Comparison of Two Surveillance Methods for Detecting Nosocomial Infections in Surgical Patients

Abstract

Nosocomial infections play a role in quality and cost control in health care. Surveillance of these infections is the only way to gain more insight into their frequency and causes. Since the results of surveillance may lead to changes in both patient and hospital management, which are sometimes major, it is necessary that all healthcare workers involved agree on the criteria used for the diagnosis and surveillance of these complications. In order to compare the efficacy of two surveillance methods, nosocomial infections in surgical patients were registered by both the Department of Surgery (complication surveillance [CS]) and the Department of Infection Control (nosocomial infection surveillance [NIS]) at the University Medical Center Utrecht, The Netherlands, over a 2-month period. The CS team used the national criteria of the Association of Surgeons of the Netherlands and the NIS team used the international criteria of the Centers for Disease Control and Prevention, USA, to define cases of nosocomial infection. A total of 515 patients were included in both arms of the study. The CS team diagnosed 69 infections in 49 patients, and the NIS team diagnosed 64 infections in 45 patients. Of 104 total infections, 39 were diagnosed by the CS team exclusively, 35 by the NIS team exclusively and only 30 by both. The main reasons for the inconsistent results were as follows: (i) the lack of follow-up after discharge in the NIS arm, (ii) the use of clinical criteria for the definition of a nosocomial infection in the CS arm, and (iii) the use of positive cultures as part of the criteria in the NIS arm. From the perspective of infection control, the CS system cannot be recommended for the surveillance of nosocomial infections.

Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

“…Providing the SSI definition did not improve the correlation between scores in our study, in keeping with a previous study demonstrating variable interpretations of the same definition [10]. Our results further support the need for a multidisciplinary approach to SSI surveillance [27]. Our data from 10 European countries consistently showed differences in agreement in each country, suggesting that our results may be also relevant to other countries.…”

“…Thus, SSI surveillance aims not only to obtain accurate SSI rates, but also to enhance teamwork between surgical and infection-control teams in order to ensure the implementation of effective preventive strategies. Our results indicate that surveillance should not be performed by individuals in a single specialty [27]. Second, the vignettes were scored via an online database.…”

Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections

“…More surprisingly, the correlation was poor among infection control professionals. Our results further support the need for a multidisciplinary approach to SSI surveillance [28].…”

“…The main goal of SSI surveillance is accurate SSI rate determination with feedback of appropriate data to surgeons, but another goal is to strengthen collaboration between surgical and infection-control teams in order to implement effective preventive strategies and to improve quality of care. Our results indicate that surveillance should not be performed by individuals in a single specialty [28]. Second, the participants scored vignettes via an online database.…”