Impact of participation in a surgical site infection surveillance network: results from a large international cohort study

Abbas, Mohamed; Kraker, Marlieke E A de; Aghayev, Emin; Astagneau, Pascal; Aupée, Martine; Behnke, Michael; Bull, Ann; Choi, Hee Jung; Greeff, Sabine C. de; Elgohari, Suzanne; Gastmeier, Petra; Harrison, Wendy; Koek, M.B.G.; Lamagni, Theresa; Limón, Enric; Løwer, Hege Line; Lyytikäinen, Outi; Marimuthu, Kalisvar; Marquess, John; McCann, Rebecca; Prantner, Ida; Presterl, Elisabeth; Pujol, Miquel; Reilly, Jacqui; Roberts, Christopher; Lusignani, Luigi Segagni; Si, Damin; Szilágyi, Emese; Tanguy, Juliette; Tempone, Simone; Troillet, Nicolas; Worth, Leon J; Pittet, Didier; Harbarth, Stéphan Juergen

doi:10.1016/j.jhin.2018.12.003

Cited by 52 publications

(42 citation statements)

References 25 publications

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“…Checking the relevance of each singular case is more suitable for a local survey (i.e., single-hospital or regional network) than for a national survey, as the absence of uniform national guidelines may lose some relevant amount of HDF information to poor compliance. Indeed, surveys are increasingly being performed in Italian regions and university hospitals [1,6,33], while systematic surveillance networks are being tested on an international scale [13]. Two reviews and one retrospective observational study found OIDRI treatment success rates to vary between 57 and 88% [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Pirisi¹,

Pennestrì

Viganò

et al. 2020

BMC Infect Dis

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Background: Healthcare-associated infections (HAIs) represent a serious burden to individual safety and healthcare sustainability. Identifying which patients, procedures and settings are most at risk would offer a significant contribution to HAI management and prevention. The purpose of this study is to estimate 1) orthopaedic implantable device-related infection (OIDRI) prevalence in Italian hospitals and 2) the gap between the remuneration paid by the Italian healthcare system and the real costs sustained by Italian hospitals to treat these episodes. Methods: This is a cross-sectional study based on hospital discharge forms registered in 2012 and 2014. To address the first goal of this study, the national database was investigated to identify 1) surgical procedures associated with orthopaedic device implantation and 2) among them, which patient characteristics (age, sex), type of admission, and type of discharge were associated with a primary diagnosis of infection. To address the second goal, 1) each episode of infection was multiplied by the remuneration paid by the Italian healthcare system to the hospitals, based on the diagnosis-related group (DRG) system, and 2) the total days of hospitalization required to treat the same episodes were multiplied by the average daily cost of hospitalization, according to estimates from the Ministry of the Economy and Finance (MEF). Results: In 2014, 1.55% of the total hospitalizations for orthopaedic device implantation procedures were associated with a main diagnosis of infection, with a negligible increase of 0.04% compared with 2012. Hip and knee replacement revisions, male patients and patients older than 65 years were more exposed to infection. A total of 51.63% of patients were planned admissions to the hospital, 68.75% had an ordinary discharge to home, and 0.9% died. The remuneration paid by the healthcare system to the hospitals was € 37,519,084 in 2014, with 3 DRGs covering 70.6% of the total. The cost of the actual days of hospitalization to treat these episodes was 17.5 million more than the remuneration received. Conclusions: The OIDRI prevalence was lower than that described in recent surveys in acute care settings, although the numbers were likely underestimated. The cost of treatment varied significantly depending on the remuneration system adopted.

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Section: Discussionmentioning

confidence: 99%

“…Although estimating HAI incidence, complications, and attributable mortality is challenging [12], evidence suggests that systematic surveillance can help to prevent and reduce their burden [13][14][15]. These data highlight the need to identify which patients, procedures, settings and devices are most at risk.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Pirisi¹,

Pennestrì

Viganò

et al. 2020

BMC Infect Dis

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“…7 The use of surveillance to measure the risk of surgical site infection and feedback of results to surgeons has been shown to be effective in reducing the risk of infection. [8][9][10] However, surveillance of surgical site infection is resource intensive and studies to assess its cost-benefit have not been conducted. The Surgical Site Infection Surveillance Service at Public Health England provides national coordination for surgical site infection surveillance for hospitals in England.…”

Section: Introductionmentioning

confidence: 99%

Cost–benefit analysis of surveillance for surgical site infection following caesarean section

et al. 2020

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ObjectiveTo estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme.DesignEconomic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers’ perspective.SettingEngland.ParticipantsWomen undergoing caesarean section in National Health Service hospitals.Main outcome measureCosts attributable to treatment and management of surgical site infection following caesarean section.ResultsThe costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018–2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%.ConclusionSurveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.

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“…In a large‐scale study conducted by the National Healthcare Safety Network, which included 850 thousand general surgeries from across United States, the incidence of SSI was 1.9% . Surveillance of SSI rates and adherence to protocols designed to minimize risk have been shown to decrease SSI rates in high‐income countries . Few short‐term surgical missions report complications rates .…”

Section: Introductionmentioning

confidence: 99%

Reducing Surgical Site Infections During Otolaryngology Surgical Missions

2019

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Objectives:To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, shortterm surgical missions remain the predominant structure for humanitarian surgical care in low-and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort.Methods: Literature review and practical experience.Results: WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital.Conclusion: Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed.

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Impact of participation in a surgical site infection surveillance network: results from a large international cohort study

Abstract: Impact of participation in a surgical site infection surveillance network: results from a large international cohort study.

Cited by 52 publications

References 25 publications

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Cost–benefit analysis of surveillance for surgical site infection following caesarean section

Reducing Surgical Site Infections During Otolaryngology Surgical Missions

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