post-discharge infections included, except for readmitted patients.
Women having undergone caesarean section (CS) normally have a short hospital stay after delivery, which means that post-caesarean infections often occur after discharge.14, 15 The prevalence of post-discharge infections after delivery has been shown to range from 36% to 94%.16, 17, 18, 19
The aim of this study was to validate monitoring of postpartum infections in a study population of women having undergone CS. We compared a computer registration of infections based on data from various electronic hospital registries with a reference standard based on all available clinical and para-clinical data from medical records together with information about infections obtained from patient-administered questionnaires, confirmed by the general practitioner (GP).
Section snippets
Methods
We conducted this prospectively designed cohort study in the former County of Aarhus, Denmark from 1 February 2007 to 31 August 2008. In Denmark, health service is free of charge with free access for all residents to GPs and public hospitals for examinations and treatments. During the study period virtually all births in the county took place at three public hospitals.
Since 1968, all Danish residents have been assigned a unique civil registration number that enables unambiguous electronic
Results
During the 19 month period, 2492 women underwent CS of whom 2453 women were invited to participate in the questionnaire survey. A total of 1513 (61.7%) of these women answered the questionnaire. These 1513 women became our study group, of which 833 (55%) underwent emergency CS and 680 (45%) elective CS.
We found that 3.2% (48/1513) of the women had a UTI within 30 days postpartum; 38/48 (79%) were diagnosed and treated post-discharge outside hospital. Forty-nine of 1513 women had their urine
Discussion
We included more than 1500 women who underwent CS in validating the ability of an electronic surveillance system to identify post-caesarean infections. Post-caesarean UTI and PWI within 30 days was seen in 10.4% of the women. Nearly two-thirds of these infections were diagnosed and treated by the GP. The HAIR system was able to identify about 80% of in-hospital PWIs and UTIs. Post-discharge PWIs and UTIs diagnosed outside hospital were identified in 69% and 76% of the cases, respectively.
The
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