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Improving Surveillance for Surgical Site Infections Following Total Hip and Knee Arthroplasty Using Diagnosis and Procedure Codes in a Provincial Surveillance Network

Published online by Cambridge University Press:  28 March 2016

Alysha Rusk
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Kathryn Bush*
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Marlene Brandt
Affiliation:
Data Integration, Measurement, and Reporting, Alberta Health Services, Calgary, Alberta, Canada
Christopher Smith
Affiliation:
Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
Andrea Howatt
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Blanda Chow
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Elizabeth Henderson
Affiliation:
Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
*
Address correspondence to Kathryn Bush, MSc, Rm 801 ST, Foothills Medical Centre, Calgary, Canada T2N 2T9 (kathryn.bush@albertahealthservices.ca).

Abstract

OBJECTIVE

To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty.

DESIGN

Retrospective cohort study.

SETTING

All acute care facilities in Alberta, Canada.

METHODS

Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data–triggered medical chart review was assessed.

RESULTS

Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data–triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%.

CONCLUSION

Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities.

Infect Control Hosp Epidemiol 2016;37:699–703

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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