TY - JOUR
T1 - Impact of participation in a surgical site infection surveillance network
T2 - results from a large international cohort study
AU - Abbas, M.
AU - de Kraker, M. E.A.
AU - Aghayev, E.
AU - Astagneau, P.
AU - Aupee, M.
AU - Behnke, M.
AU - Bull, A.
AU - Choi, H. J.
AU - de Greeff, S. C.
AU - Elgohari, S.
AU - Gastmeier, P.
AU - Harrison, W.
AU - Koek, M. B.G.
AU - Lamagni, T.
AU - Limon, E.
AU - Løwer, H. L.
AU - Lyytikäinen, O.
AU - Marimuthu, K.
AU - Marquess, J.
AU - McCann, R.
AU - Prantner, I.
AU - Presterl, E.
AU - Pujol, M.
AU - Reilly, J.
AU - Roberts, C.
AU - Segagni Lusignani, L.
AU - Si, D.
AU - Szilágyi, E.
AU - Tanguy, J.
AU - Tempone, S.
AU - Troillet, N.
AU - Worth, L. J.
AU - Pittet, D.
AU - Harbarth, S.
N1 - Publisher Copyright:
© 2018 The Healthcare Infection Society
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - Epidemiology
KW - Healthcare-associated infection
KW - Infection control
KW - Surgical site infection
KW - Surveillance
KW - Surveillance networks
UR - http://www.scopus.com/inward/record.url?scp=85059743408&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2018.12.003
DO - 10.1016/j.jhin.2018.12.003
M3 - Article
C2 - 30529703
AN - SCOPUS:85059743408
SN - 0195-6701
VL - 102
SP - 267
EP - 276
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
IS - 3
ER -