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

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

M Abbas  1 , M E A de Kraker  2 , E Aghayev  3 , P Astagneau  4 , M Aupee  5 , M Behnke  6 , A Bull  7 , H J Choi  8 , S C de Greeff  9 , S Elgohari  10 , P Gastmeier  6 , W Harrison  11 , M B G Koek  9 , T Lamagni  10 , E Limon  12 , H L Løwer  13 , O Lyytikäinen  14 , K Marimuthu  15 , J Marquess  16 , R McCann  17 , I Prantner  18 , E Presterl  19 , M Pujol  20 , J Reilly  21 , C Roberts  11 , L Segagni Lusignani  22 , D Si  16 , E Szilágyi  23 , J Tanguy  5 , S Tempone  17 , N Troillet  24 , L J Worth  25 , D Pittet  2 , S Harbarth  2
Affiliations
Free article

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

M Abbas et al. J Hosp Infect. 2019 Jul.
Free article

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.

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