Surveillance for Surgical Site Infection After Hospital Discharge: A Surgical Procedure–Specific Perspective

Objective.To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program.Design.Prospective surveillance study.Setting.A surgical ward at a university teaching hospital in Italy.Patients.A total of 264 surgical patients were included in the study.Results.The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (±SD) for patients who acquired a postdischarge SSI was 4.9 ± 3.7 days, and SSI was diagnosed a mean duration (±SD) of 11.5 ± 4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher.Conclusions.Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.

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

Infection Control and Hospital Epidemiology ◽

10.1086/509839 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1318-1323 ◽

Cited By ~ 58

Author(s):

J. Reilly ◽

G. Allardice ◽

J. Bruce ◽

R. Hill ◽

J. McCoubrey

Keyword(s):

Length Of Stay ◽

Cesarean Section ◽

Surgical Site Infection ◽

Acute Care ◽

Direct Observation ◽

Surgical Procedures ◽

Breast Surgery ◽

Risk Index ◽

Site Infection ◽

Procedure Type

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.

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Self-reported beta-lactam allergy and the risk of surgical site infection: A retrospective cohort study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.374 ◽

2020 ◽

Vol 41 (4) ◽

pp. 438-443 ◽

Cited By ~ 1

Author(s):

Philip W. Lam ◽

Payam Tarighi ◽

Marion Elligsen ◽

Keith Gunaratne ◽

Avery B. Nathens ◽

...

Keyword(s):

Cohort Study ◽

Surgical Site Infection ◽

Surgical Procedures ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Tertiary Care ◽

Site Infection ◽

Improvement Program ◽

Increased Risk ◽

To Receive

AbstractObjective:To assess whether a self-reported β-lactam allergy is associated with an increased risk of surgical site infection (SSI) across a broad range of procedures and to determine whether this association is mediated by the receipt of an alternate antibiotic to cefazolin.Design:Retrospective cohort study.Participants:Surgical procedures sampled by an institutional National Surgical Quality Improvement Program database over an 18-month period (January 2017 to June 2018) from 7 surgical specialties.Setting:Tertiary-care academic hospital.Results:Of the 3,589 surgical procedures included in the study, 369 (10.3%) were performed in patients with a reported β-lactam allergy. Those with a reported β-lactam allergy were significantly less likely to receive cefazolin (38.8% vs 95.5%) or metronidazole (20.3% vs 26.1%) and were more likely to receive clindamycin (52.0% vs 0.2%), gentamicin (3.5% vs 0%), or vancomycin (2.2% vs 0.1%) than those without allergy. An SSI occurred in 154 of 3,220 procedures (4.8%) in patients without reported allergy and 27 of 369 (7.3%) with reported allergy. In the multivariable regression model, a reported β-lactam allergy was associated with a statistically significant increase in SSI risk (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04–2.51; P = .03). This effect was completely mediated by receipt of an alternate antibiotic to cefazolin (indirect effect aOR, 1.68; 95% CI, 1.17–2.34; P = .005).Conclusions:Self-reported β-lactam allergy was associated with an increased SSI risk mediated through receipt of alternate antibiotic prophylaxis. Safely increasing use of cefazolin prophylaxis in patients with reported β-lactam allergy can potentially lower the risk of SSIs.

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Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

Infection Control and Hospital Epidemiology ◽

10.1086/587810 ◽

2008 ◽

Vol 29 (6) ◽

pp. 477-484 ◽

Cited By ~ 103

Author(s):

Margaret A. Olsen ◽

Anne M. Butler ◽

Denise M. Willers ◽

Preetishma Devkota ◽

Gilad A. Gross ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

University Teaching ◽

Skin Closure ◽

Care Hospital ◽

Site Infection ◽

Increased Risk ◽

Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

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New risk index can identify elderly people at increased risk for death within a year after hospital discharge

PsycEXTRA Dataset ◽

10.1037/e556692006-006 ◽

2001 ◽

Keyword(s):

Elderly People ◽

Hospital Discharge ◽

Risk Index ◽

Increased Risk

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Clinico-Surgical Factors Affecting Surgical Site Infection in Colorectal Surgical Procedures

International Journal of Clinical and Experimental Medicine Research ◽

10.26855/ijcemr.2018.04.002 ◽

2018 ◽

Vol 2 (4) ◽

Keyword(s):

Surgical Site Infection ◽

Surgical Procedures ◽

Site Infection ◽

Factors Affecting

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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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Feasibility and diagnostic accuracy of Telephone Administration of an adapted wound heaLing QuestiONnaire for assessment for surgical site infection following abdominal surgery in low and middle-income countries (TALON): protocol for a study within a trial (SWAT)

Trials ◽

10.1186/s13063-021-05398-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

◽

James Glasbey ◽

Victoria Adeyeye ◽

Adesoji Ademuyiwa ◽

Alisha Bhatt ◽

...

Keyword(s):

Wound Healing ◽

Abdominal Surgery ◽

Diagnostic Accuracy ◽

Surgical Site Infection ◽

Hospital Discharge ◽

Site Infection ◽

Middle Income ◽

Middle Income Countries ◽

Wound Assessment ◽

Study Within A Trial

Abstract Background Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs). Methods A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies. Discussion Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.

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