Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-30T20:11:05.780Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Postdischarge Surveillance on the Rate of Surgical Site Infection After Orthopedic Surgery

Published online by Cambridge University Press:  21 June 2016

Kaisa Huotari ,
Outi Lyytikäinen  and
Hospital Infection Surveillance Team
Kaisa Huotari*
Affiliation:
National Public Health Institute, Helsinki University Central Hospital, Helsinki, Finland Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
Outi Lyytikäinen
Affiliation:
National Public Health Institute, Helsinki University Central Hospital, Helsinki, Finland
*
National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) rates after orthopedic surgery.

Setting.

Nine hospitals participating in the Finnish Hospital Infection Program.

Patients.

All patients who underwent hip or knee arthroplasty or open reduction of a femur fracture during 1999-2002.

Results.

The date of discharge was available for 11,812 procedures (90%). The median length of hospital stay was 8 days (range per hospital, 6-9 days). The overall SSI rate was 3.3% (range, 0.8%-6.4%). Of 384 SSIs detected, 216 (56%; range, 28%-90%) were detected after discharge: 93 (43%) were detected on readmission to the hospital, 73 (34%) at completion of a postdischarge questionnaire, and 23 (11%) at a follow-up visit. For 27 postdischarge SSIs (13%), the location of detection was unknown. Altogether, 32 (86%) of 37 of organ/space SSIs, 57 (80%) of 71 deep incisional SSIs, and 127 (46%) of 276 superficial incisional SSIs were detected after discharge. Most SSIs (70%) detected on readmission were severe (organ/space or deep incisional), whereas most SSIs (86%) detected at follow-up visits or at completion of a postdischarge questionnaire were superficial. Of all SSIs, 78% (range, 48%-100%) were microbiologically confirmed. Microbiologic confirmation was less common after discharge than during postoperative hospital stay (66% vs 93%; P< .001).

Conclusions.

Postdischarge surveillance had a large impact on the rate of SSI detected after orthopedic surgery. However, postdischarge surveillance conducted by means of a questionnaire detected only a minority of deep incisional and organ/space SSIs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1324 - 1329
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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

1. Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17:552–557.CrossRefGoogle ScholarPubMed
2. Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002; 23:183–189.CrossRefGoogle Scholar
3. Darouiche, RO. Treatment of infections associated with surgical implants. N Engl J Med 2004; 350:1422–1429.CrossRefGoogle ScholarPubMed
4. Thomas, C, Cadwallader, HL, Riley, TV. Surgical-site infections after orthopaedic surgery: statewide surveillance using linked administrative databases. J Hosp Infect 2004; 57:25–30.CrossRefGoogle ScholarPubMed
5. Holtz, TH, Wenzel, RP. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992; 20:206–213.CrossRefGoogle ScholarPubMed
6. Manian, FA. Surveillance of surgical site infections in alternative settings: exploring the current options. Am J Infect Control 1997; 25:102–105.CrossRefGoogle ScholarPubMed
7. Fanning, C, Johnston, BL, MacDonald, S, LeFort-Jost, S, Dockerty, E. Post-discharge surgical site infection surveillance. Can J Infect Control 1995; 10:75–79.Google Scholar
8. Manian, FA, Meyer, L. Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: report of a seven-year experience. Am J Infect Control 1997; 25:390–394.CrossRefGoogle ScholarPubMed
9. Friedman, C, Sturm, LK, Chenoweth, C. Electronic chart review as an aid to postdischarge surgical site surveillance: increased case finding. Am J Infect Control 2001; 29:329–332.CrossRefGoogle ScholarPubMed
10. Sands, K, Vineyard, G, Livingston, J, Christiansen, C, Piatt, R. Efficient identification of postdischarge surgical site infections: use of automated pharmacy dispensing information, administrative data, and medical record information. J Infect Dis 1999; 179:434–441.CrossRefGoogle ScholarPubMed
11. Mitt, P, Lang, K, Peri, A, Maimets, M. Surgical-site infections following cesarean section in an Estonian university hospital: postdischarge surveillance and analysis of risk factors. Infect Control Hosp Epidemiol 2005; 26:449–454.CrossRefGoogle Scholar
12. Miner, AL. Enhanced identification of postoperative infections among outpatients. Emerg Infect Dis 2004; 10:1931–1937.CrossRefGoogle ScholarPubMed
13. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470–485.CrossRefGoogle Scholar
14. Surveillance of surgical site infections, HELICS Implementation Phase II, HELICS-SSI Statistical Report, 2000-2003, 2005. Available at: http://ipse.univ-lyonl.fr/. Accessed November 20, 2006.Google Scholar
15. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13:606–608.CrossRefGoogle ScholarPubMed
16. 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
17. National Nosocomial Infections Surveillance System. NNIS Manual. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC; 1994.Google Scholar
18. Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Tolson, JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance system basic SSI risk index. Clin Infect Dis 2001; 33:S69–S77.CrossRefGoogle ScholarPubMed
19. Zimmerli, W, Trampuz, A, Ochsner, PE. Prosthetic-joint infections. N Engl J Med 2004; 351:1645–1654.CrossRefGoogle ScholarPubMed
20. Giulieri, SG, Graber, P, Ochsner, PE, Zimmerli, W. Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection 2004; 32:222–228.CrossRefGoogle ScholarPubMed
21. Platt, R, Yokoe, DS, Sands, KE. Automated methods for surveillance of surgical site infections. Emerg Infect Dis 2001; 7:212–216.CrossRefGoogle ScholarPubMed
22. Tokars, JI, Richards, C, Andrus, M, et al. The changing face of surveillance for health care-associated infections. Clin Infect Dis 2004; 39:1347–1352.CrossRefGoogle ScholarPubMed
23. Geubbels, EL, Wille, JC, Nagelkerke, NJ, Vandenbroucke-Grauls, CM, Grobbee, DE, de Boer, AS. Hospital-related determinants for surgical-site infection following hip arthroplasty. Infect Control Hosp Epidemiol 2005; 26:435–441.CrossRefGoogle ScholarPubMed
24. Ridgeway, S, Wilson, J, Coello, R, Pearson, A, Charlet, A, Kafatos, G. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005; 87:844–850.CrossRefGoogle ScholarPubMed
25. Archibald, LK, Gaynes, RP. Hospital-acquired infections in the United States: the importance of interhospital comparisons. Infect Dis Clin North Am 1997; 11:245–255.CrossRefGoogle ScholarPubMed
26. Nosocomial infection rates for interhospital comparison: limitations and possible solutions: a report from the National Nosocomial Infections Surveillance (NNIS) system. Infect Control Hosp Epidemiol 1991; 12:609–621.CrossRefGoogle Scholar
27. Wilson, AP, Gibbons, C, Reeves, BC, et al. Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. BMJ 2004; 329:720.CrossRefGoogle ScholarPubMed
28. Taylor, G, McKenzie, M, Kirkland, T, Wiens, R. Effect of surgeon's diagnosis on surgical wound infection rates. Am J Infect Control 1990; 18:295–299.CrossRefGoogle ScholarPubMed
29. Coello, R, Gastmeier, P, de Boer, AS. Surveillance of hospital-acquired infection in England, Germany, and The Netherlands: will international comparison of rates be possible? Infect Control Hosp Epidemiol 2001; 22:393–397.CrossRefGoogle ScholarPubMed
30. Mertens, R, Van den Berg, JM, Veerman-Brenzikofer, ML, Kurz, X, Jans, B, Klazinga, N. International comparison of results of infection surveillance: The Netherlands versus Belgium. Infect Control Hosp Epidemiol 1994; 15:574–578.CrossRefGoogle ScholarPubMed
31. Moro, ML, Morsillo, F. Can hospital discharge diagnoses be used for surveillance of surgical-site infections? J Hosp Infect 2004; 56:239–241.CrossRefGoogle ScholarPubMed