AMBU-KISS%20one%20day%20surgery%20surveillance%20in%20Germany%20Petra%20Gastmeier,%20MD%20%20Charit

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AMBU-KISS one day surgery surveillance in
GermanyPetra Gastmeier, MD Charité
University Medicine Berlin, Germanyand German
National Reference Center for Surveillance of
Nosocomial Infections 
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KISS
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KISS Krankenhaus-Infektions-Surveillance-System
German national nosocomial infection
surveillance system - supported by the German
Ministry of Health - organized by 3 university
institutes
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Principles of KISS participation

• Voluntary participation
• Confidentiality(instead of mandatory reporting)

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Participating hospitals
1997 20 2007 520 Total number of
hospitals 2000
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KISS is based on the experiences and principles
of the NNIS system
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KISS componentswww.nrz-hygiene.de
ICU-KISS
OP-KISS
1997
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Method OP-KISS
Infections Standardization Stratification
Surgical site infections Distribution of NNIS risk points among operated patients (Standardized Infection rate SIR) OP type number of NNIS risk points (ASA score, duration of operation, wound class)
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Neues in 2005
Feedback to the hospitals
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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)
Type of procedure Number of departments Number of operations
Hip prothesis 45 35,587
Knee prothesis 21 12,212
Appendectomy 22 11,622
Cholecystectomy, laparoscopic 24 15,340
Colon surgery 19 6,881
Herniorrhaphy 29 17,992
C-Section 27 23,936
130 119,114
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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)
-25
(n 119 114 operations from 130 departments)
Brandt, C. ICHE 2006
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KISS componentswww.nrz-hygiene.de
CDAD-KISS
ICU-KISS
MRSA-KISS
OP-KISS
ONKO-KISS
NEO-KISS
AMBU-KISS
DEVICE-KISS
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AMBU-KISS
Start January 2003
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METHOD
Do we need stratification according to the
number of risk points?
Do we get sufficient information about the
postoperative period?
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PILOT STUDY Patients with NNIS risk points in
ambulatory surgery
Hernia repair Varicosis operations
All patients 322 603
Patients with at least 1 risk point 6 231
Percentage 1.9 5.4
Hirsemann S et al. AJIC 2005 336-10
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Experience with data from hospitals
(OP-KISS) Does stratifying surgical site
infection rates by the NNIS risk index influence
the rank order of the hospitals in a surveillance
system?
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Correlation of departments rank, vascular surgery
of the leg
Depart-ment Number of procedures Number of Infections Crude infection rate (CIR) Depart-ment rank CIR Depart-ment rank SIR Standardized infection ratio (SIR)
1 66 0 0.00 1 1 0.00
2 315 2 0.63 2 2 0.17
3 560 5 0.89 3 4 0.44
4 677 7 1.03 4 3 0.42
5 401 5 1.25 5 6 0.49
6 555 7 1.26 6 5 0.46
7 252 4 1.59 7 7 0.56
8 337 8 2.37 8 8 0.68
9 182 5 2.75 9 11 1.11
10 386 11 2.85 10 9 1.02
11 141 5 3.55 11 10 1.03
12 303 11 3.63 12 13 1.29
13 731 29 3.97 13 12 1.21
14 90 4 4.44 14 14 1.75
15 334 17 5.09 15 18 2.06
16 272 15 5.51 16 16 1.77
17 231 13 5.63 17 17 2.03
18 33 2 6.06 18 15 1.77
19 46 4 8.70 19 19 2.34
20 168 18 10.71 20 20 3.30
Brümmer et al. J Hosp Infect, in press
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Correlation of departments rank, vascular surgery
of the leg
Spearman coefficient 0,977
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Spearman correlation coefficients per procedure
types
Surgical procedure type Spearman coefficient
Appendectomy 0.959
Colectomy 0.982
Open Cholecystectomy 0.989
Laparoscopic Cholecystectomy 0.995
Open reduction of femur fracture 0.991
Vascular surgery of the leg 0.977
Herniorrhaphy 0.983
Hip prosthesis (arthrosis) 0.990
Hip prosthesis (fracture) 0.999
Knee prosthesis 0.982
Abdominal Hysterectomy 0.995
Mastectomy 0.992
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Number of SSI for a procedure type
--------------------------------------------------
---- x 100 Number of operations of this
procedure type
Method AMBU-KISS
Calculation of crude SSI rates

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Method AMBU-KISS
Infections Standardization Stratification
Surgical site infections OP type
Mlangeni et al. Chirurg 2004 75265-68
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METHOD
Do we need stratification according to the
number of risk points?
Do we get sufficient information about the
postoperative period?
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Detecting of SSI in AMBU-KISS, n99
Methods of the surgeons participating in AMBU-KISS yes
The surgeon himself is investigating the patient postoperatively (at least once during the first 30 postoperative days) 98
A routine letter to the general practitioner asking for SSI reporting 34
A routine list to the general practioner asking for SSI reporting 12
Routine telephone contact with the general practioner to record SSI 19
Information of the general practitioner about CDC definitions for SSI 31
Performance of microbiology tests to confirm SSIs 93
Blaich A et al. Der Chirurg 2007
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Question to the surgeon, n99
yes
Do you believe that you will be informed in the case of SSI? 87
Blaich A et al. Der Chirurg 2007
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AMBU-KISS-Data 12/2007
Centers OPs Pooled SSI rates ()
Arthroscopic knee procedures 103 81 669 0.08
Varicosis stripping 90 42 283 0.23
Hernia repair 95 24 785 0.25
Testis procedures 28 1 549 0.13
Mamma exzision 27 633 0.16
Mamma enlargement 5 223 0.00
Nose septum-OP 7 1135 0.09
12/2007
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www.nrz-hygiene.de
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KISS data for hospitals12/2006
Comparison
KISS data for day surgery centers 12/2007
OPs SSI rate () SSI rate () NNIS Index 0 OPs SSI rate ()
Hernia repair 21 969 1.07 0.77 24 785 0.25
Varicosis OPs 4 062 0.79 42 283 0.23
Arthroscopic knee procedures 14 647 0.30 0.15 81 669 0.08
KISS 12/2007
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Summary

• Many day surgery centers are interested to
  participate and provide data
• Calculation of crude SSI rates seems to be
  appropriate
• Follow-up information seems to be appropriate
• SSI rates from day surgery centers are in
  general lower, probable due
• - to fewer underlying diseases in this patient
  group - to sufficient experience of the
  surgeons with this operation type