Abstract
BackgroundSurgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method.MethodsThis study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics.ResultsTotally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%.ConclusionTo recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.
Highlights
Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications
SSI is a kind of Nosocomial Infections (NIs) - called Health care-associated Infections (HAIs) that occur within 30 days of the procedure or in a one-year period if mechanical or prosthetic material is implanted at surgery [2]
The results of studying 503 SSIs in six educational hospitals during the 2017–2018 period showed that the coverage percentages based on existing data in Nosocomial Infections Surveillance system (NNIS) and Health Information Management (HIM) were 59.95 and 65.17%, respectively (Table 1)
Summary
Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. Surgical Site Infection (SSI) is one of the most common surgical-related problems in the world, especially in developing countries [1]. According to the past reports, the incidence rate of SSI is globally about 10–20% [4] and is the most frequent type of HAIs in low and middle income countries [5]. As stated by the World Health Organization (WHO), due to the limited and low quality of data in low and middle-income countries, the incidence and prevalence of SSIs are underestimated. The overall prevalence of HAI in Iran, as a middle-upper-income country, was about 4.5% in 2017, where bloodstream infections, surgical site infections, and pneumonia were the most common types of HAIs in Iran, respectively [4]
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