title: Surveillance of surgical site infection after cholecystectomy using the hospital in Europe link for infection control through surveillance protocol.
abstract: BACKGROUND
  The third most common healthcare-associated infection is surgical site infection (SSI), accounting for 14%-16% of infections. These SSIs are associated with high morbidity, numerous deaths, and greater cost.
  
  
  METHODS
  A prospective study was conducted to assess the incidence of SSI in a single university hospital in Croatia. We used the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol for surveillance. The SSIs were classified using the standard definition of the National Nosocomial Infections Surveillance (NNIS) system.
  
  
  RESULTS
  The overall incidence of SSI was 1.44%. The incidence of infection in the open cholecystectomy group was 6.06%, whereas in the laparoscopic group, it was only 0.60%. The incidence density of in-hospital SSIs per 1,000 post-operative days was 5.76. Patients who underwent a laparoscopic cholecystectomy were significantly younger (53.65±14.65 vs. 64.42±14.17 years; p<0.001), spent roughly one-third as many days in the hospital (2.40±1.72 vs. 8.13±4.78; p<0.001), and had significantly shorter operations by nearly 26 min (60.34±28.34 vs. 85.80±37.17 min; p<0.001). Procedures that started as laparoscopic cholecystectomies and were converted to open procedures (n=28) were reviewed separately. The incidence of SSI in this group was 17.9%. The majority of converted procedures (71.4%) were elective, and the operating time was significantly longer than in other two groups (109.64±85.36 min).
  
  
  CONCLUSIONS
  The HELICS protocol has a good concept for the monitoring of SSI, but in the case of cholecystectomy, additional factors such as antibiotic appropriateness, gallbladder entry, empyema of the gallbladder, and obstructive jaundice must be considered.
authors.affiliation: Department of Surgery, University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia. dr.bogdanic@gmail.com
authors.forename: Branko
authors.initials: B
authors.lastname: Bogdanic
authors.forename: Zrinka
authors.initials: Z
authors.lastname: Bosnjak
authors.forename: Ana
authors.initials: A
authors.lastname: Budimir
authors.forename: Goran
authors.initials: G
authors.lastname: Augustin
authors.forename: Milan
authors.initials: M
authors.lastname: Milosevic
authors.forename: Vanda
authors.initials: V
authors.lastname: Plecko
authors.forename: Smilja
authors.initials: S
authors.lastname: Kalenic
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Fiolic
authors.forename: Maja
authors.initials: M
authors.lastname: Vanek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D017523:Croatia / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062486:Public Health Surveillance / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology*