Validation of coronary artery bypass graft surgical site infection surveillance data from a statewide surveillance system in Australia.
OBJECTIVE
To measure the accuracy and determine the positive predictive value (PPV) and negative predictive value (NPV) of data submitted to a statewide surveillance system for identifying surgical site infection (SSI) complicating coronary artery bypass graft (CABG) surgery.


METHODS
Retrospective review of hospital medical records comparing SSI data with surveillance data submitted by infection control consultants (ICCs).


METHODS
Victorian Hospital Acquired Infection Surveillance System (VICNISS) Coordinating Centre in Victoria, Australia.


METHODS
All patients reported to have an SSI following CABG surgery and a random sample of approximately 10% of patients reported not to have an SSI following CABG surgery.


RESULTS
The VICNISS ascertainment rate for CABG procedures in Victoria was 95%. One hundred sixty-nine medical records were reviewed, and reviewers agreed with ICCs about 46 (96%) of the patients reported as infected by the ICCs and 31 (91%) of the patients identified with a sternal SSI by the ICCs. In one-third of SSIs, the depth of SSI documented by ICCs was discordant with that documented by the reviewers. Disagreement about patients with donor site SSI was frequent. When the review findings were used as the reference standard, the PPV for ICC-reported SSI was 96% (95% confidence interval [CI], 86%-99%), and the NPV was 97% (95% CI, 92%-99%). For ICC-reported sternal SSI, the PPV was 91% (95% CI, 76%-98%) and the NPV was 98% (95% CI, 94%-100%).


CONCLUSIONS
There was broad agreement on the number of infected patients and the number of patients with sternal SSI. However, discordance was frequent with respect to the depth of sternal SSI and the identification of donor site SSI. We recommend modifications to the methodology for National Nosocomial Infection Surveillance System-based surveillance for SSI following CABG surgery.
Friedman
N Deborah
ND
Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, North Melbourne, Australia. friedman.deb@gmail.com
Russo
Philip L
PL
Bull
Ann L
AL
Richards
Michael J
MJ
Kelly
Heath
H
D001315:Australia / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D011182:Postoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology*