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E Simchen

Publications and source records attributed to E Simchen.

At least 37 records · Page 2Linked to original sources
PubMed1988

The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections.

The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.

Data Collection↗
PubMed1988

The Israeli Study of Surgical Infections (ISSI): II. Initial comparisons among hospitals with special focus on hernia operations.

In a study of 5,571 patients from the general surgery departments of 11 Israeli hospitals, the crude overall wound infection rates showed interhospital heterogeneity. The rates ranged from 6.3% to 12.4% (P(chi 2) = 0.039). Controlling for the different distributions of procedures performed in the various institutions did not reduce this variability. None of the hospitals had either consistently high or consistently low infection rates. A hospital could have low rates for one procedure and high rates for another. Therefore, the decision was made to proceed with procedure-specific analyses. This article details results of the analysis of 1,487 hernia operations. Four variables (old age, infection at another site, incarceration, and introduction of drains) accounted for almost all the differences in infection rates among the institutions. Of the four, presence of drains had the strongest association with infection (P derived from the logistic model less than 0.001). The risk was consistent in all hospitals and was unconfounded by other measurable factors. In contrast, the pattern of using drains seemed arbitrary and inconsistent, ranging from 9% of patients in one hospital to 41% in another. These findings were used as a basis for discussion with the surgical teams and for the initiation of a randomized clinical trial on the use of drains in hernia operations.

Age Factors↗
PubMed1986

Randomized clinical trial of intra-operative antimicrobial prophylaxis of infection after neurosurgical procedures.

A randomized, placebo-controlled, double-blind and sequentially analysed clinical trial to determine the efficacy of intra-operative parenteral gentamicin and vancomycin (with streptomycin in the irrigating solution) in preventing infection at the operative site following neurosurgical procedures is described. Patients receiving prophylaxis had a significantly (P = 0.046) lower operative site infection rate (2/71 = 2.8%) than those receiving placebo (9/77 = 11.7%). This difference was most apparent during an epidemic, the source of which was not evident. Moreover, a total of 13 infections (two operative site, five pneumonia and six urinary tract) occurred among 12 patients receiving prophylaxis, whereas there was a total of 31 infections (nine operative site, nine pneumonia, 10 urinary tract and three septicaemia) among 24 patients receiving placebo. A smaller quantity of antimicrobial drugs was administered postoperatively to patients receiving prophylaxis (3.96 'antibiotic-days' per patient) than to those receiving placebo (6.87 'antibiotic-days' per patient).

Anti-Bacterial Agents↗
PubMed1985

Risk factors for coronary artery disease in 124 Jerusalem medical students.

As part of an epidemiologic teaching exercise, we studied coronary risk factors in two consecutive classes of Jerusalem medical students (n = 124) and calculated a summary coronary risk score for each student. Men were at higher risk than women because of greater body mass, higher blood pressure and more cigarette smoking. Married males were at lower risk than single males because they had lower cholesterol levels and smoked less. Married and single females were at equal risk. Jerusalem students smoked more than most groups of American medical students and less than their European counterparts. There is reason to believe that an exercise of this kind may result in risk-reducing behavior on the part of high-risk students.

Adult↗
PubMed1984

Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients.

In a prospective study of 376 orthopaedic patients, the relative contribution of host factors and patient-care variables to the risk of postoperative wound infection was evaluated. Host factors studied were age, sex, ethnic origin and diagnosis. The number of operations, the insertion of an open drain, the use of prophylactic antibiotics and the length of the operation were the patient-care variables studied. Of the risk factors identified, the performance of more than one operation during an admission had the highest risk coefficient, followed by the presence of an open drain, internal fixation of a fracture, and spine fusion. Within the group of operations for internal fixation, those for fractures of the femur had the highest risk of infection. In spine fusions those operations lasting 5 or more hours were associated with a high risk of infection. The length of stay of infected patients was on average 17.9 days longer than that of their individually-matched non-infected controls.

Aged↗
PubMed1984

A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours.

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for greater than 24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p less than or equal to 0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs greater than Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theatres, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (greater than or equal to 7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for greater than or equal to 7 days than among those ultimately catheterized for less than 7 days (P less than 0.05).

