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, Theresa 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
JournalJournal of Hospital Infection
Volume102
Issue number3
DOIs
Publication statusPublished - Jul 2019

Bibliographical note

Funding Information:
The networks would like to extend their thanks towards hospitals that are participating in the networks, as well as to the co-ordinating staff. SSI prevention studies by Drs Abbas and Harbarth leading to this project idea have received support from the Innovative Medicines Initiative Joint Undertaking under the Combatting Bacterial Resistance in Europe (COMBACTE) grant agreement no. 115523 , resources of which are composed of the financial contribution from the EU's Seventh Framework Programme ( FP7/20072013 ) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in-kind contribution. We would like to thank Assist. Prof. B.A.S. Peng (Tan Tock Seng Hospital), Prof. D. Fisher (National University Health System), Dr C.W. George (Khoo Teck Puat Hospital), Dr S.K.M.S. Pada (Ng Teng Fong Hospital), and Dr T.T. Yen (Changi General Hospital) for supplying data, and we would like to thank Dr C. Wloch and Ms P. Harrington for their assistance in designing and piloting the survey questionnaire.

Funding Information:
The networks would like to extend their thanks towards hospitals that are participating in the networks, as well as to the co-ordinating staff. SSI prevention studies by Drs Abbas and Harbarth leading to this project idea have received support from the Innovative Medicines Initiative Joint Undertaking under the Combatting Bacterial Resistance in Europe (COMBACTE) grant agreement no. 115523, resources of which are composed of the financial contribution from the EU's Seventh Framework Programme (FP7/20072013) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies’ in-kind contribution. We would like to thank Assist. Prof. B.A.S. Peng (Tan Tock Seng Hospital), Prof. D. Fisher (National University Health System), Dr C.W. George (Khoo Teck Puat Hospital), Dr S.K.M.S. Pada (Ng Teng Fong Hospital), and Dr T.T. Yen (Changi General Hospital) for supplying data, and we would like to thank Dr C. Wloch and Ms P. Harrington for their assistance in designing and piloting the survey questionnaire.Drs M. Abbas, E. Aghayev, S. Harbarth, and N. Troillet have worked on an investigator-initiated projected mandated by Swissnoso that was funded by Pfizer USA. Drs S. Harbarth and I. Prantner report grants from Pfizer USA, outside the submitted work. Dr E. Presterl reports grants from the Ministry of Health of Austria, during the conduct of the study. All other authors have no conflicts of interest to disclose.

Funding Information:
The networks would like to extend their thanks towards hospitals that are participating in the networks, as well as to the co-ordinating staff. SSI prevention studies by Drs Abbas and Harbarth leading to this project idea have received support from the Innovative Medicines Initiative Joint Undertaking under the Combatting Bacterial Resistance in Europe (COMBACTE) grant agreement no. 115523, resources of which are composed of the financial contribution from the EU's Seventh Framework Programme (FP7/20072013) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in-kind contribution. We would like to thank Assist. Prof. B.A.S. Peng (Tan Tock Seng Hospital), Prof. D. Fisher (National University Health System), Dr C.W. George (Khoo Teck Puat Hospital), Dr S.K.M.S. Pada (Ng Teng Fong Hospital), and Dr T.T. Yen (Changi General Hospital) for supplying data, and we would like to thank Dr C. Wloch and Ms P. Harrington for their assistance in designing and piloting the survey questionnaire.Drs M. Abbas, E. Aghayev, S. Harbarth, and N. Troillet have worked on an investigator-initiated projected mandated by Swissnoso that was funded by Pfizer USA. Drs S. Harbarth and I. Prantner report grants from Pfizer USA, outside the submitted work. Dr E. Presterl reports grants from the Ministry of Health of Austria, during the conduct of the study. All other authors have no conflicts of interest to disclose.

Funding Information:
Drs M. Abbas, E. Aghayev, S. Harbarth, and N. Troillet have worked on an investigator-initiated projected mandated by Swissnoso that was funded by Pfizer USA. Drs S. Harbarth and I. Prantner report grants from Pfizer USA , outside the submitted work. Dr E. Presterl reports grants from the Ministry of Health of Austria , during the conduct of the study. All other authors have no conflicts of interest to disclose.

Publisher Copyright:
© 2018 The Healthcare Infection Society

Keywords

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

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