Surgical site infection (SSI) surveillance in France: a benchmarking experience through a network during the last decade

Background: SSI is one of the most frequent healthcare-associated infections. Since 1999, French authorities have set up a coordination of the regional surveillance networks to gather national SSI incidence data. In parallel, a national campaign was implemented to promote benchmarking through the network and guidelines on SSI preventive measures.

Objective: The aim of the current study was to describe the largest database ever collected in France on SSI and to analyze temporal trends.

Methods: Surgery patients were enrolled by voluntary participating surgical wards in a yearly 3-month incidence survey. In each ward, 100 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard international criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Regional and national reports were edited yearly feeding back the overall results of the network to all participants including the rank of surgery units. Temporal variation of incidence risk was tested using chi-square for linear trends and multivariate logistic regression model. 

Results: Since 1999, 1,179,418 operations (35,626,300 operated patients-days follow-up; median post-operative follow-up: 29 days). The overall crude SSI incidence rate was 1.47%. Organ space and deep incisional SSI accounted for 42.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.84% for NNIS-0 patients to 5.94% for NNIS-2, 3 patients. The SSI incidence varied from 0.49% for knee prosthesis to 9.24% for colon surgery. From 1999 to 2007, NNIS-0 SSI incidence decreased from 1.10 to 0.80 for 100 operated patients. Over the last 4 years 2004-2007, 65% of surgery wards had SSI incidence rate lower than the median reference value in 2004. The decrease was the most significant for hernia repair (-68%) and cholecystectomy (-62%) NNIS-0 incidence rates. Multivariate analysis showed a -29.5% relative decrease of SSI risk over the study period.

Conclusions: These encouraging results demonstrate the potential impact of the national policy on SSI reduction in France, although efforts have to be maintained for some specific surgery