Surveillance of surgical site infections after gastrointestinal surgery in the south region of the Netherlands

Stéphanie Breukink,Amita Ramcharan,Jan Tordoir,Ed Smeets,Cor Baeten,Margriet Rouflart,Cathrien Bruggeman,Frank Tiel, Van

doi:10.3396/ijic.v10i2.012.14

Abstract

A surgical site infection (SSI) is a serious and costly complication with the highest rates being reported after gastrointestinal surgery. The objective of this cross sectional study was to assess the incidence and risk factors of SSI after gastrointestinal surgery during and after hospitalization, and to evaluate the effect of the VMS (Dutch: “VeiligheidsManagementSysteem”) safety programme on the SSI rate. We assessed the SSI rate from July 2008 until December 2011, according to the criteria of the Centres for Disease Control and Prevention (CDC), before and after implementation of the VMS safety programme which includes a bundle of four interventions. We differentiated between the SSI rate during and after hospitalization and between superficial, deep and organ/ space infections. The incidence of SSI in relation to the wound class, risk factors for SSI, and the compliance with the programme were assessed. Data were obtained during a thirty-day follow-up period after surgery. Surveillance after discharge significantly increased the overall SSI rate. Age higher than fifty years and contaminated or dirty wounds were risk factors for SSIs. Despite increased compliance with the safety programme, no significant decrease in SSI rate was found after implementation. The Dutch VMS safety programme did not show a significant effect on the decrease in incidence of SSI. Surveillance during and after hospitalization is essential for a reliable assessment of the SSI rate.

Highlights

To evaluate the factors determining the effect of the VMS safety programme on the surgical site infection (SSI) rate after
Page 6 of 10 not for citation purposes gastrointestinal surgery, we compared the incidence during the pre-test period with the incidence during the post-test period
We showed that for a reliable assessment of the SSI rate, surveillance during and after hospitalisation is crucial

Summary

Introduction

A surgical site infection (SSI) is a serious and costly complication resulting in prolonged hospital stay, increased antibiotic use, increased morbidity, and even mortality.[1,2,3,4] SSIs affect up to 5% of surgical patients, with the highest rates being reported after gastrointestinal surgery.[5,6,7,8,9] The negative effect that SSI has on patient safety depends partly on whether the infection is superficial or deep or whether it concerns organ or space, i.e. any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure.[8,10] Since the risk of an SSI is amongst others associated with the degree of intrinsic microbial contamination of the surgical wound, wounds are classified into four wound classes.[11]Patients with advanced stages of disease and multiple co-morbid diagnoses are often referred to a tertiarycare hospital for further treatment.[12]. Analysis of patients’ clinical data and feedback to healthcare workers.[11,16,17,18,19]

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Conclusion