Skip to main content
×
×
Home

First Results of the Swiss National Surgical Site Infection Surveillance Program: Who Seeks Shall Find

  • Nicolas Troillet (a1) (a2) (a3), Emin Aghayev (a4), Marie-Christine Eisenring (a1) (a2), Andreas F. Widmer (a1) (a5) and Swissnoso...
  • Please note a correction has been issued for this article.
Abstract
OBJECTIVES

To report on the results of the Swiss national surgical site infection (SSI) surveillance program, including temporal trends, and to describe methodological characteristics that may influence SSI rates

DESIGN

Countrywide survey of SSI over a 4-year period. Analysis of prospectively collected data including patient and procedure characteristics as well as aggregated SSI rates stratified by risk categories, type of SSI, and time of diagnosis. Temporal trends were analyzed using stepwise multivariate logistic regression models with adjustment of the effect of the duration of participation in the surveillance program for confounding factors.

SETTING

The study included 164 Swiss public and private hospitals with surgical activities.

RESULTS

From October 2011 to September 2015, a total of 187,501 operations performed in this setting were included. Cumulative SSI rates varied from 0.9% for knee arthroplasty to 14.4% for colon surgery. Postdischarge follow-up was completed in >90% of patients at 1 month for surgeries without an implant and in >80% of patients at 12 months for surgeries with an implant. High rates of SSIs were detected postdischarge, from 20.7% in colon surgeries to 93.3% in knee arthroplasties. Overall, the impact of the duration of surveillance was significantly and independently associated with a decrease in SSI rates in herniorraphies and C-sections but not for the other procedures. Nevertheless, some hospitals observed significant decreases in their rates for various procedures.

CONCLUSIONS

Intensive post-discharge surveillance may explain high SSI rates and cause artificial differences between programs. Surveillance per se, without structured and mandatory quality improvement efforts, may not produce the expected decrease in SSI rates.

