The quality of denominator data in surgical site infection surveillance versus administrative data in Norway 2005–2010

Abstract

BackgroundHigh quality of surveillance systems for surgical site infections (SSIs) is the key to their usefulness. The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections (NOIS) was introduced by regulation in 2005, and is based largely on automated extraction of data from underlying systems in the hospitals.MethodsThis study investigates the quality of NOIS-SSI’s denominator data by evaluating completeness, representativeness and accuracy compared with de-identified administrative data for 2005–2010. Comparisons were made by region, hospital type and size, age and sex for 4 surgical procedures.ResultsThe completeness of NOIS improved from 29.2 % in 2005 to 79.8 % in 2010. NOIS-SSI became representative over time for most procedures by hospital size and type, but not by region. It was representative by age and sex for all years and procedures. Accuracy was good for all years and procedures by all explanatory variables.ConclusionsA flexible and incremental implementation strategy has encouraged the development of computer-based surveillance systems in the hospitals which gives good accuracy, but the same strategy has adversely affected the completeness and representativeness of the denominator data. For the purpose of evaluating risk factors and implementing prevention and precautionary measures in the individual hospitals, representativeness seems sufficient, but for benchmarking and/or public reporting it is not good enough.

Is It Valid to Compare Surgical Site Infections Rates Between Countries? Insights From a Study of English and Norwegian Surveillance Systems

“…Previous studies have shown that voluntary and periodic reporting can influence the representativeness of the data and can affect the reported incidence of SSI. 12 In addition, public reporting could affect participation and reported SSI rates in settings in which reporting is either voluntary or mandatory. 13,14 The mandatory nature of surveillance in Norway could result in better representation of nonorthopedic categories, although its impact on the overall SSI estimate can go in either direction.…”

“…In addition, voluntary reporting in England might also affect the reported rates through selection bias. Previous studies have shown that voluntary and periodic reporting can influence the representativeness of the data and can affect the reported incidence of SSI 12 . In addition, public reporting could affect participation and reported SSI rates in settings in which reporting is either voluntary or mandatory 13 …”

Risk factors for surgical site infection following cesarean delivery: A hospital‐based case–control study

“…NOIS registers selected characteristics such as gender, age, duration of surgery in minutes, and administration of antibiotic prophylaxis. The accuracy of reported SSI by NOIS was 97.5% in 2010 15 …”

“…The accuracy of reported SSI by NOIS was 97.5% in 2010. 15 Haukeland University Hospital is a tertiary referral care center and with approximately 5000 deliveries per year, it is the country´s second largest maternity unit. All emergency hospitals in Norway including maternity hospitals are public and free of cost for the patient.…”

Risk Factors for Surgical Site Infection Following Cesarean Delivery

“…According to the previous study, the incidence of emergency and elective cesarean section was 75% and 25%, with a 2% general risk of SSI after CS [17,18]. Emergency type cesarean section was the SSI-related independent risk factor [19].…”