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J Hosp Infect. 2018 Dec 7. pii: S0195-6701(18)30680-7. doi: 10.1016/j.jhin.2018.12.003. [Epub ahead of print]

Impact of participation in a surgical site infection surveillance network: results from a large international cohort study.

Author information

1
Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: mohamed.abbas@hcuge.ch.
2
Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
3
Swiss RDL, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Schulthess Klinik, Zürich, Switzerland.
4
Reference Centre for Prevention and Control of Healthcare-associated Infections, APHP University Hospital, Paris, France.
5
Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France.
6
Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany.
7
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia.
8
Division of Infectious Diseases, Office of Infection Control, Ewha Woman's University Medical Center, Seoul, Republic of Korea.
9
National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands.
10
National Infection Service, Public Health England, London, UK.
11
Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK.
12
VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain.
13
Norwegian Institute of Public Health, Department of Infectious Disease Epidemiology, Oslo, Norway.
14
Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland.
15
Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
16
Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia.
17
Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia.
18
National Center for Epidemiology, Budapest, Hungary.
19
Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria.
20
VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
21
Healthcare Associated Infection, Antimicrobial Resistance, Decontamination and Infection Control Group, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK; Safeguarding Health Through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK.
22
Hospital Universitari de Bellvitge, Barcelona, Spain.
23
National Public Health and Medical Officer Service, Budapest, Hungary.
24
Swissnoso, National Center for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospital, Sion, Switzerland.
25
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale.

AIM:

To determine the time-trend of SSI rates in surveillance networks.

METHODS:

SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept.

FINDINGS:

Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis.

CONCLUSION:

In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.

KEYWORDS:

Epidemiology; Healthcare-associated infection; Infection control; Surgical site infection; Surveillance; Surveillance networks

PMID:
30529703
DOI:
10.1016/j.jhin.2018.12.003

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