We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2-22·0] and 5·5 (95% CI 2·1-14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.

QUESTION ASKED: What is the real rate of surgical site infection (SSI) after surgery for gynecologic malignancy and benign gynecologic disease?SUMMARY ANSWER: Overall SSI rates differed greatly between the University HealthSystem Consortium (UHC), National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) (1.5%, 8.8%, and 2.8% respectively, P , .001) due to wide variation in reporting methodology. Variation was notable among deep (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P , .001) and organ space infections (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P , .001) as well as when the reporting agencies were compared with institutional chart review by the authors. Also, because of differences in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%).WHAT WE DID: We compared SSI rates after gynecologic surgery obtained from the UHC, NSQIP and NHSN databases and the reporting methodologies used by these agencies among themselves. We also compared the SSI rates reported by these agencies to the SSI rate obtained from chart review.WHAT WE FOUND: There was significant variation in the rate of SSI after gynecologic surgery reported by national reporting agencies. Variations in reporting methodology also resulted in limited overlap between reporting agencies in identification of cases with SSI. BIAS, CONFOUNDING FACTORS, DRAWBACKS:A limitation of this analysis is that these data are from a single institution and relate to SSI after surgery for gynecologic malignancy and benign gynecologic disease. Results may not be generalizable for the rate of SSI after surgery in other institutions or specialties. Finally, care must be taken when comparing the reported rates of SSI across agencies as there is variation in the denominators on the basis of the differing inclusion and exclusion criteria. REAL-LIFE IMPLICATIONS:There is discordance among national reporting agencies tracking the rate of SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates. When planning an initiative to improve SSI rates and patient outcomes, it is important to assess which metric and reporting method will be most useful and appropriate (Fig). AbstractPurpose Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology.

Objective: To evaluate the efficacy and economic impact of a transfusion reduction initiative for patients undergoing gynecologic surgery. Methods:We conducted a prospective healthcare improvement study to align transfusion practices with the American Society of Hematology's Choosing Wisely® campaign. Baseline transfusion rates were determined retrospectively for all major gynecologic surgical cases from

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Background-Surgical site infections (SSI) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.