Surgical site infections (SSI) are the most-common healthcare-associated infections among surgical patients and have severe adverse consequences. Surveillance is the ongoing systematic collection,... Show moreSurgical site infections (SSI) are the most-common healthcare-associated infections among surgical patients and have severe adverse consequences. Surveillance is the ongoing systematic collection, analysis, interpretation, and feedback of data, and has been accepted worldwide as a primary step toward prevention of healthcare-associated infections. In the Netherlands, a national network for the surveillance of healthcare-associated infections was set up in 1996 and called PREZIES (__PREventie van ZIEkenhuisinfecties door Surveillance__). In this thesis, the quality of the SSI surveillance within this network is evaluated. The method for postdischarge surveillance recommended by PREZIES seemed feasible and effective, and the mandatory validation visits ensured reliability and robustness of the surveillance data. Furthermore, the predictive power of the NNIS risk index was sufficient for several surgical procedures and could not be significantly improved by using other procedure-specific determinants. Analysis of the time-trend in SSI rates for five surgical procedures showed encouraging decreasing trends, although mostly not statistically significant. Comparison of the Dutch and German SSI surveillance data revealed that even though similar infection surveillance protocols were used, differences occurred in the implementation which hampered the comparison of SSI rates. Additionally, PREZIES contributed to a multi-center intervention project to improve the quality of surgical prophylaxis. Show less
This thesis elaborates the occurrence of venous thrombosis in cancer patients. Cancer is known to be associated with venous thrombosis with a spectrum of clinical manifestations varying from deep... Show moreThis thesis elaborates the occurrence of venous thrombosis in cancer patients. Cancer is known to be associated with venous thrombosis with a spectrum of clinical manifestations varying from deep vein thrombosis of the leg and pulmonary embolism, recurrent thrombophlebitits saltans et migrans (also called Trousseau__s syndrome) to disseminated intravascular coagulation and arterial embolism. The causes of venous thrombosis can be divided in environmental risk factors such as bed rest, surgery, plaster cast, trauma, long-distance travel, oral contraceptives or pregnancy and puerperium and genetic risk factors such as factor V Leiden and prothrombin 20210A mutation. Various factors may contribute to the development of venous thrombosis in cancer patients, and circulating mucins as well as circulating microparticles which express active TF on their surface may provide a missing link between cancer and thrombosis in (adeno) carcinoma patients. Treatment options include vitamin K antagonists and low-molecular-weight heparins, and the long-term use of these heparins in prevention of venous thrombosis may improve the outcome in comparison with oral anticoagulants. Further research is needed to better understand the morbidity and mortality associated with thrombosis in cancer patients and to optimize strategies of prevention and treatment Show less
