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Procedure-Specific Surgical Site Infection Rates and Postdischarge Surveillance in Scotland

Published online by Cambridge University Press:  21 June 2016

J. Reilly ,
G. Allardice ,
J. Bruce ,
R. Hill  and
J. McCoubrey
J. Reilly*
Affiliation:
Health Protection Scotland, University of Strathclyde, Glasgow, United Kingdom
G. Allardice
Affiliation:
Department of Statistics & Modelling Science, University of Strathclyde, Glasgow, United Kingdom
J. Bruce
Affiliation:
Department of Public Health, University of Aberdeen, Aberdeen, United Kingdom
R. Hill
Affiliation:
Health Protection Scotland, University of Strathclyde, Glasgow, United Kingdom
J. McCoubrey
Affiliation:
Health Protection Scotland, University of Strathclyde, Glasgow, United Kingdom
*
HAI and Infection Control, Health Protection Scotland, 1 Cadogan Square, 3rd Floor, Glasgow G2 7HF, United Kingdom ([email protected])
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Abstract

Objective.

To investigate the impact of postdischarge surveillance (PDS) on surgical-site infection (SSI) rates for selected surgical procedures in acute care hospitals in Scotland.

Design.

Prospective surveillance of SSI after selected surgical procedures.

Setting.

The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP), which is based on the methodology of the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance system (NNIS). Thirty-two of 46 acute care hospitals throughout Scotland contributed data to SSHAIP for this study.

Methods.

Data were from 21,710 operations that took place between April 1, 2002, and June 30, 2004; nine categories of surgical procedures were analyzed. CDC NNIS system definitions and methods were used for SSI PDS. PDS is a voluntary component of the mandatory SSI surveillance program in Scotland. PDS was categorized as none, passive, active without direct observation, and active with direct observation.

Results.

From our study information, PDS data were available for 12,885 operations (59%). A total of 2,793 procedures (13%) were associated with passive PDS and 10,092 (46%) with active PDS. The SSI rate among the 8,825 operations with no PDS was 2.61% (95% confidence interval [CI], 2.3%-3.0%), which was significantly lower than the SSI rate found among the 12,885 operations for which PDS was performed (6.34% [95% CI, 5.9%-6.8%]). For breast surgery, cesarean section, hip replacement, and abdominal hysterectomy, the rate of SSI when PDS was performed was significantly higher than that when PDS was not performed (P< .01 for each procedure). No differences in SSI rates were found for surgery to repair fractured neck of the femur or for knee replacement. SSI rates were examined according to procedure type, performance of PDS, and NNIS risk index; rates of SSI increased with NNIS risk index within procedure group and PDS group. Logistic regression analyses confirmed that procedure type, performance of PDS, and NNIS risk index were all statistically independent predictors of report of an SSI (P< .05).

Conclusions.

This Scottish national data set incorporates a substantial amount of PDS data. We recommend a procedure-specific approach to PDS, with direct observation of patients after breast surgery, cesarean section, and hysterectomy, for which the length of stay is typically short. Readmission surveillance may be adequate to detect most SSIs after orthopedic surgery or vascular surgery, for which the length of stay is typically longer.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1318 - 1323
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Reilly, J, Twaddle, S, McIntosh, J, Kean, L. An economic analysis of surgical wound infection. J Hosp Infect 2001; 49:245–249.Google Scholar
2. Plowman, R, Graves, N, Griffin, M, et al. The Socioeconomic Burden of Hospital Acquired Infection. London: Public Health Laboratory Service; 1999.Google Scholar
3. Health Department Letter (HDL). A framework for national surveillance of HAI infection in Scotland. Scottish Executive 2001; HDL57.Google Scholar
4. Bruce, J, Russell, EM, Mollison, J, Krukowski, ZH. The quality of measurement of surgical wound infection as the basis for monitoring: a systematic review. J Hosp Infect 2001; 49:99–108.Google Scholar
5. Reilly, J, Ward, V, Crawshaw, S, et al. A UK approach to post discharge surveillance: exploring the decision making process. In: Poster presented at: 5th International Conference of the Hospital Infection Society; September 2002; London.Google Scholar
6. McCoubrey, J, Reilly, J, Mullings, A, et al. Validation of surgical site infection surveillance data in Scotland. J Hosp Infect 2005; 61:194–200.CrossRefGoogle ScholarPubMed
7. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infection: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13:606–608.Google Scholar
8. Stata [computer program]. Release 7.0. College Station, TX: Stata; 2001.Google Scholar
9. Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Boriello, P. Adverse impact of surgical site infection in English hospitals. J Hosp Infect 2005; 60:93–103.Google Scholar
10. Geubbels, EL, Mintjes-de Groot, AJ, van den Berg, JM, de Boer, AS. 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.CrossRefGoogle ScholarPubMed
11. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470–485.CrossRefGoogle Scholar
12. 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
13. Mertens, R, van den Berg, JM, Veerman-Brenzikofer, ML, Kurtz, X, Jans, B, Klazinga, N. International comparison of results. Infect Control Hosp Epidemiol 1994; 9:574–578.CrossRefGoogle Scholar
14. 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. Aust N Z J Surg 2001; 71:583–589.CrossRefGoogle Scholar
15. Gravel-Tropper, D, Oxley, C, Memish, Z, Garber, GE. Underestimation of surgical site infection rates in obstetrics and gynecology. Am J Infect Control 1995; 23:22–26.Google Scholar
16. Santos, KR, Bravo Neto, GP, Fonseca, LS, Gontijo Filho, PP. Incidence surveillance of wound infection in hernia surgery during hospitalization and after discharge in a university hospital. J Hosp Infect 1997; 36:229–233.Google Scholar
17. Lecuona, M, Torres-Lana, A, Delgado-Rodriquez, M, Llorca, J, Sierra, A. Risk factors for surgical site infections diagnosed after hospital discharge. J Hosp Infect 1998; 39:71–74.Google Scholar
18. 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
19. 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.CrossRefGoogle ScholarPubMed
20. Taylor, EW, Duffy, K, Lee, K, et al. Telephone call contact for post-discharge surveillance of surgical site infections: a pilot, methodological study. J Hosp Infect 2003; 55:8–13.Google Scholar
21. Reilly, J, Noone, A, Clift, A, et al. A study of telephone screening and direct observation of surgical wound infections after discharge from hospital. J Bone Joint Surg Br 2005; 87-B:997–999.CrossRefGoogle Scholar