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Rates of Surgical-Site Infection: An International Comparison

Published online by Cambridge University Press:  21 June 2016

Maria Luisa Moro ,
Filomena Morsillo ,
Marilena Tangenti ,
Maria Mongardi ,
Maria Cristina Pirazzini ,
Pietro Ragni  and
ICN Regional Group
Maria Luisa Moro*
Affiliation:
Agenzia Sanitaria Regione Emilia Romagna, Area di Programma Rischio Infettivo, Bologna, Italy
Filomena Morsillo
Affiliation:
Agenzia Sanitaria Regione Emilia Romagna, Area di Programma Rischio Infettivo, Bologna, Italy
Marilena Tangenti
Affiliation:
Presidio Ospedaliero Maggiore-Bellaria, Azienda USL Cittá di Bologna, Bologna, Italy
Maria Mongardi
Affiliation:
Agenzia Sanitaria Regione Emilia Romagna, Area di Programma Rischio Infettivo, Bologna, Italy
Maria Cristina Pirazzini
Affiliation:
Distretto Territoriale di Porretta, Azienda USL di Bologna, Bologna, Italy
Pietro Ragni
Affiliation:
Azienda USL Reggio Emilia, Reggio Emilia, Italy
*
Agenzia Sanitaria Regione Emilia Romagna, Area di Programma Rischio Infettivo, Viale Aldo Moro 21, 40127 Bologna, Italy[email protected]
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Abstract

Objectives:

To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison.

Design:

Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation.

Results:

Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9–3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ–space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population.

Conclusions:

The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 442 - 448
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine; 2000.Google Scholar
2.Gaynes, RP, Culver, DH, Horan, TC, et al. 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:S69–S77.CrossRefGoogle ScholarPubMed
3.Nosocomial Infection National Surveillance Scheme. Surveillance of Surgical Site Infections in English Hospitals, 1997-1999. London: Public Health Laboratory Service; 2000.Google Scholar
4.Astagneau, P, Rioux, C, Golliot, F, Bruker, G, for the INCISO Network Study Group. Morbidity and mortality associated with surgical site infections: results from the 1997-1999 INCISO surveillance. J Hosp Infect 2001;48:267–274.Google Scholar
5.Gulacsi, L, Tatar Kiss, ZS, Goldmann, DA, Huskins, WC. Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes. J Hosp Infect 2000;44:43–52.Google Scholar
6.Geubbels, E, Minties-de Groot, J, van den Berg, JMJ, de Boer, A. 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.Google Scholar
7.Ronveaux, O, Mertens, R, Dupont, Y. Surgical wound infection surveillance: results from the Belgian hospital network. Acta Chir Belg 1996;96:1–2.Google Scholar
8.Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
9.Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Centers for Disease Control, Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:559–605.Google Scholar
10.Hospitals in Europe Link for Infection Control through Surveillance (HELICS). Hospitals in Europe Link for Infection Control through Surveillance (HELICS) Protocol: Surgical Wound Infection Surveillance. Brussels: Institute of Hygiene and Epidemiology; 1994.Google Scholar
11.Greco, D, Moro, ML, Tozzi, AE, De Giacomi, GV. Effectiveness of an intervention program in reducing postoperative infections. Am J Med 1991;91 (suppl 3B):164S–169S.Google Scholar
12.Moro, ML, Carrieri, MP, Tozzi, AE, Lana, S, Greco, D, the Italian PRI-NOS Study Group. Risk factors for surgical wound infections in clean surgery: a multicenter study. Annali Italiani di Chirurgia 1996;1:13–19.Google Scholar
13.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988:16:128–140.Google Scholar
14.Vacanti, CJ, van Houten, RJ, Hill, RC. A statistical analysis of the relationship between physical status to postoperative mortality in 68,388 cases. Anesth Analg 1970;49:564–566.Google Scholar
15.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TC. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
16.Centers for Disease Control and Prevention. NNIS Manual. Atlanta, GA: Centers for Disease Control and Prevention, Department of Health and Human Services; 1994:XI3–XI7.Google Scholar
17.Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York: John Wiley & Sons; 1989.Google Scholar
18.Holtz, TH, Wenzel, RP. Post-discharge surveillance for nosocomial wound infections: a brief review and commentary. Am J Infect Control 1992;20:206–213.CrossRefGoogle Scholar
19.Richards, C, Emori, TG, Edwards, J, Fridkin, S, Tolson, J, Gaynes, R. Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29:400–403.CrossRefGoogle ScholarPubMed
20.Gaynes, RP. Surveillance of surgical-site infections: the world coming together? Infect Control Hosp Epidemiol 2000;21:309–310.Google Scholar