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NSIH day - 20 Feb 20041
Surveillance of Surgical Site Infections
H.Carsauw, C.SuetensH.Carsauw, C.SuetensNSIHNSIHWIV WIV –– EpidemiologyEpidemiology
NSIH day - 20 Feb 20042
Importance of Surgical Site Infections
l SSI are one of the most common adverse events of surgery
l Excess morbidity, length of stay, costs, antibiotic use…
E Monitoring the incidence of SSI is essential Monitoring the incidence of SSI is essential component in the prevention & control component in the prevention & control
NSIH day - 20 Feb 20043
NSIH – SSI Surveillance
l Reestablished July 2001 before: 1992 – 96
l Protocol in agreement with :
v Quality Decree Flemish government
v Requirements in the field of surveillance of nosocomial infections at European level : HELICSHELICS
NSIH day - 20 Feb 20044
Participation in NSIH - SSI surveillanceJuly 2001 – Dec 2003*
Other Categ.°
Categ. QualityDecree
No. Operations
No. Hosp.Registr. Option
141214.82116.23346
(39+7)1 ICD-9-CM
2 NNIS category
20.37121.78359Total
--55505550133 Aggregated denominator data
* Preliminary data KPRO, Gastric surg, Other vasc, Spinal fusion
°Other categories:
NSIH day - 20 Feb 20045
Number of operations registered by quarter, July 2001 – Dec 2003*
0
1000
2000
3000
4000
5000
6000
7000
8000
2001q3 2001q4 2002q1 2002q2 2002q3 2002q4 2003q1 2003q2 2003q3 2003q4
Quarter
No
. of O
per
atio
ns
ICD-9-CM code NNIS categ. Aggreg. denom. data
NSIH day - 20 Feb 20046
The Quality Decree Flemish government, 01/01/2000
Operation categories to be followed mandatorily:(NNIS system, CDC)
v Colon surgery (COLO)
v Herniorrhaphy (HER)
v Hip prosthesis (HPRO)
v Laminectomy (LAM)
v Vascular surgery (VS)
v Coronary bypass (CBGB & CBGC)
NSIH day - 20 Feb 20047
Stratification by Risk IndexNNIS system, CDC
l Basic Risk Index:
– Wound class– ASA score– Duration
RI : 0 à 3
l Idem + consider Laparo/Endoscopy :
v For COLO , CHOL:Basic Risk Index - 1
v For APPY, GAST:If Basic Risk Index=0:l 0 - lapl 0 – no lap
NOT applicable to other operation categories !
e.g. Hernia, Appendectomy, ...
NSIH day - 20 Feb 20048
Missing Risk Index factors
At least one
Duration
Wound class
ASA score
Risk stratification factor
1,2 %1.1 %1.2 %
9,4 %17.5 %8.6 %
% Missing
TotalOther operation categories
Operation cat. Quality decree
2,7 %0.9 %2.9 %
6,9 %16.2 %6.0 %
NSIH day - 20 Feb 20049
Discharge date versus End of Follow-up in the hospital
01/0
7/01
01/0
1/02
04/0
7/02
04/0
1/03
07/0
7/03
01/0
1/04
Dat
e of
dis
ch./d
eath
, FU
scr
een
01/07/01 01/01/02 04/07/02 04/01/03 07/07/03 01/01/04Date end FU in hosp., pt screen
End FU in hosp > Discharge ??
NSIH day - 20 Feb 200410
Distribution of operations by NNIS Risk Index
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
-1 0 1 2 3 unknown
NNIS Risk Index
No
of o
pera
tions
NSIH day - 20 Feb 200411
SSI rate by NNIS Risk Index
1,5%
2,3%
6,6%
2,4%
0,0%
1,0%
2,0%
3,0%
4,0%
5,0%
6,0%
7,0%
0 1 2+3 unknownNNIS Risk Index
% S
SI
NSIH day - 20 Feb 200412
SSI rate by NNIS operation category
1,1%
6,4%
1,9%
0,8%
1,6% 1,8%
0,0%
1,0%
2,0%
3,0%
4,0%
5,0%
6,0%
7,0%
her colo hpro lam vs cabg
NNIS operation category
% S
SI
NSIH day - 20 Feb 200413
Types of SSI
NSIH day - 20 Feb 200414
Type of SSI by NNIS operation category
0%
20%
40%
60%
80%
100%
HER COLO HPRO LAM VS CBGCNNIS surgical procedure category
% o
f pro
ced
ure
s
Superf. incis.
Deep incis.
Organ/space
NSIH day - 20 Feb 200415
SSI date vs. discharge date
01/0
1/02
02/0
7/02
01/0
1/03
01/0
7/03
Dat
e of
dis
char
ge
01/01/02 02/07/02 01/01/03 01/07/03Infection date
38, 2 %38, 2 %
61, 8 %61, 8 %
NSIH day - 20 Feb 200416
Proportion of SSI diagnosed during hospital stay vs. post-discharge, by surgical procedure category
80,0%
37,5% 46,7% 49,1%27,3%
12,5%
0%
20%
40%
60%
80%
100%
her colo hpro lam vs cabg
NNIS operation category
% o
f SS
I dia
gnos
ed in
hos
p /
post
dis
char
ge
Post discharge
In hospital
NSIH day - 20 Feb 200417
SSI diagnosed after discharge from hospital
l NSIH 1992 - 96: 12,6 %l NSIH 2001 – 03: 38,2 %
Detection source
7%
23%
24%
30%
16%
OPDSurgeon Private
GP
ReadmissionOther
NSIH day - 20 Feb 200418
Discussion & Conclusion
l NSIH - SSI surveillance data : “Flemish data” (Quality decree)
l Missing NNIS Risk Index factors => comparability ?
l Involvement of the surgical profession generally poor (the “owners of the data”)
l Importance of postdischarge surveillance