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Surveillance for Surgical Site Infection After Hospital Discharge: A Surgical Procedure–Specific Perspective

Published online by Cambridge University Press:  21 June 2016

E. Prospero ,
A. Cavicchi ,
S. Bacelli ,
P. Barbadoro ,
L. Tantucci  and
M. M. D'Errico
E. Prospero*
Affiliation:
Department Infectious Disease and Public Health, Università Politecnica Marche, Ancona, Italy
A. Cavicchi
Affiliation:
General Surgery Unit, Associated Hospitals Ancona, Ancona, Italy
S. Bacelli
Affiliation:
Department Infectious Disease and Public Health, Università Politecnica Marche, Ancona, Italy
P. Barbadoro
Affiliation:
Department Infectious Disease and Public Health, Università Politecnica Marche, Ancona, Italy
L. Tantucci
Affiliation:
Department Infectious Disease and Public Health, Università Politecnica Marche, Ancona, Italy
M. M. D'Errico
Affiliation:
Department Infectious Disease and Public Health, Università Politecnica Marche, Ancona, Italy
*
Department of Infectious Diseases and Public Health, School of Medicine, Università Politecnica Marche, Piazza Roma 2, 60100, Ancona, Italy ([email protected])
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Abstract

Objective.

To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program.

Design.

Prospective surveillance study.

Setting.

A surgical ward at a university teaching hospital in Italy.

Patients.

A total of 264 surgical patients were included in the study.

Results.

The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (±SD) for patients who acquired a postdischarge SSI was 4.9 ± 3.7 days, and SSI was diagnosed a mean duration (±SD) of 11.5 ± 4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher.

Conclusions.

Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1313 - 1317
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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