Surgical Site Infection (SSI) Surveillance in Caesarean Section Procedures in Wales - A Cut Above

Background: In 2004 The Welsh Healthcare Associated Infection Programme (WHAIP) was tasked by the Welsh Assembly Government (WAG) to develop and support the implementation of SSI surveillance following Caesarean section procedures in Wales. SSI is the second most common infection following a Caesarean section in healthy females. The surveillance became mandatory in 2006.

Objective: Coordinate a means of capturing inpatient and post-discharge SSI data following Caesarean section procedures from all hospitals in Wales. Engage clinical teams and encourage the collection of reliable data by providing timely meaningful feedback. Reduce the SSI rate by identifying possible risk factors. Provide clinical teams with training as required in data analysis and translating results into practical risk prevention measures.

Methods: A form was created to capture inpatient and post-discharge data based on the Pan Celtic collaboration core dataset with internationally agreed definitions. In addition, questions to identify possible risk factors relevant to hospital practice in Wales were included. A surveillance coordinator was identified in each hospital to monitor form return. A steering group was established to provide clinical guidance and advice to WHAIP. Training workshops were run instructing on form completion and diagnosis of SSI based on the definitions. Quarterly reports are produced detailing compliance and SSI rates. A web based reporting tool was developed to allow hospital staff access to more timely data. Training was provided in running reports, data manipulation, turning results into practical interventions and measuring outcomes.

Results: In 2007 the compliance rate was 38%. WHAIP attended audit meetings to report on form completion and SSI rates. Following clinical feedback the form was reduced and redesigned with clearer instructions. Compliance rose to 53% in 2008. From 2009 hospitals have had access to a web based reporting tool and training has been provided. Compliance has increased to 71% and form completion has improved with 89% of returned forms included in analysis compared to 71% in 2007. As compliance and form completion improve the SSI rate has dropped from 21.4% (2007) to 12.4% (2009). 92% of inpatient forms have a post-discharge record. Clinician engagement has also increased as data has become more reliable and they in turn are encouraging improvements in data return.

Conclusions: A successful surveillance system relies on clinical engagement. Providing timely relevant feedback and training on how to interpret feedback is vital to keep staff involved and encourages them to provide complete data. It is important to agree all data items in the initial stages and use national definitions to ensure data is comparable over time. As the quality and validity of the data has improved interest from clinical teams has increased and this surveillance has become fully embedded in clinical practice.