Trends in the incidence of surgical site infection in the Netherlands.
OBJECTIVE
To evaluate the time trend in the surgical site infection (SSI) rate in relation to the duration of surveillance in The Netherlands.


METHODS
Forty-two hospitals that participated in the the Dutch national nosocomial surveillance network, which is known as PREZIES (Preventie van Ziekenhuisinfecties door Surveillance), and that registered at least 1 of the following 5 frequently performed surgical procedures for at least 3 years during the period from 1996 through 2006: mastectomy, colectomy, replacement of the head of the femur, total hip arthroplasty, or knee arthroplasty.


METHODS
Analyses were performed for each surgical procedure. The surveillance time to operation was stratified in consecutive 1-year periods, with the first year as reference. Multivariate logistic regression analysis was performed using a random coefficient model to adjust for random variation among hospitals. All models were adjusted for method of postdischarge surveillance.


RESULTS
The number of procedures varied from 3,031 for colectomy to 31,407 for total hip arthroplasty, and the SSI rate varied from 1.6% for knee arthroplasty to 12.2% for colectomy. For total hip arthroplasty, the SSI rate decreased significantly by 6% per year of surveillance (odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.90-0.98]), indicating a 60% decrease after 10 years. Nonsignificant but substantial decreasing trends in the rate of SSI were found for replacement of the head of the femur (OR, 0.94 [95% CI, 0.88-1.00]) and for colectomy (OR, 0.92 [95% CI, 0.83-1.02]).


CONCLUSIONS
Even though most decreasing trends in the SSI rate were not statistically significant, they were encouraging. To use limited resources as efficiently as possible, we would suggest switching the surveillance to another surgical procedure when the SSI rate for that particular procedure has decreased below the target rate.
Manniën
Judith
J
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Judith.Mannien@rivm.nl
van den Hof
Susan
S
Muilwijk
Jan
J
van den Broek
Peterhans J
PJ
van Benthem
Birgit
B
Wille
Jan C
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology*