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A computerized indicator for surgical site infection (SSI) assessment after total hip or total knee replacement: The French ISO-ORTHO indicator

Published online by Cambridge University Press:  09 September 2021

Leslie Grammatico-Guillon Open the ORCID record for Leslie Grammatico-Guillon [Opens in a new window] ,
Katiuska Miliani ,
Linda Banaei-Bouchareb ,
Agnès Solomiac ,
Jessica Sambour ,
Laetitia May-Michelangeli  and
Pascal Astagneau
Leslie Grammatico-Guillon*
Affiliation:
Service of Public Health, Epidemiology and Data Center, Teaching Hospital of Tours, Tours, France Medical School, University of Tours, Tours, France
Katiuska Miliani
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France
Linda Banaei-Bouchareb
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Agnès Solomiac
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Jessica Sambour
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France
Laetitia May-Michelangeli
Affiliation:
French National Authority for Health (Haute Autorité de Santé, HAS), Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l’Amélioration de la qualité et de la sécurité des soins, Saint-Denis-La-Plaine, France
Pascal Astagneau
Affiliation:
Centre de prévention des infections associés aux soins (CPIAS), Paris, France Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
*
Author for correspondence: Dr Leslie Grammatico-Guillon, E-mail: [email protected]
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Abstract

Objective:

The French National Authority for Health (HAS), with a multidisciplinary working group, developed an indicator ‘ISO-ORTHO’ to assess surgical site infections (SSIs) after total hip arthroplasty or total knee arthroplasty (THA/TKA) based on the hospital discharge database. We present the ISO-ORTHO indicator designed for SSI automated detection and its relevance for quality improvement and hospital benchmarks.

Methods:

The algorithm is based on a combination of International Statistical Classification of Diseases, Tenth Revision (ICD-10) and procedure codes of the hospital stay. The target population was selected among adult patients who had a THA or TKA between January 1, 2017, and September 30, 2017. Patients at very high risk of SSI and/or with SSI not related to hospital care were excluded. We searched databases for SSIs up to 3 months after THA/TKA. The standardized infection ratio (SIR) of observed versus expected SSIs was calculated (logistic regression) and displayed as funnel plot with 2 and 3 standard deviations (SD) after adjustment for 13 factors known to increase SSI risk.

Results:

In total, 790 hospitals and 139,926 THA/TKA stays were assessed; 1,253 SSI were detected in the 473 included hospitals (incidence, 0.9%: 1.0% for THA, 0.80% for TKA). The SSI rate was significantly higher in males (1.2%), in patients with previous osteo-articular infection (4.4%), and those with cancer (2.3%), obesity, or diabetes. Most hospitals (89.9%) were within 2 SD; however, 12 hospitals were classified as outliers at more than +3 SD (1.6% of facilities), and 59 hospitals (7.9%) were outliers between +2 SD and +3 SD.

Conclusion:

ISO-ORTHO is a relevant indicator for automated surveillance; it can provide hospitals a metric for SSI assessment that may contribute to improving patient outcomes.

Keywords

surgical site infectionorthopedicsautomated surveillance indicatorhealthcare quality improvement
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1171 - 1178
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

