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

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

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891. Is Post-discharge Surveillance of Surgical Patients Really Worth It? Results Observed in Three Years of a Multicenter Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1079 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S479-S481

Author(s):

Rafaela Tonholli Pinho ◽

Luciana Coelho Tanure ◽

Joice Ribeiro Lopes ◽

Bárbara Caldeira Pires ◽

Flávio Henrique Batista de Souza ◽

...

Keyword(s):

Surgical Site Infection ◽

Infection Rate ◽

Tertiary Care ◽

Patient Discharge ◽

Surgical Patient ◽

Surveillance Program ◽

Site Infection ◽

Infection Rates ◽

Post Discharge ◽

Belo Horizonte

Abstract Background Surgical site infections (SSIs) can account for 25% of all nosocomial infections and contribute significantly to the economic burden resulting from infectious complications. To control this problem, an active surveillance program with the feedback of SSI rates to surgeons can reduce subsequent rates by up to 40%, since 19% to 65% of these infections are diagnosed after patient discharge. However, there is no standard method for conducting surveillance outside the hospital and the best methodology is still unknown. For many hospitals, SSI surveillance has three main objectives: to feedback surgeons with their SSI rates; to evaluate SSI rates over time, identifying outbreaks; and to compare data among different institutions. This study aims to answer the crucial question: is surveillance after patient discharge worthwhile? Methods Prospective surveillance according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC) at Hospital Lifecenter, Hospital Madre Teresa and Hospital Universitário Ciências Médicas, tertiary care centers, which serve the metropolitan area of Belo Horizonte, Brazil. The data were collected between Jan/2017 and Dec/2019. Results In almost three years of study, the infection rate data were calculated with and without surveillance. The monthly analysis by clinic showed that the inclusion of post-discharge patients in the computed rates increases its value, but not significantly. Of 22.009 patients analyzed, in Lifecenter Hospital, 229(1%) had SSI. This percentage refers to the infection rate with the post-discharge survey, while the rate of surgical infection without vigilance corresponds to 202(0,9%) (Table 1). The surveillance for Madre Teresa, those numbers were: 29.770, 382(1,3%) and 351(1,2%), respectively (Table 2). In Hospital Universitário Ciências Médicas: 20.286, 447 (2,2%) and 215(1,1%) (Table 3). Table 1 - Surgical site infection: data with and without post-discharge surveillance. Hospital Lifecenter (Jan/ 2017 to Jul/2019): month-by-month analysis. Table 2 - Surgical site infection: data with and without post-discharge surveillance. Hospital Madre Teresa (Jan/ 2017 to Dec/2019): month-by-month analysis. Table 3 - Surgical site infection: data with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/ 2017 to Dec/2019): month-by-month analysis. Conclusion SSI post-discharge surveillance is indicated only for specific procedures. However, once the endemic curve with the infection rate did not change with the inclusion of post-discharge SSI, the study strongly suggests that surveillance after the discharge of the surgical patient is not necessary. Graph 1 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Lifecenter (Jan/2017 to Jul/2019): endemic curve. Graph 2 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Madre Teresa (Jan/2017 to Jul/2019): endemic curve. Graph 3 - Surgical site infection: rate with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/2017 to Jul/2019): endemic curve. Disclosures All Authors: No reported disclosures

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Evaluation of underreported surgical site infection evidenced by post-discharge surveillance

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692007000500017 ◽

2007 ◽

Vol 15 (5) ◽

pp. 992-997 ◽

Cited By ~ 6

Author(s):

Adriana Cristina de Oliveira ◽

Daclé Vilma Carvalho

Keyword(s):

Prospective Study ◽

Surgical Site Infection ◽

Digestive System ◽

Site Infection ◽

Post Discharge ◽

General Hospitals ◽

Infection Incidence ◽

Surgical Site Infection Incidence ◽

Digestive System Surgery ◽

The Impact

The Surgical Site Infection (SSI) has been pointed as one of the most important infection sites. This study aimed to determine the surgical site infection incidence during hospitalization and the impact of notification after discharge through two methods. This prospective study was carried out in the digestive system surgery service (DSS) of two general hospitals of São Paulo, in the period from August, 2001 to March, 2002. Incidence levels of 6.7% and 4.5% were notified in the institutions A and B respectively. The incidence of SSI after discharge in the institution A was 27% and 13.4% in the institution B. Surveillance after discharge evidenced global rates of 33.7% and 17.9% for institutions A and B respectively. The rates of infection increased 5.02 and 3.98 times respectively in institutions A and B.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.202 ◽

2017 ◽

Vol 38 (11) ◽

pp. 1389-1389

Keyword(s):

Surgical Site Infection ◽

Surveillance Program ◽

Site Infection ◽

Infection Surveillance ◽

First Results

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Cerebrospinal Fluid Shunt-Associated Surgical Site Infection With Three- Versus Twelve-Month Follow-Up in Canadian Hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.679 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s157-s157

Author(s):

Kelly Baekyung Choi ◽

John Conly ◽

Blanda Chow ◽

Joanne Embree ◽

Bonita Lee ◽

...

