scholarly journals Surgical Site Infection (SSI) Rates in the United States, 1992–1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

2001 ◽  
Vol 33 (s2) ◽  
pp. S69-S77 ◽  
Author(s):  
Robert P. Gaynes ◽  
David H. Culver ◽  
Teresa C. Horan ◽  
Jonathan R. Edwards ◽  
Chesley Richards ◽  
...  
Keyword(s):  
United States ◽  
Surgical Site Infection ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Risk Index ◽  
The United States ◽  
Site Infection

Validation of a Modified Version of the National Nosocomial Infections Surveillance System Risk Index for Health Services Research

2009 ◽  
Vol 30 (6) ◽  
pp. 563-569 ◽  
Author(s):  
Nick Daneman ◽  
Andrew E. Simor ◽  
Donald A. Redelmeier
Keyword(s):  
Surgical Site Infection ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Elective Surgery ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Population Based ◽  
Site Infection ◽  
Services Research ◽  
System Risk

Objective.To validate the National Nosocomial Infections Surveillance system risk index through administrative data to predict surgical site infections.Design.Retrospective cohort study.Setting.Population-based analysis in Ontario, Canada.Patients.All elderly patients who underwent elective surgery from April 1, 1992, through March 31, 2006 (n = 469,349).Methods.Data on procedural and patient outcomes were gathered from linked population-wide hospital discharge records and physician claims. The 75th percentile of surgical duration was estimated through anesthesiologist billing fees recorded in 15-minute increments; the American Society of Anesthesiology score of at least 3 out of 5 was estimated by diagnostic codes for severe systemic illness; and all surgeries were classified as clean or clean-contaminated because of their elective nature (thus, the maximum score on the modified index was 2).Results.A total of 147,216 surgeries (31%) had a score of 0;246,592 (53%) had a score of 1; and 75,541 (16%) had a score of 2 on the modified index. The 30-day risk of surgical site infection increased with each increment in the modified index (score of 0, 5.4%; score of 1, 8.0%; score of 2, 14.3%; P < .001). The association was evident for surgical site infection diagnosed during the index admission (score of 0, 2.0%; score of 1, 3.7%; score of 2, 8.9%; P < .001), as well as that associated with reoperation or death (score of 0, 0.04%; score of 1, 0.23%; score of 2, 0.73%; P < .001). The modified index predicted increases in surgical site infection risk within each of 11 surgical subgroups. In accord with past research, the modified index had modest discrimination (C statistic, 0.59), and the majority of surgical site infections (72%) occurred within lower risk strata.Conclusions.The modified index predicts surgical site infection in population-based analyses and is associated with incremental increases in risk.

Accounting for Incomplete Postdischarge Follow-Up During Surveillance of Surgical Site Infection by Use of the National Nosocomial Infections Surveillance System's Risk Index

2009 ◽  
Vol 30 (5) ◽  
pp. 433-439 ◽  
Author(s):  
Fernando Martín Biscione ◽  
Renato Camargos Couto ◽  
Tânia M. G. Pedrosa
Keyword(s):  
Surgical Site Infection ◽  
Nosocomial Infections ◽  
Goodness Of Fit ◽  
Risk Index ◽  
Operative Procedures ◽  
Site Infection ◽  
Goodness Of Fit Test ◽  
Simple Method ◽  
Genitourinary System

Objective.We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index.Design.Retrospective cohort study that used data prospectively collected from 1993 through 2006.Setting.Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil.Patients.Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies.Methods.For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated.Results.The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy.Conclusions.Compared with the NNIS-based model, the modified NNIS-based model added potentially useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.

The Standardized Incidence Ratio as a Reliable Tool for Surgical Site Infection Surveillance

2006 ◽  
Vol 27 (08) ◽  
pp. 817-824 ◽  
Author(s):  
Christophe Rioux ◽  
Bruno Grandbastien ◽  
Pascal Astagneau
Keyword(s):  
Surgical Site Infection ◽  
Incidence Rate ◽  
Surveillance System ◽  
Risk Index ◽  
Temporal Trends ◽  
Site Infection ◽  
Standardized Incidence Ratio ◽  
Surveillance Network ◽  
Reliable Tool ◽  
Number Of Patients

Objective.To evaluate whether the standardized incidence ratio (SIR) is a more reliable tool for comparing rates and temporal trends of surgical site infection (SSI) in surgery wards than the incidence rate among patients with an National Nosocomial Infections Surveillance system (NNIS) risk index category of 0.Design.Observational, prospective cohort study in a sequential SSI surveillance system.Setting.Volunteer surgery wards in a surveillance network in northern France that annually conducted SSI surveillance for 3 months from 1998 to 2000.Methods.The incidence rate was the number of SSIs divided by the number of patients included, stratified by the NNIS risk index category. SIR was the observed number of SSIs divided by the expected number computed using a multiple regression model.Results.Overall, 26,904 patients in 67 surgery wards were enrolled. Between 1998 and 2000, the SSI incidence rate among patients with NNIS risk index category 0 decreased from 2.1% to 1.4%, which was a 33% reduction (P= .002). The SIR decreased from 1.2 (95% confidence interval [CI], 1.1-1.3) to 0.8 (95% CI, 0.7-0.9), which was a 20% decrease per year and an overall 33% reduction. The number of SSIs was significantly higher than expected in 17 of 201 surveillance periods over the 3 years. The classification of the wards according to the 2 indicators over the 3 years showed that wards with a high SIR did not consistently have the highest SSI incidence rate among patients with NNIS risk index category 0, partly because the type of surgical procedure and the duration of follow-up are not taken into account in the NNIS risk index.Conclusion.SIR should be considered a reliable indicator to estimate the reduction in SSI incidence that results from implementation of infection control policies and for comparison of SSI rates between wards.