Aged↗
PubMed1984

Determinants of wound infection after colon surgery.

Over a period of 54 months, every patient undergoing colon surgery at the Hadassah University Hospital in Jerusalem was followed up prospectively by the same nurse epidemiologist. A total of 403 patients completed the analysis. Risk factors for postoperative wound infection were explored in an epidemiological study, using both single and multivariate analysis. Of the 13 potential risk factors investigated, the four showing the highest association with wound infection were: the performance of more than one operation during a single admission; Arab ethnicity; the use of open drains; and the performance of a colostomy. In patients undergoing more than one operation, the risk for infection was greater if the second operation followed a surgical complication than if it was performed as an elective second procedure; whether the first operation was elective or not did not affect the infection rate. Second operations performed within 7 days of the first carried a higher risk for infection than those performed later. The different prophylactic protocols used during the period of investigation did not have an independently significant contribution to the risk of infection.

Aged↗
PubMed1984

"Swimmer's ear" among children of kindergarten age and water quality of swimming pools in 11 Kibbutzim.

In an effort to determine if bacterial water quality was related to the incidence of otitis externa ("swimmer's ear") in kindergarten children, a prospective study was conducted between May and September 1980 in 11 communal agricultural settlements (kibbutzim) in Israel. High total bacterial count, total coliforms and fecal coliform counts were found to be positively associated with otitis externa. This association was enhanced when nondivers were separated from divers. Among the divers, the rate of ear inflammation was high regardless of water quality. Among nondivers at the time of the study, the rate of otitis externa was as high as 35.7% in swimming pools with poor quality water, and as low as 17.0% in those with good quality water (P = 0.03). Younger children had a slightly higher risk of otitis externa than had older children.

Age Factors↗
PubMed1984

Incidence of tuberculosis among children born in Israel--1956 to 1979.

The incidence of tuberculosis (TB) among Israeli-born children was studied. The incidence rates for Jews and non-Jews were compared at various ages and in different years. Non-Jews had higher rates of TB than had Jews at all ages. The difference between the two groups was largest at age 5 to 9 years (rate ratio, non-Jews to Jews, 4.0). Among Jews, the highest rates of TB were found in the youngest age-group, while among the non-Jews rates continued to be high until the age of 14. The annual incidence of TB showed a general decline for all age-groups among the Jews, while among the non-Jews only children aged 0 to 4 demonstrated a similar trend. The largest reductions in the incidence of TB occurred in children of this age in both groups. During the last years of the study, the annual incidence of TB among Israeli-born persons reached particularly low levels, with only 14 new cases being diagnosed during 1979, 5 among Jews and 9 among non-Jews. The respective incidence rates were 0.3 and 2.6 per 100,000 population.

Adolescent↗
PubMed1984

Effect of mass BCG vaccination at birth on the incidence of tuberculosis among Jewish children in Israel.

This report evaluates the effect of BCG vaccination at birth on the incidence of tuberculosis (TB) among Jewish children born in Israel between 1956 and 1979 and aged 0 to 12 years. In the years 1956-79, 299 new cases of TB were diagnosed; 164 of these patients had been vaccinated at birth (an incidence rate of 1.9/100,000 person-years at risk), and 106 had not (a rate of 3.1 significantly higher than among the vaccinated children). Nevertheless, because of the low incidence of TB among Jewish children born in Israel, the number of cases that were prevented by vaccination was relatively small (mean of 4.2/year). The protective efficacy of vaccination was 38%: 24% for pulmonary and 64% for extrapulmonary TB.

BCG Vaccine↗
PubMed1983

An epidemiologic study of the risks associated with peripheral intravenous catheters.

