Surveillance of surgical-site infections: impact on quality of care and reporting dilemmas

Abstract

Among a wide range of publications on surgical-site infections (SSIs), many issues are still controversial, especially those concerning their monitoring and feedback. This review focuses on recent advances in surveillance as a tool for improving healthcare quality performance in surgery. Recent data were obtained from many reference surveillance systems which tend to demonstrate significant decrease in SSI incidence rates over a several-year period. Most studies emphasize data feedback to surgical team is an important way to improve care quality and surgical performance. Few data demonstrated the relationship between the lack of compliance to control measures and SSI risk, including suboptimal antibiotic prophylaxis, perforated gloves, control of blood glucose, and avoidance of shaving. No clear consensus is achieved yet regarding preoperative systematic screening and decolonization of multidrug-resistant Staphylococcus aureus. There is a good amount of recent data regarding the benchmark approach for ranking surgery wards according to SSI rates. However, methodological issues on SSI indicator for public reporting are still being debated. Pilot studies attempt to demonstrate the usefulness of more cost-effective surveillance systems, especially those based on automated data process. There are new exciting developments and perspectives in the field of surveillance and control of SSI. More data are needed to better establish the relationship with global care quality.