title: An enhanced benchmark for prosthetic joint replacement infection rates.
abstract: BACKGROUND
  The National Nosocomial Infection Surveillance System (NNIS) has historically provided the infection control community with the most accurate benchmark for healthcare-associated infections. However, NNIS does not require postdischarge surveillance. For medical centers where comprehensive postdischarge surveillance is possible, the efficiency of surgical site infection (SSI) detection is enhanced and rates may be higher than those provided by NNIS.
  
  
  METHODS
  From 1999 to 2004, a large integrated healthcare system (IHCS) used a standard surveillance methodology inclusive of the postdischarge period. This article compares IHCS and NNIS SSI data.
  
  
  RESULTS
  IHCS infection rates, stratified and weighted average (hip, 1.7; knee, 2.1) for the study period are higher than the corresponding NNIS rates (hip, 1.4; knee, 1.2) (hip, P = .006; knee, P = .012) when infections detected by the IHCS during the postdischarge period are included.
  
  
  CONCLUSIONS
  The data from the study period show that when comprehensive postdischarge surveillance is used by the IHCS, SSI rates are higher than those reflected in the NNIS database.
authors.affiliation: Northern California Regional Infection Control, Kaiser Permanente, 1800 Harrison Street, Oakland, CA 94612, USA. sue.barnes@kp.org
authors.forename: Sue
authors.initials: S
authors.lastname: Barnes
authors.forename: Charles
authors.initials: C
authors.lastname: Salemi
authors.forename: Donald
authors.initials: D
authors.lastname: Fithian
authors.forename: Lois
authors.initials: L
authors.lastname: Akiyama
authors.forename: Dana
authors.initials: D
authors.lastname: Barron
authors.forename: Enid
authors.initials: E
authors.lastname: Eck
authors.forename: Kathy
authors.initials: K
authors.lastname: Hoare
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D019985:Benchmarking / Q000458:organization & administration*; D015982:Bias; D002487:Centers for Disease Control and Prevention, U.S.; D003625:Data Collection / Q000592:standards; D003627:Data Interpretation, Statistical; D016208:Databases, Factual / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D017598:Efficiency, Organizational; D017408:Guidelines as Topic; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D007902:Length of Stay / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology