Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T00:49:54.477Z Has data issue: false hasContentIssue false
  • English
  • Français

First Results of the Swiss National Surgical Site Infection Surveillance Program: Who Seeks Shall Find

Published online by Cambridge University Press:  31 May 2017

Nicolas Troillet ,
Emin Aghayev ,
Marie-Christine Eisenring ,
Andreas F. Widmer  and
Swissnoso
Nicolas Troillet*
Affiliation:
Swissnoso-National Center for Infection Control, Bern, Switzerland Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland Services of Preventive Medicine and Infectious Diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
Emin Aghayev
Affiliation:
Swiss RDL-Medical Registries and Data Linkage, Institute for Social and Preventive Medicine, University of Bern, Switzerland
Marie-Christine Eisenring
Affiliation:
Swissnoso-National Center for Infection Control, Bern, Switzerland Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
Andreas F. Widmer
Affiliation:
Swissnoso-National Center for Infection Control, Bern, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
*
Address correspondence to Nicolas Troillet, Central Institute, Valais Hospital, Ave. Grand-Champsec 86, Sion, CH 1950, Switzerland ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVES

To report on the results of the Swiss national surgical site infection (SSI) surveillance program, including temporal trends, and to describe methodological characteristics that may influence SSI rates

DESIGN

Countrywide survey of SSI over a 4-year period. Analysis of prospectively collected data including patient and procedure characteristics as well as aggregated SSI rates stratified by risk categories, type of SSI, and time of diagnosis. Temporal trends were analyzed using stepwise multivariate logistic regression models with adjustment of the effect of the duration of participation in the surveillance program for confounding factors.

SETTING

The study included 164 Swiss public and private hospitals with surgical activities.

RESULTS

From October 2011 to September 2015, a total of 187,501 operations performed in this setting were included. Cumulative SSI rates varied from 0.9% for knee arthroplasty to 14.4% for colon surgery. Postdischarge follow-up was completed in >90% of patients at 1 month for surgeries without an implant and in >80% of patients at 12 months for surgeries with an implant. High rates of SSIs were detected postdischarge, from 20.7% in colon surgeries to 93.3% in knee arthroplasties. Overall, the impact of the duration of surveillance was significantly and independently associated with a decrease in SSI rates in herniorraphies and C-sections but not for the other procedures. Nevertheless, some hospitals observed significant decreases in their rates for various procedures.

CONCLUSIONS

Intensive post-discharge surveillance may explain high SSI rates and cause artificial differences between programs. Surveillance per se, without structured and mandatory quality improvement efforts, may not produce the expected decrease in SSI rates.

