Validation of an algorithm for semiautomated surveillance to detect deep surgical site infections after primary total hip or knee arthroplasty—A multicenter study

AbstractObjective:Surveillance of healthcare-associated infections is often performed by manual chart review. Semiautomated surveillance may substantially reduce workload and subjective data interpretation. We assessed the validity of a previously published algorithm for semiautomated surveillance of deep surgical site infections (SSIs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Dutch hospitals. In addition, we explored the ability of a hospital to automatically select the patients under surveillance.Design:Multicenter retrospective cohort study.Methods:Hospitals identified patients who underwent THA or TKA either by procedure codes or by conventional surveillance. For these patients, routine care data regarding microbiology results, antibiotics, (re)admissions, and surgeries within 120 days following THA or TKA were extracted from electronic health records. Patient selection was compared with conventional surveillance and patients were retrospectively classified as low or high probability of having developed deep SSI by the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction were calculated and compared to conventional surveillance.Results:Of 9,554 extracted THA and TKA surgeries, 1,175 (12.3%) were revisions, and 8,378 primary surgeries remained for algorithm validation (95 deep SSIs, 1.1%). Sensitivity ranged from 93.6% to 100% and PPV ranged from 55.8% to 72.2%. Workload was reduced by ≥98%. Also, 2 SSIs (2.1%) missed by the algorithm were explained by flaws in data selection.Conclusions:This algorithm reliably detects patients with a high probability of having developed deep SSI after THA or TKA in Dutch hospitals. Our results provide essential information for successful implementation of semiautomated surveillance for deep SSIs after THA or TKA.

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Semiautomated Surveillance of Deep Surgical Site Infections After Primary Total Hip or Knee Arthroplasty

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.37 ◽

2017 ◽

Vol 38 (06) ◽

pp. 732-735 ◽

Cited By ~ 6

Author(s):

Meander E. Sips ◽

Marc J. M. Bonten ◽

Maaike S. M. van Mourik

Keyword(s):

Electronic Health Records ◽

Knee Arthroplasty ◽

Surgical Site Infections ◽

Routine Care ◽

Infect Control Hosp ◽

Health Records ◽

Total Hip ◽

Electronic Health

Manual surveillance of surgical site infections (SSIs) after total hip or knee arthroplasty is time-consuming and prone to error. Semiautomated surveillance based on routine care data extracted from electronic health records can retrospectively identify deep SSIs and substantially reduce workload while maintaining 100% sensitivity.Infect Control Hosp Epidemiol2017;38:732–735

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Reporting Surgical Site Infections Following Primary and Revision Hip Arthroplasty— One Size Does Not Fit All

Infection Control and Hospital Epidemiology ◽

10.1086/658912 ◽

2011 ◽

Vol 32 (3) ◽

pp. 296-297 ◽

Cited By ~ 4

Author(s):

LJ Worth ◽

AL Bull ◽

MJ Richards

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Risk Index ◽

Surgical Site Infections ◽

Revision Hip Arthroplasty ◽

Total Hip ◽

Clinical Phenomenon ◽

Using Data ◽

Healthcare Associated ◽

Current Risk

The risk of surgical site infection (SSI) is greater after revision hip arthroplasty than after primary procedures. While this is accepted as a clinical phenomenon, standardized surveillance strategies for healthcare-associated infections, including SSIs, do not currently take this into consideration. Most notably, the National Nosocomial Infections Surveillance (NNIS) risk index for stratification does not differentiate between primary and revision surgeries. Using data from a single US center, Leekha et al. recently demonstrated that the risk for SSI was almost twice as high after revision total hip arthroplasty when compared to primary total hip arthroplasty and that risk was even greater when deep incisional or organ/space infections were analyzed. The objective of this study was to compare SSI rates following primary and revision hip arthroplasty in a much larger Australian population to determine whether differences are accounted for by current risk indexing.

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Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty

American Journal of Infection Control ◽

10.1016/j.ajic.2005.05.008 ◽

2005 ◽

Vol 33 (8) ◽

pp. 455-462 ◽

Cited By ~ 30

Author(s):

Frank Huenger ◽

Adriane Schmachtenberg ◽

Helga Haefner ◽

Dirk Zolldann ◽

Katharina Nowicki ◽

...