Nosocomial Infections in Surgical Patients in the United States, January 1986-June 1992

1993 ◽  
Vol 14 (2) ◽  
pp. 73-80 ◽  
Author(s):  
Teresa C. Horan ◽  
David H. Culver ◽  
Robert P. Gaynes ◽  
William R. Jarvis ◽  
Jonathan R. Edwards ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Nosocomial Infection ◽  
Surgical Site Infection ◽  
Bloodstream Infection ◽  
Nosocomial Infections ◽  
The United States ◽  
Surgical Patients ◽  
Site Infection

AbstractObjectives:To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.Design:Surveillance of surgical patients during January 1986-June 1992 using standard definitions and protocols for both comprehensive (all sites, all operations) and targeted (all sites, selected operations) infection detection.Setting and Patients:Acute care US hospitals participating in the National Nosocomial Infection Surveillance (NNIS) System: 42,509 patients with 52,388 infections from 95 hospitals using comprehensive surveillance protocols and an additional 5,659 patients with 6,963 infections from 11 more hospitals using a targeted protocol.Results:Surgical site infection was the most common nosocomial infection site (37%) when data were reported by hospitals using the comprehensive protocols. When infections reported from both types of protocols were stratified by type of operation, other sites were most frequent following certain operations (e.g., urinary tract infection after joint prosthesis surgery [52%]). Among the infected surgical patients who died, the probability that an infection was related to the patient's death varied significantly with the site of infection, from 22% for urinary tract infection to 89% for organ/space surgical site infection, but was independent of the type of operation performed. The probability of developing a secondary bloodstream infection also varied significantly with the primary site of infection, from 3.1% for incisional surgical site infection to 9.5% for organ/space surgical site infection (p<.001). For all infections except pneumonia, the risk of developing a secondary bloodstream infection also varied significantly with the type of operation performed (p<.00l) and was generally highest for cardiac surgery and lowest for abdominal hysterectomy. Surgical patients who developed ventilator-associated pneumonia were more than twice as likely to develop a secondary bloodstream infection as nonventilated pneumonia patients (8.1% versus 3.3%, p<.001).Conclusions:For surgical patients with nosocomial infection, the distribution of nosocomial infections by site varies by type of operation, the frequency with which nosocomial infections contribute to patient mortality varies by site of infection but not by type of operation, and the risk of developing a secondary bloodstream infection varies by type of primary infection and, except for pneumonia, by type of operation.

Validating a 3-Point Prediction Rule for Surgical Site Infection after Coronary Artery Bypass Surgery

2010 ◽  
Vol 31 (1) ◽  
pp. 64-68 ◽  
Author(s):  
Luke F. Chen ◽  
Deverick J. Anderson ◽  
Keith S. Kaye ◽  
Daniel J. Sexton
Keyword(s):  
Coronary Artery ◽  
Surgical Site Infection ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Risk Index ◽  
The United States ◽  
Site Infection ◽  
Cabg Surgery ◽  
Control Subjects ◽  
Clinical Risk

Background.Surgical site infection (SSI) after coronary artery bypass graft (CABG) surgery is an increasing healthcare problem. Investigators from Australia proposed a new, 3-point scale that assesses SSI risk on the basis of diagnosis of diabetes mellitus and body mass index.Objective.To validate the Australian Clinical Risk Index among patients undergoing CABG surgery in the United States.Design and Setting.Nested case-control study involving patients undergoing CABG surgery at 9 hospitals during 1991-2002.Patients.Case patients were those who developed SSIs after CABG surgery. Control subjects were matched to case patients on the basis of hospital, age, and procedure date.Methods.Odds ratios (ORs) for SSIs were calculated for the comparison of case patients with control subjects for all risk categories determined using the Australian Clinical Risk Index and National Nosocomial Infections Surveillance System (NNIS) risk index. An adjusted area under the curve was used to compare predictive values among risk indices.Results.Four hundred sixty patients were studied, including 269 patients with SSI and 191 control subjects. NNIS risk group 2 was associated with increased rate of SSI (OR, 1.79; 95% confidence interval [CI], 1.19-2.67). No patient had an NNIS risk index of 3. The remaining NNIS categories were not predictive of infection. In contrast, an increase in Australian Clinical Risk Index was associated with an increase in risk of SSI (category 2: OR, 2.39 [95% CI, 1.33-4.29]; category 3: OR, 4.46 [95% CI, 1.83-10.85]).Conclusions.The NNIS risk index predicts the risk of SSI associated with many procedures, but it has limited use in predicting the risk of SSI after CABG surgery. The new Australian Clinical Risk Index stratified patients into discrete groups associated with increased risk of SSI. Data from our study support the use of this new risk index in the US population.

Predictors of Hospital Readmission and Surgical Site Infection in the United States, Denmark, and Japan

Spine ◽  
2017 ◽  
Vol 42 (17) ◽  
pp. 1311-1315 ◽  
Author(s):  
Steven Glassman ◽  
Leah Y. Carreon ◽  
Mikkel Andersen ◽  
Anthony Asher ◽  
Soren Eiskjær ◽  
...  
Keyword(s):  
United States ◽  
Surgical Site Infection ◽  
Hospital Readmission ◽  
The United States ◽  
Site Infection
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