Gastmeier P, Sohr D, Brandt C, Eckmanns T, Behnke M, Rüden H
Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Arch Orthop Trauma Surg. 2005 Oct;125(8):526-30. doi: 10.1007/s00402-005-0036-y. Epub 2005 Oct 22.
The German national nosocomial infections surveillance system (KISS) has been collecting surveillance data from hip and knee prosthesis operations since 1997. The purpose of this article is to investigate whether surveillance and feedback of surgical site infection (SSI) information to the physicians and nurses of participating hospitals lead to reduced SSI rates or not.
Only information from hospitals previously participating for at least 3 years was used for the analysis. Monthly SSI rates were pooled over the 36-month period, beginning in each clinic's case with its first month of participation, the rates then being compared for 12-month periods. Relative risks were calculated for comparison of the SSI rates in the first and third years of participation. A multiple logistic regression analysis with stepwise variable selection was performed to identify significant risk factors, including the year of surveillance after starting surveillance activities.
The overall SSI rates were 1.4% for hip prosthesis and 1.0% for knee prosthesis. Fourteen clinics participated in KISS for at least 3 years continuously with HIP prostheses and 21 with knee prostheses. It was possible to include a total of 15,457 hip and 9,011 knee procedures for this analysis. A comparison of data from the first and the third years show a significant SSI reduction with hip procedures, with a relative risk of 0.54 (CI95 0.38-0.77), and a trend towards reduced SSI rates for knee procedures. The multiple logistic regression analysis confirmed that the SSI rate for hip prosthesis was significantly lower in the third year than in the first year of surveillance (OR = 0.57; CI95 0.42-0.78), though for knee prosthesis the level of significance was not achieved.
A reduction of SSIs following hip and knee prosthesis operations through the introduction of ongoing surveillance and the possibility of using benchmark data for comparison does seem to be possible in many institutions.
德国国家医院感染监测系统（KISS）自1997年以来一直在收集髋关节和膝关节假体手术的监测数据。本文的目的是调查向参与医院的医生和护士提供手术部位感染（SSI）信息的监测和反馈是否会降低SSI发生率。
仅使用此前至少参与3年的医院的信息进行分析。每月的SSI发生率汇总在36个月期间，从每个诊所参与的第一个月开始计算，然后对12个月期间的发生率进行比较。计算相对风险以比较参与的第一年和第三年的SSI发生率。进行逐步变量选择的多元逻辑回归分析以确定显著的风险因素，包括开始监测活动后的监测年份。
髋关节假体的总体SSI发生率为1.4%，膝关节假体为1.0%。14个诊所连续至少3年参与KISS进行髋关节假体手术监测，21个诊所参与膝关节假体手术监测。本次分析共纳入了15457例髋关节手术和9011例膝关节手术。第一年和第三年的数据比较显示，髋关节手术的SSI显著降低，相对风险为0.54（95%CI 0.38 - 0.77），膝关节手术的SSI发生率有降低趋势。多元逻辑回归分析证实，髋关节假体手术的SSI发生率在监测的第三年显著低于第一年（OR = 0.57；95%CI 0.42 - 0.78），尽管膝关节假体手术未达到显著水平。
通过引入持续监测以及使用基准数据进行比较，在许多机构中似乎确实有可能降低髋关节和膝关节假体手术后的SSI发生率。
