The impact of depth of infection and postdischarge surveillance on rate of surgical-site infections in a network of community hospitals.
OBJECTIVE
To describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI.


METHODS
Retrospective cohort study.


METHODS
Thirty-seven community hospitals in the southeastern United States.


METHODS
Consecutive sample of patients undergoing surgical procedures between July 1, 2007, and December 31, 2008.


METHODS
ANOVA was used to compare rates of SSIs, and the F test was used to compare the distribution of rates of SSIs. Wilcoxon Signed Rank test [corrected] was used to test for differences in performance rankings of hospitals.


RESULTS
Following 177,706 surgical procedures, 1,919 SSIs were identified (incidence, 1.08 per 100 procedures). Sixty-four percent (1,223 of 1,919) of these were identified as complex SSIs; 87% of the complex SSIs were diagnosed in inpatient settings. The median proportion of superficial-incisional SSIs was 37% (interquartile range, 29.6%-49.5%). Postdischarge SSI surveillance was variable, with 58% of responding hospitals using surgeon letters. As reporting focus was narrowed from all SSIs to complex SSIs (incidence, 0.69 per 100 procedures) and, finally, to complex SSIs diagnosed in the inpatient setting (incidence, 0.51 per 100 procedures), variance in rates changed significantly ([Formula: see text]). Performance ranking of individual hospitals, based on rates of SSIs, differed significantly, depending on the reporting method utilized ([Formula: see text]).


CONCLUSIONS
Inconsistent reporting methods focused on variable depths of infection and healthcare location at time of diagnosis significantly impact rates of SSI, distribution of rates of SSI, and hospital comparative-performance rankings. We believe that public reporting of SSI rates should be limited to complex SSIs diagnosed in the inpatient setting.
Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, NC 27710, USA.
David Y
DY
Ming
Luke F
LF
Chen
Becky A
BA
Miller
Deverick J
DJ
Anderson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003428:Cross Infection / Q000453:epidemiology*; D006764:Hospitals, Community; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D015144:Southeastern United States / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult