Developing a Practical Surveillance Tool for Surgical Site Infections after Clean Orthopedic Surgeries

Background:

Surgical site infection (SSI) is the most frequent complication in operated patients. It is well known that monitoring the SSI rate leads to its decrease but an ongoing surveillance is labor intensive. During 2008, we have started a surveillance of SSI in clean surgeries in the department of orthopedic surgery at the Hadassah Mount Scopus hospital in Jerusalem in cooperation with the medical staff.

Objective:

Embedding an ongoing surveillance program in the department's clinical activity.

Methods:

The study population included all the patients undergoing clean hip, knee or back surgeries. Infection was identified according to the CDC criteria. Demographic and clinical information was collected by an infection control nurse. Daily assessment of the surgical wound was performed by the attending surgeon. Follow-up after discharge was done by the surgeon during the post operative outpatient clinic visit. Patients, for whom the clinic follow-up form was not completed, were interviewed by a n infection control nurse by phone using a structured questionnaire. Additional phone call is planned one year after the operation. The data were analyzed using SPSS version 14 statistical software.

Results:

During the first year 706 operations were followed: hip procedures – 396 (57%); knee – 265 (37%); back – 44 (6%). In 96% of the cases the wound was adequately assessed during hospitalization by the attending physician.  Wound assessment after discharge was performed in all patients at the six weeks follow up outpatient visit; in 32% the results of this examination were adequately recorded; the remainders were assessed by telephone.  Most of the infections were identified after discharge (84%); all were subsequently hospitalized or at least were examined in the emergency department.

Conclusions:

This ongoing monitoring allows comparison to the NHSN data and gives information concerning the quality of care in the department. In order to decrease the surveillance work load there is a need to assimilate this surveillance in the computerized records. The fact that every patient who developed a SSI after discharge was readmitted, allows us to give-up the phone calls and to follow only patients who returned to the hospital.