title: Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System.
abstract: BACKGROUND
  Surveillance of healthcare-associated infection has been associated with a reduction in surgical site infection (SSI).
  
  
  OBJECTIVE
  To evaluate the Korean Nosocomial Infection Surveillance System (KONIS) in order to assess its effects on SSI since it was introduced.
  
  
  METHODS
  SSI data after gastrectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) between 2008 and 2012 were analysed. The pooled incidence of SSI was calculated for each year; the same analyses were also conducted from hospitals that had participated in KONIS for at least three consecutive years. Standardized SSI rates for each year were calculated by adjusting for SSI risk factors. SSI trends were analysed using the Cochran-Armitage test.
  
  
  RESULTS
  The SSI rate following gastrectomy was 3.12% (522/16,918). There was a significant trend of decreased crude SSI rates over five years. This trend was also evident in analysis of hospitals that had participated for more than three years. The SSI rate for THA was 2.05% (157/7656), which decreased significantly from 2008 to 2012. The risk factors for SSI after THA included the National Nosocomial Infections Surveillance risk index, trauma, reoperation, and age (60-69 years). The SSI rate for TKA was 1.90% (152/7648), which also decreased significantly during a period of five years. However, the risk-adjusted analysis of SSI did not show a significant decrease for all surgical procedures.
  
  
  CONCLUSIONS
  The SSI incidence of gastrectomy and prosthetic joint replacement declined over five years as a result of active surveillance by KONIS.
authors.affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea. Electronic address: heechoi@ewha.ac.kr.
authors.forename: H J
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Epidemiology and Institute of Environment and Health, Seoul National University, Seoul, South Korea.
authors.forename: L
authors.initials: L
authors.lastname: Adiyani
authors.affiliation: Department of Epidemiology and Institute of Environment and Health, Seoul National University, Seoul, South Korea.
authors.forename: J
authors.initials: J
authors.lastname: Sung
authors.affiliation: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: H B
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors.forename: Y K
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Seoul, South Korea.
authors.forename: Y G
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Yoo
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Infection Prevention and Control, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Han
authors.affiliation: Infection Control Office, Korea University Guro Hospital, Seoul, South Korea.
authors.forename: S R
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, South Korea.
authors.forename: T H
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Kwandong University College of Medicine, Gangneung, South Korea.
authors.forename: H M
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Infection Control, Kyunghee University Hospital, Seoul, South Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Chun
authors.affiliation: Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: J-S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Ewha Woman's University School of Medicine, Seoul, South Korea.
authors.forename: J D
authors.initials: JD
authors.lastname: Yoo
authors.affiliation: Division of Infectious Disease Control, Korean Centers for Disease Control and Prevention, Osong, South Korea.
authors.forename: H-S
authors.initials: HS
authors.lastname: Koo
authors.affiliation: Division of Infectious Disease Control, Korean Centers for Disease Control and Prevention, Osong, South Korea.
authors.forename: E H
authors.initials: EH
authors.lastname: Cho
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Wonju, South Korea.
authors.forename: K W
authors.initials: KW
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D062665:Epidemiological Monitoring; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Healthcare-associated infection; Surgical site infection; Surveillance