Surgical wound infection surveillance: results from the Belgian hospital network.

Since October 1992, the Belgian National Programme for the Surveillance of Hospital Infections has been implemented successfully in more than two-thirds of all Belgian acute-care institutions. Practitioners from hospitals participating in the surgical wound infection surveillance describe a selection of surgical procedures, practices connected (antimicrobial prophylaxis), and record the eventual infection, enabling the calculation of wound infection rates. The network allows comparisons of each hospital results with the national picture. From October 1992 to June 1993, 16,799 procedures were recorded by 51 hospitals; the crude incidence rate of infection was 1.47 per 100 operations. However, this figure may be an underestimation of the reality because of potentially missed post-discharge infections. Risk factors significantly associated with infection include length of preoperative stay, emergency, duration of surgery, wound contamination class, and American Society of Anesthesiologists (ASA) score. The National Nosocomial Infections Surveillance system (NNIS) risk index, a combination of the three latter shows a good correlation for predicting infection. Increased length of stay attributable to the infection was computed at 8.9 days. Micro-organisms isolated reveal a staphylococcal predominance. Antibiotic prophylaxis prescription present satisfactory quality performances regarding duration and time of initiation but rational prescribing about the indications is still of concern.