Keyword(s):

Surgical Site Infection ◽

Age Distribution ◽

Patient Characteristics ◽

Csf Shunt ◽

Surveillance Program ◽

Site Infection ◽

Infection Surveillance ◽

Surgical Manipulation ◽

National Systems

Background: Surgical site infection (SSI) after cerebrospinal fluids (CSF) shunt surgery is thought to be acquired intraoperatively. Biomaterial-associated infection can present up to 1 year after surgery, but many national systems have shortened follow-up to 90 days. We compared 3- versus 12-month follow-up periods to determine the nature of case ascertainment in the 2 periods. Methods: Participants of any age with placement of an internal CSF shunt or revision surgical manipulation of an existing internal shunt identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) participating hospitals between 2006 and 2018 were eligible. We excluded patients with external shunting devices or culture-positive CSF at the time of surgery. Patients were followed for 12 months after surgery for the primary outcome of a CSF infection with a positive CSF culture by review of laboratory and health records. Patients were categorized as adult (aged ≥18 years) or pediatric (aged < 18 years). The infection rate was expressed as the number of CSF shunt-associated infections divided by the number of shunt surgeries per 100 procedures. Results: In total, 325 patients (53% female) met inclusion criteria in 14 hospitals from 7 provinces were identified. Overall, 46.1% of surgeries were shunt revisions and 90.3% of shunts were ventriculoperitoneal. For pediatric patients, the median age was 0.7 years (IQR, 0.2–7.0). For adult patients, the median age was 47.9 years (IQR, 29.6–64.6). The SSI rates per 100 procedures were 3.69 for adults and 3.65 for pediatrics. The overall SSI rates per 100 procedures at 3 and 12 months were 2.74 (n = 265) and 3.48 (n = 323), respectively. By 3 months (90 days), 82% of infection cases were identified (Fig. 1). The median time from procedure to SSI detection was 30 days (IQR, 10–65). No difference was found in the microbiology of the shunt infections at 3- and 12-month follow-ups. The most common pathogens were coagulase-negative Staphylococcus (43.6 %), followed by S. aureus (24.8 %) and Propionibacterium spp (6.5 %). No differences in age distribution, gender, surgery type (new or revision), shunt type, or infecting organisms were observed when 3- and 12-month periods were compared. Conclusions: CSF-SSI surveillance for 3 versus 12 months would capture 82.0% (95% CI, 77.5–86.0) of cases, with no significant differences in the patient characteristics, surgery types, or pathogens. A 3-month follow-up can reduce resources and allow for more timely reporting of infection rates.Funding: NoneDisclosures: None

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58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

British Journal of Surgery ◽

10.1093/bjs/znab134.356 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Mistry ◽

B Woolner ◽

A John

Keyword(s):

Surgical Site Infection ◽

Open Cholecystectomy ◽

Surgical Site Infections ◽

Standard Operating Procedure ◽

Site Infection ◽

Infection Rates ◽

Local Evidence ◽

Audit Data ◽

The Impact ◽

To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

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Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region

Microorganisms ◽

10.3390/microorganisms9040743 ◽

2021 ◽

Vol 9 (4) ◽

pp. 743

Author(s):

Blenda Gonçalves Cabral ◽

Danielle Murici Brasiliense ◽

Ismari Perini Furlaneto ◽

Yan Corrêa Rodrigues ◽

Karla Valéria Batista Lima

Keyword(s):

Caesarean Section ◽

Surgical Site Infection ◽

Carbapenem Resistance ◽

Brazilian Amazon ◽

Amazon Region ◽

Site Infection ◽

Acinetobacter Species ◽

Brazilian Amazon Region ◽

Acinetobacter Spp ◽

The Impact

Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.

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The impact of copper impregnated wound dressings on surgical site infection following caesarean section: A double blind randomised controlled study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.534 ◽

2019 ◽

Vol 234 ◽

pp. e171 ◽

Cited By ~ 1

Author(s):

Linda Arendsen ◽

Ranee Thakar ◽

Abdul Sultan

Keyword(s):

Caesarean Section ◽

Surgical Site Infection ◽

Wound Dressings ◽

Controlled Study ◽

Site Infection ◽

Double Blind ◽

Randomised Controlled Study ◽

Randomised Controlled ◽

The Impact

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Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3933-y ◽

2014 ◽

Vol 473 (5) ◽

pp. 1612-1619 ◽

Cited By ~ 40

Author(s):

Sjoerd P. F. T. Nota ◽

Yvonne Braun ◽

David Ring ◽

Joseph H. Schwab

Keyword(s):

Surgical Site Infection ◽

Spine Surgery ◽

Site Infection ◽

Definition Of ◽

The Impact

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Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

Journal of Perioperative Practice ◽

10.1177/1750458919850727 ◽

2019 ◽

Vol 30 (1-2) ◽

pp. 24-33

Author(s):

Theresa Mangold ◽

Erin Kinzel Hamilton ◽

Helen Boehm Johnson ◽

Rene Perez

Keyword(s):

Treatment Group ◽

Surgical Site Infection ◽

Infection Rate ◽

Caesarean Delivery ◽

Chlorhexidine Gluconate ◽

Control Group ◽

Antibiotic Administration ◽

Site Infection ◽

Infection Rates ◽

The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

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