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. McCannI. 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

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


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.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
JournalJournal of Hospital Infection
Issue number3
StatePublished - Jul 2019

Bibliographical note

Publisher Copyright:
© 2018 The Healthcare Infection Society


  • Epidemiology
  • Healthcare-associated infection
  • Infection control
  • Surgical site infection
  • Surveillance
  • Surveillance networks


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