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862 Surveillance of surgical site infections by surgeons: biased underreporting or useful epidemiological data?

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Rachel Rosenthal, MD , University Hospital Basel, Basel, Switzerland
Walter P. Weber, MD , University Hospital Basel, Basel, Switzerland
Walter W. Marti, MD, FACS , University Hospital Basel, Basel, Switzerland
Heidi Misteli, MD , University Hospital Basel, Basel, Switzerland
Stefan Reck, MD , University Hospital Basel, Basel, Switzerland
Marc Dangel, MPH , University Hospital Basel, Basel, Switzerland
Daniel Oertli, MD, FACS , University Hospital Basel, Basel, Switzerland
Andreas F. Widmer, MD, MS , University Hospital Basel, Basel, Switzerland
Background: Surgical site infections (SSIs) significantly increase postoperative morbidity and mortality. SSI surveillance is an established monitoring tool and decreases SSI rates.

Objective: The purpose of this study was to compare prospective in-hospital SSI surveillance (I) by the surgical staff and (II) additionally by an infection control team (ICT). (III) The reference method was defined by data generated by the surgical team, supplemented by the ICT and completed by postdischarge surveillance with a postoperative follow-up of one year representing the sum of all available resources.

Methods: During 24 months, all consecutive inpatient procedures (n=6283) were prospectively recorded by the surgical staff until patients' discharge (I). SSI rates were compared to the surveillance performed by the ICT (II) and to the reference method (III).

Results: The overall SSI rate (reference method) was 4.7% (n=293), of which 187 (63.8%) were detected inhospital and 106 (36.2%) after discharge. (I) The surgical staff detected 91/187=48.7% of in-hospital SSIs (91/293=31.0% of the reference), (II) the ICT an additional 96/187=51.3% during hospitalization (96/293=32.8% of the reference). Further cross-checking as performed in the visceral surgery
department increased the surgeons' detection rate (I) to 59/105=56.2% of in-hospital SSIs (59/147=40.1% of the reference).

Conclusions: SSI surveillance by the surgical staff detects almost half of all in-hospital SSIs and has the potential to increase the detection rate by simple interventions such as cross-checking. Such a relatively inexpensive surveillance system is an option for hospitals without an ICT or for low risk surgical procedures. Moreover, trends in SSI rates can easily be detected allowing early intervention.