Surveillance of surgical site infections Petra Gastmeier Hanover Medical University German National

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Surveillance of surgical site infectionsPetra
GastmeierHanover Medical University German
National Center Reference for Surveillance of
Nosocomial Infections
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To convince surgeons ...

• They do not have a problem
• They do not observe any wound infections
• They do not need any help
• .... therefore data are needed

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Quality management
4. Evaluation
3. Intervention
Patient
1. Surveillance
2. Analysis
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Data for benchmarking are needed
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Germany
http//www.nrz-hygiene.de
Krankenhaus-Infektions-Surveillance-System (KISS)
Surveillance component for SSI since 1997
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Reduction of SSI rates in KISS ?

• Inclusion criteria
• Surgical departments
• with having had at least 4 years of ongoing
  participation (between 1997 and June 2004) and
• with at least 30 operations per year registered
  for the operative procedure category in
  question.
• 130 departments from 86 hospitals met the
  inclusion crieria

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Data analyzed(only procedures with at least 15
departments participating)
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Univariate analysis

• The SSI rates of all participating departments
  were calculated for each year of surveillance
  and for each operative procedure category
  taking into account the beginning of
  participation by each department

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KISS (D) Pooled SSI rates according to the year
of participation in the surveillance system
RR 0.75 (CI95 0.68-0.82)
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(n 119 114 Operations from 130 departments
Brandt, C. ICHE 2006
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Multivariate analysis

• The variables available for KISS were considered
  to be possible confounders
• Gender
• Age
• NNIS risk index categories
• Fully endoscopically performed operations
• The departments yearly frequency of the
  operative procedure under question
• Year of participation in the surveillance system
• ? adjusted Odds ratios

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Adjusted Odds ratios (only procedures with at
least 15 departments participating)
Brandt, C. ICHE 2006
Only significant results are shown (plt 0.05)
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Adjusted Odds ratios (only procedures with at
least 15 departments participating)
Only significant results are shown (plt 0.05)
Brandt, C. ICHE 2006
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Reduction on the level of the individual
department
Departments with a baseline rate gt median
All departments
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Netherlands
http//www.prezies.nl
PREventie van ZIEkenhiusinfecties door
Surveillance (PREZIES)
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PREZIES (NL) Relative risk for SSI in
comparison to the 1st year of participation
-31
-57
(n 21.920 operations from 37 participants)
Guebbels et al. Int J Quality in Health Care,
2006 18 127-33
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European countries with a national SSI
surveillance system
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Websites of European nosocomial infection
surveillance systems
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SSI Surveillance Networks in Europe
SSI Report 2004
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Variability of methods
HELICS IMPLEMENTATION Phase II, Final Report 2005
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Hospitals in Europe Link for Infection Control
through Surveillance

• OBJECTIVES
• To share surveillance experience between
  countries
• To encourage the development of further
  surveillance systems
• To establish a European database

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Hospitals in Europe Link for Infection Control
through Surveillance

• METHOD
• Standardized protocols and definitions
• Uniform data management

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SSI Report 2004

• Example HIP procedure
• Data from 11 countries and 14 networks
• 49.476 HIP procedures
• Overall SSI rate 2.2

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SSI rates following HIP procedures by country

Country
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SSI rates following HIP procedures by country
Random effects

Number of HIP procedures
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Reasons for differences

• Different surveillance methods

• Different infection control procedures

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Uniform definitions CDC
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Type of SSI
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Differences in type of HIP surgical procedures
within HPRO category
Distrubution for NNIS risk index
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Percentage of SSI detected after discharge from
the hospital
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Reasons for differences

• Different surveillance methods

• Different infection control procedures

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Comparison of national reference data should be
done with caution