Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T21:26:19.732Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands

Published online by Cambridge University Press:  21 June 2016

Judith Manniën ,
Jan C. Wille ,
Ruud L. M. M. Snoeren  and
Susan van den Hof
Judith Manniën*
Affiliation:
National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Jan C. Wille
Affiliation:
Dutch Institute for Healthcare Improvement, CBO, Utrecht, The Netherlands
Ruud L. M. M. Snoeren
Affiliation:
St. Elisabeth Hospital, Tilburg, The Netherlands
Susan van den Hof
Affiliation:
National Institute for Public Health and the Environment, Bilthoven, The Netherlands
*
National Institute for Public Health and the Environment, PO Box 1, Bilthoven, The Netherlands, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.

Design.

Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.

Setting.

Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.

Results.

We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).

Conclusions.

For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 8 , August 2006 , pp. 809 - 816
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. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986–April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System Am J Infect Control 1996; 24:380–388.Google Scholar
2. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20:725–730.CrossRefGoogle ScholarPubMed
3. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996; 173:963–970.Google Scholar
4. Martone, WJ, Nichols, RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis 2001;33(Suppl 2):S67–S68.Google Scholar
5. 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(Suppl 2):S69–S77.Google Scholar
6. Holtz, TH, Wenzel, RP. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992; 20:206–213.Google Scholar
7. Brown, RB, Bradley, S, Opitz, E, Cipriani, D, Pieczarka, R, Sands, M. Surgical wound infections documented after hospital discharge. Am J Infect Control 1987; 15:54–58.Google Scholar
8. Smith, RL, Bohl, JK, McElearney, ST, et al. Wound infection after elective colorectal resection. Ann Surg 2004; 239:599–605.CrossRefGoogle ScholarPubMed
9. Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003; 9:196–203.Google Scholar
10. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31:481–498.Google Scholar
11. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27:97–132.Google Scholar
12. Manian, FA. Surveillance of surgical site infections in alternative settings: exploring the current options. Am J Infect Control 1997; 25:102–105.CrossRefGoogle ScholarPubMed
13. de Haas, R, Mintjes-de Groot, AJ, Geubbels, ELPE, van den Berg, JMJ, de Boer, AS. Inventarisatie van surveillance na ontslag in het PREZIES-project. Bilthoven, The Netherlands: National Institute for Public Health and the Environment and Utrecht, The Netherlands; The Dutch Institute for Healthcare Improvement; 1998.Google Scholar
14. Avato, JL, Lai, KK. Impact of postdischarge surveillance on surgical-site infection rates for coronary artery bypass procedures. Infect Control Hosp Epidemiol 2002; 23:364–367.Google Scholar
15. Delgado-Rodriguez, M, Gomez-Ortega, A, Sillero-Arenas, M, Llorca, J. Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study. Infect Control Hosp Epidemiol 2001; 22:24–30.Google Scholar
16. Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2004:1659–1702.Google Scholar
17. Infection Prevention Working Party (WIP). Registration of hospital infections. Guideline 25b. Leiden: Leiden University Medical Center; 2001.Google Scholar
18. Owens, WD, Felts, JA, Spitznagel, EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978; 49:239–243.Google Scholar
19. 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.Google Scholar
20. Noy, D, Creedy, D. Postdischarge surveillance of surgical site infections: a multi-method approach to data collection. Am J Infect Control 2002; 30:417–424.Google Scholar
21. Taylor, EW, Duffy, K, Lee, K et al. Surgical site infection after groin hernia repair. Br J Surg 2004; 91:105–111.Google Scholar
22. 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.Google Scholar
23. Kent, P, McDonald, M, Harris, O, Mason, T, Spelman, D. Post-discharge surgical wound infection surveillance in a provincial hospital: follow-up rates, validity of data and review of the literature. ANZ J Surg 2001; 71:583–589.Google Scholar
24. 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.Google Scholar
25. Couto, RC, Pedrosa, TM, Nogueira, JM, Gomes, DL, Neto, MF, Rezende, NA. Post-discharge surveillance and infection rates in obstetric patients. Int J Gynaecol Obstet 1998; 61:227–231.Google Scholar
26. Medina-Cuadros, M, Sillero-Arenas, M, Martinez-Gallego, G, Delgado-Rodriguez, M. Surgical wound infections diagnosed after discharge from hospital: epidemiologic differences with in-hospital infections. Am J Infect Control 1996; 24:421–428.Google Scholar
27. Law, DJ, Mishriki, SF, Jeffery, PJ. The importance of surveillance after discharge from hospital in the diagnosis of postoperative wound infection. Ann R Coll Surg Engl 1990; 72:207–209.Google Scholar
28. Eriksen, HM, Chugulu, S, Kondo, S, Lingaas, E. Surgical-site infections at Kilimanjaro Christian Medical Center. J Hosp Infect 2003; 55:14–20.Google Scholar
29. Reid, R, Simcock, JW, Chisholm, L, Dobbs, B, Frizelle, FA. Postdischarge clean wound infections: incidence underestimated and risk factors overemphasized. ANZ J Surg 2002; 72:339–343.Google Scholar