Tissingh E K, Sudlow A, Jones A, Nolan J F
Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Bone Joint J. 2017 Feb;99-B(2):171-174. doi: 10.1302/0301-620X.99B2.BJJ-2016-0420.R1.
The importance of accurate identification and reporting of surgical site infection (SSI) is well recognised but poorly defined. Public Health England (PHE) mandated collection of orthopaedic SSI data in 2004. Data submission is required in one of four categories (hip prosthesis, knee prosthesis, repair of neck of femur, reduction of long bone fracture) for one quarter per year. Trusts are encouraged to carry out post-discharge surveillance but this is not mandatory. Recent papers in the orthopaedic literature have highlighted the importance of SSI surveillance and the heterogeneity of surveillance methods. However, details of current orthopaedic SSI surveillance practice has not been described or quantified.
All 147 NHS trusts in England were audited using a structured questionnaire. Data was collected in the following categories: data collection; data submission to PHE; definitions used; resource constraints; post-discharge surveillance and SSI rates in the four PHE categories. The response rate was 87.7%.
Variation in practice was clear in all categories in terms of methods and timings of data collection and data submission. There was little agreement on SSI definitions. At least six different definitions were used, some trusts using more than one definition. Post-discharge surveillance was carried out by 62% of respondents but there was again variation in both the methods and staff used. More than half of the respondents felt that SSI surveillance in their unit was limited by resource constraints. SSI rates ranged from 0% to 10%.
This paper quantifies the heterogeneity of SSI surveillance in England. It highlights the importance of adequate resourcing and the unreliability of relying on voluntary data collection and submission. Conformity of definitions and methods are recommended to enable meaningful SSI data to be collated. Cite this article: Bone Joint J 2017;99-B:171-4.
准确识别和报告手术部位感染（SSI）的重要性已得到广泛认可，但定义尚不明确。英国公共卫生部（PHE）于2004年规定收集骨科SSI数据。每年需按四个类别（髋关节假体、膝关节假体、股骨颈修复、长骨骨折复位）之一提交一个季度的数据。鼓励信托机构开展出院后监测，但这并非强制性要求。骨科文献中的近期论文强调了SSI监测的重要性以及监测方法的异质性。然而，目前骨科SSI监测实践的细节尚未得到描述或量化。
使用结构化问卷对英格兰所有147家国民健康服务信托机构进行审核。收集以下类别的数据：数据收集；向PHE提交的数据；使用的定义；资源限制；出院后监测以及PHE四个类别中的SSI发生率。回复率为87.7%。
在数据收集和提交的方法及时间方面，所有类别在实践中均存在明显差异。对于SSI的定义几乎没有达成共识。至少使用了六种不同的定义，一些信托机构使用不止一种定义。62%的受访者开展了出院后监测，但在方法和人员使用方面同样存在差异。超过一半的受访者认为其所在单位的SSI监测受到资源限制。SSI发生率在0%至10%之间。
本文量化了英格兰SSI监测的异质性。它强调了充足资源的重要性以及依赖自愿数据收集和提交的不可靠性。建议统一定义和方法，以便能够整理出有意义的SSI数据。引用本文：《骨与关节杂志》2017年；99 - B：171 - 4。
