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549 Post-discharge Surveillance for Infection Following Caesarian Section: a Prospective Cohort Study Comparing Methodologies

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Muhammad A. Halwani, PhD , Johns Hopkins Medical Institutions and University, Baltimore, MD
Alison E Turnball , Johns Hopkins Medical Institutions and University, Baltimore, MD
Meredith Harris , Johns Hopkins Medical Institutions and University, Baltimore, MD
Lisa M Maragakis , Johns Hopkins Medical Institutions and University, Baltimore, MD
Frank Witter , Johns Hopkins Medical Institutions and University, Baltimore, MD
Trish M. Perl , Johns Hopkins Medical Institutions and University, Baltimore, MD
Background: Post-Caesarean Section Surgical Site Infection (SSI) is common, even among relatively healthy obstetric populations.  SSI frequently occurs after discharge and may not be identified by traditional SSI surveillance systems that rely on patients returning to the hospital where the operation was performed. 

Objective: To compare a traditional surveillance method with surveillance augmented by post-discharge, telephone follow-up surveys for the identification of SSIs.

Methods: A prospective cohort study included 193 patients admitted to The Johns Hopkins Hospital (JHH) who underwent Caesarean section between 22 of April and 22 of August 2010. A single investigator interviewed patients by phone 7, 14, and 30 days after the operation.  Survey questions were based on NHSN/CDC criteria to identify SSI.  An infection control practitioner blinded to the telephone calls, applied NHSN/CDC definitions using standard case finding methods. An infectious disease physician blinded to study findings reviewed all cases of suspected SSI identified by both methods. Agreement and sensitivity were calculated to compare the incidence of SSI as determined by standard hospital surveillance with surveillance enhanced by telephone follow-up.  Data were analyzed using STATA software version 11.0 (STATA Corporation, College Station, Texas). 

Results: Standard surveillance identified 14/193 patients (7.3%) with SSI. Post discharge telephone surveillance identified an additional 5 patients who did not return to JHH when they developed SSI with a calculated SSI rate of (10%). Sensitivity of standard surveillance was 73% compared with telephone surveillance and Kappa was 0.84 (95% confidence interval 0.68 – 0.98).   126 patients (65.3%) answered all 3 telephone calls, another 12% were interviewed twice and 5.2% were interviewed once.  17% of patients could not be contacted.  The median duration of follow-up calls was 2 minutes, and the maximum time spent on any call was 5 minutes.

Conclusions: Enhanced SSI surveillance with telephone follow-up identified 27% more patients with SSI compared to traditional surveillance. Telephone surveys are a feasible method to enhance SSI surveillance following C-section and may be especially helpful in communities where patients are unlikely to return to the same hospital for follow-up care.