References

NNIS system. 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
Manniën, J, van den Hof, S, Muilwijk, J, van den 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
Gastmeier, P, Geffers, C, Sohr, D, Dettenkofer, M, Daschner, F, Rüden, H. Five years working with the German nosocomial infection surveillance system (Krankenhaus Infektions Surveillance System). Am J Infect Control 2003;31:316–321.CrossRefGoogle Scholar
Coello, R, Gastmeier, P, Boer AS de. 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 Scholar
Del Pozo, JL, Patel, R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med 2009;361:787–794.CrossRefGoogle ScholarPubMed
Wilson, J, Charlett, A, Leong, G, McDougall, C, Duckworth, G. Rates of surgical site infection after hip replacement as a hospital performance indicator: analysis of data from the English mandatory surveillance system. Infect Control Hosp Epidemiol 2008;29:219–226.CrossRefGoogle ScholarPubMed
Dal-Paz, K, Oliveira, PRD, Paula, AP de, Emerick, MC da S, Pécora, JR, Lima, ALLM. Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil. Braz J Infect Dis 2010;14:356–359.CrossRefGoogle Scholar
Parneix, P. La surveillance des infections nosocomiales en France: un élément clé des programmes nationaux surveillance of healthcare-associated infections in France: a key component of national programs. Bull Epidémiol Hebd 2011;26:15–16-17.Google Scholar
Grammatico-Guillon, L, Baron, S, Gettner, S, et al. Bone and joint infections in hospitalized patients in France, 2008: clinical and economic outcomes. J Hosp Infect 2012;82:40–48.CrossRefGoogle ScholarPubMed
Zimmerli, W. Infection and musculoskeletal conditions: prosthetic-joint–associated infections. Best Pract Res Clin Rheumatol 2006;20:1045–1063.CrossRefGoogle ScholarPubMed
Astagneau, P, Rioux, C, Golliot, F, Brücker, G. Morbidity and mortality associated withsurgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48:267–274.CrossRefGoogle ScholarPubMed
Barnes, S, Salemi, C, Fithian, D, et al. An enhanced benchmark for prosthetic joint replacement infection rates. Am J Infect Control 2006;34:669–672.CrossRefGoogle ScholarPubMed
Mabit, C, Marcheix, PS, Mounier, M, et al. Impact of a surgical site infection (SSI) surveillance program in orthopedics and traumatology. Orthop Traumatol Surg Res 2012;98:690–695.CrossRefGoogle ScholarPubMed
Muilwijk, J, van den Hof, S, Wille, JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol 2007;28:557–563.CrossRefGoogle ScholarPubMed
Grammatico-Guillon, L, Rusch, E, Astagneau, P. Surveillance of prosthetic joint infections: international overview and new insights for hospital databases. J Hosp Infect 2015;89:90–98.CrossRefGoogle ScholarPubMed
Van Mourik, MSM, Perencevich, EN, Gastmeier, P, Bonten, MJM. Designing surveillance of healthcare-associated infections in the era of automation and reporting mandates. Clin Infect Dis 2018;66:970–976.CrossRefGoogle ScholarPubMed
DGOS. Programme national d’actions de prévention des infections associées aux soins - PROPIAS. Ministère des Solidarités et de la Santé website. https://solidarites-sante.gouv.fr/soins-et-maladies/qualite-des-soins-et-pratiques/securite/programme-national-d-actions-de-prevention-des-infections-associees-aux-soins/. Accessed August 18, 2021.Google Scholar
THA/TKA: actes pose reprise prothese hanche genou ATIH. Haute Autorité de Santé website. https://www.has-sante.fr/upload/docs/application/pdf/2019-10/actes-pose-reprise-prothese-hanche-genou-atih_mars2019.pdf. Accessed August 18, 2021.Google Scholar
Grammatico-Guillon, L, Baron, S, Gaborit, C, Rusch, E, Astagneau, P. Quality assessment of hospital discharge database for routine surveillance of hip and knee arthroplasty–related infections. Infect Control Hosp Epidemiol 2014;35:646–651.CrossRefGoogle ScholarPubMed
Grammatico-Guillon, L, Perreau, C, Miliani, K, et al. Association of partial hip replacement with higher risk of infection and mortality in France. Infect Control Hosp Epidemiol 2016:1–3.Google ScholarPubMed
Fung, CH, Lim, Y-W, Mattke, S, Damberg, C, Shekelle, PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008;148:111–123.CrossRefGoogle ScholarPubMed
McKibben, L, Horan, T, Tokars, JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control 2005;33:217–226.CrossRefGoogle ScholarPubMed
Outcome indicators measured from medico-administrative databases. Haute Autorité de Santé website. https://www.has-sante.fr/jcms/p_3076997/en/outcome-indicators-measured-from-medico-administrative-databases. Accessed August 18, 2021.Google Scholar
