Reduced risk of surgical site infections through surveillance in a network.
OBJECTIVE
To estimate the effect of multicentre surveillance for nosocomial infections on patients' risk of surgical site infection (SSI).


METHODS
Prospective multi-centre cohort study, from January 1996 to December 2000.


METHODS
Acute care hospitals in The Netherlands.


METHODS
All 50 hospitals performing surveillance for one of seven selected procedures in the Dutch surveillance network for nosocomial infections PREZIES were invited. Thirty-seven hospitals participated (74%) and provided information on 21 920 operations, after which 885 (4%) SSI occurred.


METHODS
The surveillance comprised the following: Development of surveillance methodology by multidisciplinary team; use of a standardized registration protocol and software; regular training of data collectors; anonymous inter-hospital comparison of infection rates and feedback of results; appointment of one contact person per hospital, responsible for data collection; and dissemination of results to other health care professionals. Regular discussion of both successful and failing prevention strategies that had been instituted based on the surveillance results.


METHODS
Risk of SSI.


RESULTS
The risk of infection was reduced for patients who had an operation during the fourth surveillance year (RR = 0.69; 95% confidence interval (CI) = 0.52-0.89) and decreased further for patients operated on during the fifth surveillance year (RR = 0.43; CI = 0.24-0.76) as compared with patients who underwent surgery within one year of the start of surveillance in their hospital. No significant risk reduction was observed for patients operated on during the second and third surveillance years.


CONCLUSIONS
Surveillance, supported by participation in a surveillance network, reduced the risk of SSI in surgical patients registered in the Dutch surveillance network PREZIES. Our results suggest that infection control teams need to be perseverant and that surveillance programmes should be given time before evaluation.
Geubbels
Eveline L P E
EL
Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, The Netherlands.
Nagelkerke
Nico J D
NJ
Mintjes-De Groot
A Joke
AJ
Vandenbroucke-Grauls
Christina M J E
CM
Grobbee
Diederick E
DE
De Boer
Annette S
AS
D000328:Adult; D000368:Aged; D019985:Benchmarking; D005246:Feedback; D006755:Hospital Shared Services; D006801:Humans; D017053:Infection Control / Q000458:organization & administration* / Q000592:standards; D016357:Infection Control Practitioners; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D040442:Public Health Informatics; D011787:Quality of Health Care; D012041:Regional Medical Programs; D018570:Risk Assessment; D012308:Risk Management; D018571:Sentinel Surveillance; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*