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Eurosurveillance, Volume 7, Issue 44, 31 October 2003
Articles

Citation style for this article: Reilly J. Surgical site infection: first report from Scotland emphasizes the importance of post-discharge surveillance. Euro Surveill. 2003;7(44):pii=2317. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2317

Surgical site infection: first report from Scotland emphasizes the importance of post-discharge surveillance

Jacqui Reilly (Jacqui.Reilly@scieh.csa.scot.nhs.uk) on behalf of the SSHAIP team, the Scottish Centre for Infection and Environmental Health, Glasgow, Scotland

The first report from the Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) was published earlier this month (1). Surgical site infections (SSI), also referred to as infections of the surgical wound, are one of the most common healthcare associated infections (HAI). SSI can result in a delay in patient recovery and increase in the duration of hospital stay and costs associated with treatment of the infection. A recently published study has indicated that the average cost of treatment is around €4700 per patient (2). SSI is therefore an important outcome measure for surgical procedures and a priority for surveillance.

A national programme of active, prospective SSI surveillance has been implemented in Scotland through collaboration between the SSHAIP team, based at the Scottish Centre for Infection and Environmental Health (SCIEH), and staff in the acute hospitals. This programme resulted from a Health Department letter, which required acute trusts (grouped hospitals) to have structures in place by April 2002 for surveillance of in-patient surgical site infection for at least two operative procedures (including one orthopaedic procedure) from a specified list of nine categories of surgery, and to make surveillance data available in 2003 (3). The first report of the data was published on 7 October 2003. The report summarises data reported to SSHAIP for the period 1 April 2002 to 30 June 2003 and is available on the SCIEH website (http://www.show.scot.nhs.uk/scieh/).

In order to obtain robust and comparable national data, surveillance in Scotland is conducted according to the SSHAIP national protocol, with consistent adherence by all trusts to the standard definitions. The SSHAIP team has trained staff in data definitions who liaise directly with a named SSI surveillance coordinator at each hospital site. Quality assurance mechanisms are in place to ensure that the correct criteria for infection are applied for the definition. These definitions, including surgical site infection definitions, have been developed by the United States Centers for Disease Control and Prevention for use in the National Nosocomial Infection Surveillance (NNIS) programme. The dataset collected by the SSHAIP programme is compatible with United Kingdom (UK), European and worldwide datasets, encompassing the Hospitals In Europe Link for Infection Control and Surveillance (HELICS) dataset and the NNIS programme.

The first report presents the results of the analysis of these preliminary data. It must, however, be emphasized that the results provided in this report do not represent infection rates in Scotland as a whole. The data are heavily biased towards results from those trusts that have contributed large numbers of reports, and so these data should be interpreted with due caution. Results are presented for 128 in-patient infections from 7586 procedures. The data are stratified using the NNIS risk index (4), and the infection rates quoted vary by procedure and are broadly similar to those presented by NNIS (5).

The SSHAIP SSI surveillance scheme is the first national surveillance scheme in the UK to have published information on surgical infections occurring after discharge from hospital. Trusts have established post discharge surveillance utilising direct observation of the patient by staff, for example, community midwives, who have received training in the data definitions. The surveillance is coordinated by the named coordinator at each site to promote robustness of data collected. In total, 349 infections from 5829 procedures were reported by the trusts performing post discharge surveillance. Of these, 97 were in-patient infections detected during the post-operative stay in hospital, 24 infections were detected on readmission to hospital, and 228 were detected through post-discharge surveillance.

The report indicates that post-discharge surveillance is an important area for development of national surveillance of SSI. For those trusts that performed post discharge surveillance, 65% of infections occurred after discharge from hospital. The proportion of SSI detected after discharge varied by procedure and was most frequent for breast, abdominal hysterectomy, and caesarean section procedures, which might be expected due to the short length of stay associated with these procedures. The report recommends that these types of surgical procedure should be prioritised for post-discharge surveillance of SSI, and this is included in the SSHAIP protocol.

In trusts where data collection has been established for a year or more, results have been fed back to clinicians to facilitate review of practice, and as a result, some local improvements have been noted. It is anticipated that as a more robust dataset is collected, trust-specific data will be available for comparative purposes in future reports from SSHAIP.

References:
  1. Scottish Surveillance of Healthcare Associated Infection Programme. Surveillance of surgical site infection for procedures carried out from: 1/04/02 - 30/06/03. Glasgow: Scottish Centre for Infection and Environmental Health; 7 October 2003. (http://www.show.scot.nhs.uk/scieh/infectious/hai/SSHAIP/SSI_report.htm) [accessed 31 October 2003]
  2. Plowman R, Graves N, Griffin M, Roberts JA, Swan A, Cookson B, et al. The Socio-economic burden of hospital acquired infection. London: Public Health Laboratory Service; 2000. (executive summary available at http://www.doh.gov.uk/pub/docs/doh/phls.pdf) [accessed 31 October 2003]
  3. SEHD. A Framework for National Surveillance of HAI in Scotland. Health Department Letter NHS HDL(2001)57. Edinburgh: Scottish Executive Health Department; 6 July 2001. (http://www.show.scot.nhs.uk/sehd/mels/HDL2001_57.htm) [accessed 31 October 2001]
  4. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991; 91(3B): 152S-157S.
  5. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002; 30: 458-75. (http://www.cdc.gov/ncidod/hip/surveill/NNIS.htm) [accessed 31 October 2003]

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