Infect Control Hosp Epidemiol 2017;38:697–704

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 697 - 704
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Sax, H, Uçkay, I, Balmelli, C, et al. Overall burden of healthcare associated infections among surgical patients: results of a national study. Ann Surg 2011;253:365–370.CrossRefGoogle ScholarPubMed
2. Smyth, ET, McIlvenny, G, Enstone, JE, et al. Four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect 2008;69:230–248.CrossRefGoogle ScholarPubMed
3. Edwards, JR, Peterson, KD, Mu, Y, et al. National healthcare safety network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.CrossRefGoogle ScholarPubMed
4. Staszewicz, W, Eisenring, MC, Bettschart, V, Harbarth, S, Troillet, N. Thirteen years of surgical site infection surveillance in Swiss hospitals. J Hosp Infect 2014;88:40–47.CrossRefGoogle ScholarPubMed
5. Anderson, DJ, Podgorny, K, Berrios-Torres, I, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.CrossRefGoogle ScholarPubMed
6. Broex, EC, van Asselt, AD, Bruggeman, CA, van Tiel, FH. Surgical site infections: how high are the costs? J Hosp Infect 2009;72:193–201.CrossRefGoogle ScholarPubMed
7. Weber, WP, Zwahlen, M, Reck, S, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol 2008;29:623–629.CrossRefGoogle Scholar
8. Astagneau, P, Rioux, C, Golliot, F, Brücker, G, INCISO Network Study Group. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48:267–274.CrossRefGoogle ScholarPubMed
9. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
10. Surgical site infections. 2008. clinical guideline 74. National Institute for Clinical Excellence website. http://www.nice.org.uk/CG74. Published 2008. Accessed December 9, 2016.Google Scholar
11. Romy, S, Eisenring, MC, Bettschart, V, Petignat, C, Francioli, P, Troillet, N. Laparoscope use and surgical site infetions in digestive surgery. Ann Surg 2008;247:627–632.CrossRefGoogle Scholar
12. Hubner, M, Diana, M, Zanetti, G, Eisenring, MC, Demartines, N, Troillet, N. Surgical site infections in colon surgery: the pateint, the procedure, the hospital, and the surgeon. Arch Surg 2011;146:1240–1245.CrossRefGoogle Scholar
13. Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
14. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(Suppl B):152S–157S.CrossRefGoogle ScholarPubMed
15. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
16. Manniën, J, van der Hof, S, Muilwijk, J, van der Broek, PJ, van Benthem, B, Wille, JC. Trends in the incidence of surgical site infection in the Netherlands. Infect Control Hosp Epidemiol 2008;29:1132–1138.CrossRefGoogle ScholarPubMed
17. Armitage, P. Tests for linear trends in proportions and frequencies. Biometrics 1955;11:375–386.CrossRefGoogle Scholar
18. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.CrossRefGoogle ScholarPubMed
19. Surveillance des infections du site opératoire, France 2013. Institut de Veille sanitaire website. http://www.invs.sante.fr/fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2015/Surveillance-des-infections-du-site-operatoire-France-2013. Published 2014. Accessed December 9, 2016.Google Scholar
20. Surveillance of surgical site infections in NHS hospitals in England, 2014-15. Public Health England website. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/484874/Surveillance_of_Surgical_Site_Infections_in_NHS_Hospitals_in_England_report_2014-15.pdf. Published 2015. Accessed December 9, 2016.Google Scholar
21. Surveillance of surgical site infections in Europe 2010-2011.European Centre for Diseases prevention and Control website. http://ecdc.europa.eu/en/healthtopics/healthcare-associated_infections/surgical-site-infections/pages/ssi.aspx. Published 2013. Accessed December 9, 2016.Google Scholar
22. National and state healthcare-associated infections. Progress report. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Published 2016. Accessed December 9, 2016.Google Scholar
23. Mannien, J, van den Hof, S, Brandt, C, Behnke, M, Wille, JC, Gastmeier, P. Comparison of the national surgical site infection surveillance data between the Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007;66:224–231.CrossRefGoogle ScholarPubMed
24. Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilmoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:51–57.CrossRefGoogle ScholarPubMed
25. Huotari, K, Lyytikäinen, O. Impact of post-discharge surveillance on the rate of surgical site infection after orthopedic surgery. Infect Control Hosp Epidemiol 2006;27:1324–1329.CrossRefGoogle Scholar
26. Manniën, J, Wille, JC, Snoeren, RLMM, van den Hof, S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in the Netherlands. Infect Control Hosp Epidemiol 2006;27:809–816.CrossRefGoogle Scholar
27. Reilly, J, Allardice, G, Bruce, J, Hill, R, McCoubrey, J. Procedure-specific surgical site infection rates and post-discharge surveillance in Scotland. Infect Control Hosp Epidemiol 2006;27:1318–1323.CrossRefGoogle Scholar
28. Sands, K, Vineyard, G, Platt, R. Surgical site infections occuring after hospital discharge. J Infect Dis 1996;173:963–970.CrossRefGoogle ScholarPubMed
29. Whitby, M, McLaws, ML, Collopy, B, et al. Post-discharge surveillance: can patients reliably diagnose surgical wound infections? J Hosp Infect 2002;52:155–160.CrossRefGoogle ScholarPubMed
30. Gastmeier, P, Behnke, M. Electronic surveillance and using administrative data to identify healthcare associated infections. Curr Opin Infect Dis 2016;29:394–399.CrossRefGoogle ScholarPubMed
31. McNeish, J, Lyle, D, McCowan, M, et al. Post-discharge surgical site infection surveillance by automated telephony. J Hosp Infection 2007;66:232–236.CrossRefGoogle ScholarPubMed
32. Talbot, TR, Bratzler, DW, Carrico, RM, et al. Public reporting of health care-associated surveillance data: recommendations from the healthcare infection control practices advisory committee. Ann Intern Med 2013;159:631–635.CrossRefGoogle ScholarPubMed
33. Mc Coubrey, J, Reilly, J, Mullings, A, Pollock, KG, Johnston, F. Validation of surgical site infection surveillance data in Scotland. J Hosp Infect 2005;61:194–200.CrossRefGoogle ScholarPubMed
34. Manniën, J, van der Zeeuw, AE, Wille, JC, van der Hof, S. Validation of surgical site infection surveillance in the Netherlands. Infect Control Hosp Epidemiol 2007;28:36–41.CrossRefGoogle ScholarPubMed
35. Friedman, ND, Russo, PL, Bull, AL, Richards, MJ, Kelly, H. Validation of coronary artery bypass graft surgical site infection surveillance data from a statewide surveillance system in Australia. Infect Control Hosp Epidemiol 2007;28:812–817.CrossRefGoogle ScholarPubMed
36. Haley, VB, van Antwerown, C, Tserenpuntsag, B, et al. Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York state 2009–2010. Infect Control Hosp Epidemiol 2012;33:565–571.CrossRefGoogle ScholarPubMed
37. Birgand, G, Lepelletier, D, Baron, G, et al. Agreement among healthcare professionals in ten European countries in daignosing case-vignettes of surgical site infections. PLoS One 2013;8:e68618.CrossRefGoogle Scholar
38. Brandt, C, Sohr, D, Behnke, M, Daschner, F, Rüden, H, Gastmeier, P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:1347–1351.CrossRefGoogle ScholarPubMed
39. Astagneau, P, L’Hériteau, F, Daniel, F, et al. Reducing surgical site infection through a network: results from the French ISO-RAISIN surveillance system. J Hosp Infect 2009;72:127–134.CrossRefGoogle ScholarPubMed
40. Gastmeier, P, Sohr, G, Schwab, F, et al. Ten years of KISS: the most important requirements for success. J Hosp Infection 2008;70(Suppl 1):11–16.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Troillet et al. supplementary material

Supplementary material

Download Troillet et al. supplementary material(PDF)
PDF 26.3 KB
Supplementary material: PDF

Troillet et al. supplementary table 1

Supplementary table 1

Download Troillet et al. supplementary table 1(PDF)
PDF 134.4 KB
Supplementary material: PDF

Troillet et al. supplementary table 2

Supplementary table 2

Download Troillet et al. supplementary table 2(PDF)
PDF 55.7 KB
Supplementary material: PDF

Troillet et al. supplementary table 3

Supplementary table 3

Download Troillet et al. supplementary table 3(PDF)
PDF 40.2 KB