As part of a standardized, multi-hospital prospective surveillance system for nosocomial infections in Rhode Island, an analysis was undertaken in March 1980-February 1982 to determine the interplay of factors that contribute to the risk of phlebitis in peripheral, non-steel, non-butterfly intravenous catheters. The authors studied 3094 patients with 5161 total episodes of peripheral intravenous catheters from day of admission until day of discharge. The overall rate of phlebitis was 2.3% (118 episodes), and the rate of intravenous catheter-associated bacteremia was 0.08% (1 definite episode, 3 possible episodes). Factors significantly associated with the occurrence of phlebitis were: underlying risk for any nosocomial infection, duration of the catheter episode, chronological order of the episode and an interaction between the latter two variables. Analysis of day-specific risk of phlebitis indicated that, for patients with low risk diagnoses, initial peripheral intravenous catheters might be left in place with relative safety for up to 96 hours. Over this time period, the day-specific risk for such patients ranged between 0.8% and 1.4%, exclusive of the first day. In all other circumstances, the current recommendation of 48-72 hours seems appropriate.

Adult↗
PubMed1979

Reduction of postoperative infection rate in hip surgery: collaborative effort between orthopedic surgeons and control-of-infection team.

The success of a collaborative program between the ward staff and the control-of-infection team in reducing postoperative infection in patients undergoing hip surgery in a university hospital is described. The program was used to detect infection, to introduce control measures and to evaluate their effectiveness. The infection rate dropped from 25.7 to less than 1.0%, and this low rate was maintained over the 2 1/2 years of follow-up surveillance. The reduction in infection rate was associated with a six-day reduction (22.4%) in the duration of postoperative hospitalization.

Adult↗
PubMed1977

Pattern of prophylactic use of antibiotics in six surgical departments of a teaching hospital in Jerusalem.

The prophylactic use of antibiotics for various surgical procedures was studied in six surgical departments of the Hadassah University Hospital over an 18-month period between January 1972 and June 1973. A total of 7,339 patients was discharged from the six departments during this period. Antibiotics had been used prophylactically in 17.7% of these patients and in 20.4% of the 6,313 patients in whom there was no evidence of infection on admission. The rate of prophylactic use varied from 12.8 to 47.8% in different departments. Different prophylactic regimes were used in the various departments, but there was a tendency for the same regime to be used within one department, irrespective of the nature of the surgical procedure. The antibiotics were usually started postoperatively. The duration of the prophylactic courses varied but there was a general tendency to continue for more than five days, often up to 10 or more days. The frequency of use seemed to be related to the presence of factors regarded as carrying a high risk of infection, such as advanced age, operation through a contaminated field and the presence of malignancy. The association between prophylactic use and subsequent wound infection was examined. The importance of continuous surveillance of the prophylactic use of antibiotics and the role of the infection-control unit in this surveillance is stressed.

Adult↗
PubMed1976

Infections in the surgical departments of a teaching hospital in Jerusalem.

Surveillance of hospital-associated infections at the Hadassah University Hospital has been carried out since 1970. Criteria for infection were defined and were monitored by trained nurse-epidemiologists, with the cooperation of the surgical staff. This report deals with the results of a prospective study of infections present on admission, and those acquired during hospitalization, in six surgical departments between January 1972 and June 1973. Of the 7,339 patients discharged, 7.5% acquired an infection in hospital, while 10.6% were admitted with an infection. Several important factors appeared to increase the risk of acquiring an infection in hospital. These include advanced age, certain surgical procedures, such as gallbladder and small and large bowel operations, and the presence of infection on admission. Most of the latter occurred at the site of the proposed operation, and thus increased the risk of development of postoperative wound infection.

Adult↗
PubMed1975

Infection in war wounds: experience during the 1973 October War in Israel.

The development of infections in 420 wounded soldiers, admitted to the Hadassah University Hospital in Jerusalem between October 7, 1973 and November 31, 1973, was studied. An attempt was made to relate the development of infection to the type of injury. The overall infection rate was 22%, but varied with the type of injury. Three "risk factors" were found to be associated with infection regardless of the number of injuries: 1)penetrating abdominal wounds involving the colon; 2) fractures involving the femur; 3) burns involving more than 25% of body surface. In patients with comparable injuries, the presence of infection was found to prolong the duration of hospitalization. Pseudomonas was the most common single pathogen. There were no cases of myonecrosis (gas gangrene). Of the 8 soliders who died, 5 died with or because of infection.

Adult↗