Economic Burden of Surgical Site Infections at a European University Hospital

Abstract

OBJECTIVE. To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.DESIGN. Matched case-control study nested in a prospective observational cohort study.SETTING. Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.METHODS. All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.RESULTS. A total of 6,283 procedures were performed: 187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492-SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (« = 76).CONCLUSIONS. Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers. 2008; 29:623-629 Surgical site infections (SSIs) account for 14%-16% of all nosocomial infections in inpatients and are considered the most common form of nosocomial infection among surgical patients. 1 A number of risk factors have been associated with the onset of SSI, and they can be broadly subdivided into patientrelated characteristics (eg, greater age, poor nutritional status, and more numerous and/or more severe combrbid conditions) and surgery-related characteristics (eg, long duration of procedure, high wound classification, and absence of antibiotic prophylaxis). 26 Based on such risk factors, SSI prediction scores have been developed that allow the identification of patients at high risk for developing SSI. 5,7,8 For these high-risk patients, clinicians can implement appropriate prevention strategies and effective measures to diagnose infection and initiate therapy at an early stage. In addition, in the past few years, SSI surveillance systems have been shown to decrease the rates of SSI in various countries. 1 ' 916 In such systems, clinicians share feedback on infection rates with surgical staff and reinforce adherence to Centers for Disease Control and Prevention standards. A nosocomial infection surveillance system was introduced at Basel University Hospital in 1999 to decrease the rate of SSI. Infect Control Hosp EpidemiolNowadays, hospital infections, particularly SSIs-which are potentially preventable complications directly linked to surgery-are considered to reflect the quality of...

Improvement in Adherence to Surgical Antimicrobial Prophylaxis Guidelines after Implementation of a Multidisciplinary Quality Improvement Project

“…These pre-intervention findings are consistent with those reported by other studies at both local and international hospitals. [1][2][3][4]7 However, significant improvement was observed in the adherence to surgical prophylaxis guidelines after the implementation of a multidisciplinary quality improvement project in the current study, particularly with regards to the appropriateness, dosage, timing and duration of antibiotic therapy. To the best of the authors' knowledge, this is the first study to evaluate a comprehensive approach aiming to improve adherence to antimicrobial prophylaxis guidelines.…”

“…[1][2][3][4] Therefore, antimicrobial prophylaxis is recommended in a wide range of surgical procedures for the prevention of SSIs. 5 Guidelines are available to provide clinicians with a standardised approach to the rational, safe and effective use of antimicrobial agents.…”

Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: The value of a mandatory system, automated data collection, and active postdischarge surveillance

“…The objective of this study is to investigate and quality assurance in specialist health care services, including financing and funding 75 hospitals [9]. It is considered to be the complete database for hospital care in Norway [10]. shown) the differences in distribution between NOIS-SSI and NPR were greater.…”

“…Studies indicate as much as a doubling of costs of hospital stays because of HAIs. [6][7][8][9][10] Longer life expectancy due in part to improved medical technology contributes to sicker, older and more fragile patients.…”

Interdisciplinary approach in development and implementation of local guideline for surgical antimicrobial prophylaxis: Experience of the university hospital 'Tsaritsa Yoanna - ISUL', Sofia, Bulgaria

“…SSI are an important cause of morbidity and mortality and are associated with the increased costs to health care providers [1][2][3][4]. According to the Centers for Disease Control and Prevention (CDC), SSI accounted for about 31% of nosocomial infections in the United States in 2010 [5].…”