Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Am J Infect Control. 2021 Feb;49(2):188-193. doi: 10.1016/j.ajic.2020.06.211. Epub 2020 Jul 2.
The impact of variability in infection surveillance methodologies on publicly reported rates of surgical site infection (SSI) is not well defined.
We performed a cross-sectional study to assess infection preventionists' surveillance practices across acute care US hospitals. We collected self-reported annual facility standardized infection ratios for colon surgery and abdominal hysterectomy as provided by the National Healthcare Safety Network. Trend analysis using Kendall's rank correlation evaluated the association between surveillance rigor and SSI rates.
Among 492 participating hospitals, 63%, 15%, 13%, and 8% were community, university-affiliated, critical access, and ambulatory surgical centers, respectively. Most critical access hospitals (82%) and ambulatory surgical centers (98%) reported less than one full time infection preventionists (P ≤ .001). University-affiliated medical centers spent significantly more time and used more data sources for monthly SSI review compared with other hospitals. Critical access hospitals and ambulatory surgical centers were more likely to rely on manual surveillance only (P < .001). The number of different data sources used for SSI surveillance was positively associated with higher SSI rates: (K 0.14, P = .028 for colon SSI in 2017; K 0.20, P = .009 for hysterectomy SSI in 2016; K 0.25, P = .001 for hysterectomy SSI in 2017).
Rigorous SSI surveillance using more data sources for case-finding is more likely to be associated with higher facility SSI rates for colon surgery and abdominal hysterectomy.
感染监测方法的变异性对公开报告的手术部位感染（SSI）率的影响尚不清楚。
我们进行了一项横断面研究，以评估美国急性护理医院感染预防人员的监测实践。我们收集了全国医疗保健安全网络提供的结肠手术和腹式子宫切除术的年度设施标准化感染比的自我报告。使用 Kendall 等级相关分析评估监测严格程度与 SSI 率之间的关联。
在 492 家参与医院中，分别有 63%、15%、13%和 8%为社区、大学附属、基层医疗和日间手术中心。大多数基层医疗中心（82%）和日间手术中心（98%）报告的全职感染预防人员少于一人（P≤0.001）。与其他医院相比，大学附属医疗中心每月 SSI 审查花费的时间和使用的数据来源更多。基层医疗中心和日间手术中心更有可能仅依赖手动监测（P<0.001）。用于 SSI 监测的不同数据来源的数量与更高的 SSI 率呈正相关：（2017 年结肠 SSI 的 K 0.14，P=0.028；2016 年子宫切除术 SSI 的 K 0.20，P=0.009；2017 年子宫切除术 SSI 的 K 0.25，P=0.001）。
使用更多数据来源进行病例发现的严格 SSI 监测更有可能与结肠手术和腹式子宫切除术的设施 SSI 率较高相关。