Infect Control Hosp Epidemiol 2017;38:697–704

Copyright
Corresponding author
Address correspondence to Nicolas Troillet, Central Institute, Valais Hospital, Ave. Grand-Champsec 86, Sion, CH 1950, Switzerland (nicolas.troillet@hopitalvs.ch).
References
Hide All
1. Sax, H, Uçkay, I, Balmelli, C, et al. Overall burden of healthcare associated infections among surgical patients: results of a national study. Ann Surg 2011;253:365370.
2. Smyth, ET, McIlvenny, G, Enstone, JE, et al. Four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect 2008;69:230248.
3. 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;37:783805.
4. Staszewicz, W, Eisenring, MC, Bettschart, V, Harbarth, S, Troillet, N. Thirteen years of surgical site infection surveillance in Swiss hospitals. J Hosp Infect 2014;88:4047.
5. Anderson, DJ, Podgorny, K, Berrios-Torres, I, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605627.
6. Broex, EC, van Asselt, AD, Bruggeman, CA, van Tiel, FH. Surgical site infections: how high are the costs? J Hosp Infect 2009;72:193201.
7. Weber, WP, Zwahlen, M, Reck, S, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol 2008;29:623629.
8. Astagneau, P, Rioux, C, Golliot, F, Brücker, G, INCISO Network Study Group. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48:267274.
9. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.
10. Surgical site infections. 2008. clinical guideline 74. National Institute for Clinical Excellence website. http://www.nice.org.uk/CG74. Published 2008. Accessed December 9, 2016.
11. Romy, S, Eisenring, MC, Bettschart, V, Petignat, C, Francioli, P, Troillet, N. Laparoscope use and surgical site infetions in digestive surgery. Ann Surg 2008;247:627632.
12. Hubner, M, Diana, M, Zanetti, G, Eisenring, MC, Demartines, N, Troillet, N. Surgical site infections in colon surgery: the pateint, the procedure, the hospital, and the surgeon. Arch Surg 2011;146:12401245.
13. Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:1935.
14. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(Suppl B):152S157S.
15. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
16. Manniën, J, van der Hof, S, Muilwijk, J, van der Broek, PJ, van Benthem, B, Wille, JC. Trends in the incidence of surgical site infection in the Netherlands. Infect Control Hosp Epidemiol 2008;29:11321138.
17. Armitage, P. Tests for linear trends in proportions and frequencies. Biometrics 1955;11:375386.
18. 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;37:783805.
19. Surveillance des infections du site opératoire, France 2013. Institut de Veille sanitaire website. http://www.invs.sante.fr/fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2015/Surveillance-des-infections-du-site-operatoire-France-2013. Published 2014. Accessed December 9, 2016.
20. Surveillance of surgical site infections in NHS hospitals in England, 2014-15. Public Health England website. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/484874/Surveillance_of_Surgical_Site_Infections_in_NHS_Hospitals_in_England_report_2014-15.pdf. Published 2015. Accessed December 9, 2016.
21. Surveillance of surgical site infections in Europe 2010-2011.European Centre for Diseases prevention and Control website. http://ecdc.europa.eu/en/healthtopics/healthcare-associated_infections/surgical-site-infections/pages/ssi.aspx. Published 2013. Accessed December 9, 2016.
22. National and state healthcare-associated infections. Progress report. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Published 2016. Accessed December 9, 2016.
23. Mannien, J, van den Hof, S, Brandt, C, Behnke, M, Wille, JC, Gastmeier, P. Comparison of the national surgical site infection surveillance data between the Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007;66:224231.
24. Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilmoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:5157.
25. Huotari, K, Lyytikäinen, O. Impact of post-discharge surveillance on the rate of surgical site infection after orthopedic surgery. Infect Control Hosp Epidemiol 2006;27:13241329.
26. Manniën, J, Wille, JC, Snoeren, RLMM, van den Hof, S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in the Netherlands. Infect Control Hosp Epidemiol 2006;27:809816.
27. Reilly, J, Allardice, G, Bruce, J, Hill, R, McCoubrey, J. Procedure-specific surgical site infection rates and post-discharge surveillance in Scotland. Infect Control Hosp Epidemiol 2006;27:13181323.
28. Sands, K, Vineyard, G, Platt, R. Surgical site infections occuring after hospital discharge. J Infect Dis 1996;173:963970.
29. Whitby, M, McLaws, ML, Collopy, B, et al. Post-discharge surveillance: can patients reliably diagnose surgical wound infections? J Hosp Infect 2002;52:155160.
30. Gastmeier, P, Behnke, M. Electronic surveillance and using administrative data to identify healthcare associated infections. Curr Opin Infect Dis 2016;29:394399.
31. McNeish, J, Lyle, D, McCowan, M, et al. Post-discharge surgical site infection surveillance by automated telephony. J Hosp Infection 2007;66:232236.
32. Talbot, TR, Bratzler, DW, Carrico, RM, et al. Public reporting of health care-associated surveillance data: recommendations from the healthcare infection control practices advisory committee. Ann Intern Med 2013;159:631635.
33. Mc Coubrey, J, Reilly, J, Mullings, A, Pollock, KG, Johnston, F. Validation of surgical site infection surveillance data in Scotland. J Hosp Infect 2005;61:194200.
34. Manniën, J, van der Zeeuw, AE, Wille, JC, van der Hof, S. Validation of surgical site infection surveillance in the Netherlands. Infect Control Hosp Epidemiol 2007;28:3641.
35. Friedman, ND, Russo, PL, Bull, AL, Richards, MJ, Kelly, H. Validation of coronary artery bypass graft surgical site infection surveillance data from a statewide surveillance system in Australia. Infect Control Hosp Epidemiol 2007;28:812817.
36. Haley, VB, van Antwerown, C, Tserenpuntsag, B, et al. Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York state 2009–2010. Infect Control Hosp Epidemiol 2012;33:565571.
37. Birgand, G, Lepelletier, D, Baron, G, et al. Agreement among healthcare professionals in ten European countries in daignosing case-vignettes of surgical site infections. PLoS One 2013;8:e68618.
38. Brandt, C, Sohr, D, Behnke, M, Daschner, F, Rüden, H, Gastmeier, P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:13471351.
39. Astagneau, P, L’Hériteau, F, Daniel, F, et al. Reducing surgical site infection through a network: results from the French ISO-RAISIN surveillance system. J Hosp Infect 2009;72:127134.
40. Gastmeier, P, Sohr, G, Schwab, F, et al. Ten years of KISS: the most important requirements for success. J Hosp Infection 2008;70(Suppl 1):1116.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 11
Total number of PDF views: 128 *
Loading metrics...

Abstract views

Total abstract views: 963 *
Loading metrics...

* Views captured on Cambridge Core between 31st May 2017 - 26th May 2018. This data will be updated every 24 hours.