title: Improving Surveillance for Surgical Site Infections Following Total Hip and Knee Arthroplasty Using Diagnosis and Procedure Codes in a Provincial Surveillance Network.
abstract: OBJECTIVE To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty. DESIGN Retrospective cohort study. SETTING All acute care facilities in Alberta, Canada. METHODS Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data-triggered medical chart review was assessed. RESULTS Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data-triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%. CONCLUSION Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities. Infect Control Hosp Epidemiol 2016;37:699-703.
authors.affiliation: 1Infection Prevention and Control,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Alysha
authors.initials: A
authors.lastname: Rusk
authors.affiliation: 1Infection Prevention and Control,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bush
authors.affiliation: 3Data Integration,Measurement, and Reporting,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Marlene
authors.initials: M
authors.lastname: Brandt
authors.affiliation: 4Alberta Bone and Joint Health Institute,Calgary,Alberta,Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Smith
authors.affiliation: 1Infection Prevention and Control,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Howatt
authors.affiliation: 1Infection Prevention and Control,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Blanda
authors.initials: B
authors.lastname: Chow
authors.affiliation: 1Infection Prevention and Control,Alberta Health Services,Calgary,Alberta,Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Henderson
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000517:prevention & control