IQSS 2019—Méthode de validation des indicateurs de résultats mesurés à partir des bases de données. Haute Autorité de Santé website. https://www.has-sante.fr/jcms/p_3076997/fr/iqss-2019-methode-de-validation-des-indicateurs-de-resultats-mesures-a-partir-des-bases-de-donnees. Accessed August 18, 2021.Google Scholar
IQSS 2020—ISO-ORTHO: Infections du site opératoire après pose de prothèse de hanche ou de genou. Haute Autorité de Santé website. https://www.has-sante.fr/jcms/c_2806593/fr/iqss-2020-iso-ortho-infections-du-site-operatoire-apres-pose-de-prothese-totale-de-hanche-ou-de-genou. Accessed August 18, 2021.Google Scholar
SSI: Consignes de codage infections site op, October 2018. Haute Autorité de Santé website. https://www.atih.sante.fr/sites/default/files/public/content/1288/consignes_de_codage_infections_site_op_oct_2018.pdf. Accessed August 18, 2021.Google Scholar
Grammatico-Guillon, L, Baron, S, Rosset, P, et al. Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database. Infect Control Hosp Epidemiol 2015;36:1198–1207.CrossRefGoogle ScholarPubMed
Dobson, AJ, Kuulasmaa, K, Eberle, E, Scherer, J. Confidence intervals for weighted sums of poisson parameters. Stat Med 1991;10:457–462.CrossRefGoogle ScholarPubMed
Jackson, SS, Leekha, S, Magder, LS, et al. Electronically available comorbidities should be used in surgical site infection risk adjustment. Clin Infect 2017;65:803–810.CrossRefGoogle ScholarPubMed
Surveillance of surgical site infections, HELICS implementation phase II, HELICS-SSI statistical report, 2000–2003, 2005. Published online 2006. https://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/SSI-in-europe-2010-2011.pdf.Google Scholar
National Health Safety Network. Surgical site infection (SSI) events. Protocols. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/psc/ssi/. Published 2020. Accessed August 18, 2021.Google Scholar
Current HAI Progress Report: 2019 National and State Healthcare-Associated Infections Progress Report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Published 2020. Accessed August 18, 2021.Google Scholar
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
Carling, P, Fung, T, Killion, A, Terrin, N, Barza, M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699–706.CrossRefGoogle ScholarPubMed
Goossens, H, Ferech, M, Vander Stichele, R, Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579–587.CrossRefGoogle ScholarPubMed
Geubbels, ELPE, Groot, AJM, Berg JMJ van den, Boer AS de. An operating surveillance system of surgical-site infections in the Netherlands: results of the PREZIES national surveillance network. Infect Control Hosp Epidemiol 2000;21:311–318.CrossRefGoogle Scholar
Wattier, RL, Levy, ER, Sabnis, AJ, Dvorak, CC, Auerbach, AD. Reducing second gram-negative antibiotic therapy on pediatric oncology and hematopoietic stem cell transplantation services. Infect Control Hosp Epidemiol 2017;38:1039–1047.CrossRefGoogle ScholarPubMed
Cooke, J, Stephens, P, Ashiru-Oredope, D, et al. Longitudinal trends and cross-sectional analysis of English national hospital antibacterial use over 5 years (2008–13): working towards hospital prescribing quality measures. J Antimicrob Chemother 2015;70:279–285.CrossRefGoogle ScholarPubMed
Drees, M, Gerber, JS, Morgan, DJ, Lee, GM. Research methods in healthcare epidemiology and antimicrobial stewardship: use of administrative and surveillance databases. Infect Control Hosp Epidemiol 2016;37:1278–1287.CrossRefGoogle ScholarPubMed
Evidence appraisal of Birgand G, Haudebourg, T, Grammatico-Guillon, L, et al. Improvement in staff behavior during surgical procedures to prevent post-operative complications (ARIBO2): study protocol for a cluster randomized trial. Trials. 2019;20(1):275.Google Scholar
Jouan, Y, Grammatico-Guillon, L, Espitalier, F, Cazals, X, François, P, Guillon, A. Long-term outcome of severe herpes simplex encephalitis: a population-based observational study. Crit Care Lond Engl 2015;19:345.CrossRefGoogle ScholarPubMed
Laporte, L, Hermetet, C, Jouan, Y, et al. Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care 2018;8:84.CrossRefGoogle ScholarPubMed
Grammatico-Guillon, L, Baron, S, Gaborit, C, Rusch, E, Astagneau, P. Quality assessment of hospital discharge database for routine surveillance of hip and knee arthroplasty–related infections. Infect Control Hosp Epidemiol 2014;35:646–651.CrossRefGoogle ScholarPubMed
Hermetet, C, Laurent, É, El Allali, Y, et al. Child maltreatment by nonaccidental burns: interest of an algorithm of detection based on hospital discharge database. Int J Legal Med 2021;135:509–519.CrossRefGoogle Scholar
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