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

M Abbas; M E A de Kraker; E Aghayev; P Astagneau; M Aupee; M Behnke; A Bull; H J Choi; S C de Greeff; S Elgohari; P Gastmeier; W Harrison; M B G Koek; T Lamagni; E Limon; H L Løwer; O Lyytikäinen; K Marimuthu; J Marquess; R McCann; I Prantner; E Presterl; M Pujol; J Reilly; C Roberts; L Segagni Lusignani; D Si; E Szilágyi; J Tanguy; S Tempone; N Troillet; L J Worth; D Pittet; S Harbarth

doi:10.1016/j.jhin.2018.12.003

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

J Hosp Infect. 2019 Jul;102(3):267-276. doi: 10.1016/j.jhin.2018.12.003. Epub 2018 Dec 7.

Authors

M Abbas¹, M E A de Kraker², E Aghayev³, P Astagneau⁴, M Aupee⁵, M Behnke⁶, A Bull⁷, H J Choi⁸, S C de Greeff⁹, S Elgohari¹⁰, P Gastmeier⁶, W Harrison¹¹, M B G Koek⁹, T Lamagni¹⁰, E Limon¹², H L Løwer¹³, O Lyytikäinen¹⁴, K Marimuthu¹⁵, J Marquess¹⁶, R McCann¹⁷, I Prantner¹⁸, E Presterl¹⁹, M Pujol²⁰, J Reilly²¹, C Roberts¹¹, L Segagni Lusignani²², D Si¹⁶, E Szilágyi²³, J Tanguy⁵, S Tempone¹⁷, N Troillet²⁴, L J Worth²⁵, D Pittet², S Harbarth²

Affiliations

¹ Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: [email protected].
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.

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

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.

MeSH terms

Asia / epidemiology
Australia / epidemiology
Epidemiological Monitoring*
Europe / epidemiology
Humans
Incidence
Infection Control / methods*
International Cooperation*
Retrospective Studies
Surgical Wound Infection / epidemiology*
Surgical Wound Infection / prevention & control*