Keyword(s):

Knee Arthroplasty ◽

Surgical Site Infections ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Relationship Between Staphylococcus aureus Carriage and Surgical Site Infections Following Total Hip and Knee Arthroplasty in the South Asian Population: Protocol for a Prospective Cohort Study (Preprint)

10.2196/preprints.10219 ◽

2018 ◽

Author(s):

Syed H Mufarrih ◽

Nada Q Qureshi ◽

Anum Sadruddin ◽

Pervaiz Hashmi ◽

Syed Faisal Mahmood ◽

...

Keyword(s):

South Asian ◽

Knee Arthroplasty ◽

Surgical Site Infections ◽

Asian Population ◽

University Hospital ◽

The South ◽

South Asian Population ◽

Methicillin Resistant ◽

Total Hip ◽

Hip And Knee Arthroplasty

BACKGROUND Surgical site infections following total hip or knee arthroplasties have a reported rate of 0.49%-2.5% and can cause significant morbidity as well as tripling the cost of health care expenses. Both methicillin sensitive and methicillin resistant strains of Staphylococcus aureus surgical site infections have been established as a major risk factor for postoperative surgical site infections. S. aureus colonizes the nose, axillae, and perineal region in up to 20%-30% of individuals. Although the literature has reported a higher prevalence of methicillin resistant S. aureus in the South Asian population, routine preoperative screening and prophylaxis have not yet been implemented. OBJECTIVE The primary objective of our study is to identify the relationship between preoperative colonization status of S. aureus and incidence of postoperative surgical site infections in patients undergoing following total hip and knee arthroplasties. As part of the secondary objectives of this study, we will also investigate patient characteristics acting as risk factors for S. aureus colonization as well as the outcomes of total hip and knee arthroplasty patients which are affected by surgical site infections. METHODS This prospective cohort study will comprise of screening all patients older than 18 years of age admitted to the Aga Khan University Hospital for a primary total hip or knee arthroplasty for preoperative colonization with S. aureus. The patients will be followed postoperatively for up to one year following the surgery to assess the incidence of surgical site infections. The study duration will be 2 years (March 2018 to March 2020). For the purpose of screening, pooled swabs will be taken from the nose, axillae, and groin of each patient and inoculated in a brain heart infusion, followed by subculture onto mannitol salt agar and sheep blood agar. For methicillin resistant S. aureus identification, a cefoxitin disk screen will be done. Data will be analyzed using SPSS v23 and both univariate and multivariate regression analysis will be conducted. RESULTS Data collection for this study will commence at the Aga Khan University Hospital, Pakistan during March 2018. CONCLUSIONS This study will not only estimate the true burden caused by S. aureus in the population under study but will also help identify the patients at a high risk of surgical site infections so that appropriate interventions, including prophylaxis with antibiotics such as muciprocin ointment or linezolid, can be made. Given the differences in lifestyle, quality, and affordability of health care and the geographical variation in patterns of antibiotic resistance, this study will contribute significantly to providing incentive for routine screening and prophylaxis for S. aureus including methicillin resistant S. aureus colonization in the South Asian population. REGISTERED REPORT IDENTIFIER RR1-10.2196/10219

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Targeted infection control practices lower the incidence of surgical site infections following total hip and knee arthroplasty in an Indian tertiary hospital

Journal of Patient Safety & Infection Control ◽

10.4103/jpsic.jpsic_6_19 ◽

2019 ◽

Vol 7 (1) ◽

pp. 20

Author(s):

RameshReddy Allam ◽

Guda Vaishnavi ◽

AV Gurava Reddy ◽

Dinaker Manjunath ◽

Ganesh Oruganti

Keyword(s):

Infection Control ◽

Knee Arthroplasty ◽

Surgical Site Infections ◽

Tertiary Hospital ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.86 ◽

2016 ◽

Vol 37 (8) ◽

pp. 991-993 ◽

Cited By ~ 7

Author(s):

Luciana B. Perdiz ◽

Deborah S. Yokoe ◽

Guilherme H. Furtado ◽

Eduardo A. S. Medeiros

Keyword(s):

Retrospective Study ◽

Surgical Site Infection ◽

Knee Arthroplasty ◽

Surgical Site Infections ◽

Infect Control Hosp ◽

Site Infection ◽

Total Hip ◽

Routine Surveillance ◽

Hip And Knee Arthroplasty ◽

Automated Surveillance

In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty.Infect Control Hosp Epidemiol 2016;37:991–993

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