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Structure, Process, and Outcome Quality of Surgical Site Infection Surveillance in Switzerland

Published online by Cambridge University Press:  22 August 2017

Stefan P. Kuster*
Affiliation:
Swissnoso - National Center for Infection Control, Bern, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland
Marie-Christine Eisenring
Affiliation:
Swissnoso - National Center for Infection Control, Bern, Switzerland Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
Hugo Sax
Affiliation:
Swissnoso - National Center for Infection Control, Bern, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland
Nicolas Troillet
Affiliation:
Swissnoso - National Center for Infection Control, Bern, Switzerland Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland Services of Infectious Diseases and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
*
Address correspondence to Stefan Kuster, MD, MSc, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100 / HAL14 D6 8091 Zürich, Switzerland (stefan.kuster@usz.ch).

Abstract

OBJECTIVE

To assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program.

DESIGN

Countrywide survey of SSI surveillance quality.

SETTING

147 hospitals or hospital units with surgical activities in Switzerland.

METHODS

Site visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI.

RESULTS

Of 50 possible points, the median validation score was 35.5 (range, 16.25–48.5). Public hospitals (P<.001), hospitals in the Italian-speaking region of Switzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%–81.7%), a specificity of 99.9% (95% CI, 99.5%–100%), a positive predictive value of 97.1% (95% CI, 85.1%–99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%–99.2%).

CONCLUSIONS

Irrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement.

Infect Control Hosp Epidemiol 2017;38:1172–1181

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part at the Fourth International Conference on Prevention & Infection Control (ICPIC) on June 23, 2017, in Geneva, Switzerland

a

Authors of equal contribution.

b

Members of Swissnoso are (in alphabetical order): Carlo Balmelli, MD, Lugano; Marie-Christine Eisenring, RN, ICP, CNS, Sion; Stephan Harbarth, MD, MS, Geneva; Stefan P. Kuster, MD, MSc, Zurich; Jonas Marschall, MD, MSc, Bern; Virginie Masserey Spicher, MD, Bern; Didier Pittet, MD, MS, Geneva; Christian Ruef, MD, Zurich; Hugo Sax, MD, Zurich; Matthias Schlegel, MD, St. Gallen; Alexander Schweiger, MD, Basel; Nicolas Troillet, MD, MSc, Sion; Andreas F. Widmer, MD, MSc, Basel; Giorgio Zanetti, MD, MSc, Lausanne.

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