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Surveillance of Surgical Site Infection An overview of results (2004)

Surveillance of Surgical Site Infection An overview of results (2004). Jennie Wilson Programme Lead – SSI surveillance Service, England. Hospitals in Europe Link in Infection Control through Surveillance. SSI surveillance protocol. Patient level dataset NNIS risk index Type of procedure

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Surveillance of Surgical Site Infection An overview of results (2004)

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  1. Surveillance of Surgical Site InfectionAn overview of results (2004) Jennie Wilson Programme Lead – SSI surveillance Service, England Hospitals in Europe Link in Infection Control through Surveillance

  2. SSI surveillance protocol • Patient level dataset • NNIS risk index • Type of procedure • Age/sex • CDC definition for SSI • Micro-organism data optional • Surveillance methods – potential variation • Intensity of case-finding • Post-discharge surveillance • Interpretation of definitions

  3. Participation in HELICS SSI

  4. The HELICS Network of Networks (2004) Scotland 5182 Netherlands 6225 Germany 40 437 Norway SSI network Finland 2854 Poland 6766 Northern Ireland 2001 England 24910 Wales 472 Belgium 588 Luxembourg ICU network Humgary 669 Lithuania 3340 Portugal ICU network Spain 2854 France 16 560 Austria 314

  5. Proportion of countries’ hospitals contributing data to HELICS

  6. Case-mix adjustment: NNIS Risk Index

  7. Distribution of risk Index by countryHip prosthesis

  8. Type of SSI reported: Hip prosthesis

  9. Median post-operative length of hospital stay & inter-country variation

  10. Post-discharge surveillance • Not a requirement in all countries • Variation in PDS intensity • Application of case definitions

  11. Proportion of SSI detected after discharge * Excludes 4 countries where PDS data not available/collected

  12. Daily incidence rate of SSI (all procedures)

  13. Rates (cumulative incidence) of SSI by surgical category (95%CL)

  14. Cumulative incidence of SSI by category (inter-country range) Incidence density of SSI by category (inter-country range)

  15. Comparison of cumulative incidence and incidence density for hip prosthesis

  16. Potential impact of case-mix Example: ICD9 CM codes for Hip replacements

  17. Inter-country variation in type of hip procedure

  18. Conclusions It’s complicated! ….but valuable

  19. Limitations • Differences in patient and operation characteristics • Risk index • Age • Procedure type • Differences in case finding • Type of SSI • Differences in length of inpatient stay • PDS – intensity • Discharge data

  20. Opportunities • Large dataset • Includes PDS data • Explore relationships with time post-op • Develop risk models • Useful comparators • Common protocol a major achievement • Framework to encourage SSI surveillance • Need to enhance • micro data • PDS • Procedure codes

  21. Acknowledgements • HELICS data analysis group, especially Ilse Ramboer and Carl Suetens • Surveillance networks & their co-coordinators

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