Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

Koek, M.B.G.; Wille, Jan; Isken, M; Voß, Andreas; Benthem, Birgit Hb van

doi:10.2807/1560-7917.es2015.20.8.21042

Cited by 47 publications

(52 citation statements)

References 21 publications

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“…Although labour intensive, a 30-day post-discharge surveillance is recommended in order to detect almost all SSI (including complicated infections) in the post-discharge period [29]. Since complex SSI cases would require medical care in the healthcare setting it would be expedient for a standardised surveillance method to be applied under those conditions [29]. In contrast to this view, a study from Brazil reported that for 93% of the women who developed SSI, the infection became apparent in the first 15 days following CS [26].…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

et al. 2019

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Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.

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Section: Discussionmentioning

confidence: 99%

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

et al. 2019

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“…SSI surveillance has been difficult to standardize because most infections occur post discharge and because hospitals employ a wide array of surveillance methods, such as reliance on reporting by surgeons and other hospital staff, review of postoperative micro-biology and readmissions, and chart review of all surgical cases. [8][9][10][11] The methods used impact the rates being used for performance comparisons.…”

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confidence: 99%

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Calderwood

Huang

Keller

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validationMETHODSInfection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency).RESULTSUpon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy.CONCLUSIONSClaims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.Infect Control Hosp Epidemiol 2017;38:1091–1097

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“…The results of our paper clearly demonstrate that the majority of the SSIs occur within 90 days, and a shorter PDS will substantially facilitate prompt feedback of surveillance results to the healthcare professionals [2].…”

Section: To the Editormentioning

confidence: 62%

Authors’ response: Is a reduced duration of post-discharge surgical site infection surveillance really in our best interests?

Koek

2015

Eurosurveillance

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order to try to eliminate the occurrence of surgical site infections (SSIs) [1]. In order to do so there are several instruments, and surveillance of SSIs is only one of them. Surveillance of SSIs is a standardised way to monitor and report SSIs, allowing comparison within and between hospitals and triggering improvement of internal processes.For surveillance purposes, we consider it justified to shorten the duration of post-discharge surveillance (PDS), as not only the calculated SSI incidence but also the workload involved in PDS and the speed of feedback to the healthcare professional must be considered. The results of our paper clearly demonstrate that the majority of the SSIs occur within 90 days, and a shorter PDS will substantially facilitate prompt feedback of surveillance results to the healthcare professionals [2].For clinical purposes however, it is still possible (and sometimes even advisable) to trace all SSIs, regardless of the time when they arise or of their cause. While the 90-day incidence of SSIs might be slightly lower than the one-year incidence, it might also be more accurate since it better represents truly surgery-related SSIs (instead of SSIs due to secondary causes, such as for instance bacteraemia). As such, the use of a 90-day PDS may improve the accuracy of studies investigating preventive or combative interventions.Finally, we would like to emphasise that incidence by definition is a measure of frequency during a given time period [3]. Therefore, by reducing the duration of PDS, the incidence itself is not artificially reduced as Davies et al. conclude, but the incidence is measured during a shorter given time period. We would therefore not recommend to directly compare one-year incidences with 90-day incidences without taking into account the shorter duration of PDS.

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Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

Cited by 47 publications

References 21 publications

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors

Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Authors’ response: Is a reduced duration of post-discharge surgical site infection surveillance really in our best interests?

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