Orthopaedic surgical site infection surveillance in NHS England: national audit of current practice.
OBJECTIVE
The importance of accurate identification and reporting of surgical site infection (SSI) is well recognised but poorly defined. Public Health England (PHE) mandated collection of orthopaedic SSI data in 2004. Data submission is required in one of four categories (hip prosthesis, knee prosthesis, repair of neck of femur, reduction of long bone fracture) for one quarter per year. Trusts are encouraged to carry out post-discharge surveillance but this is not mandatory. Recent papers in the orthopaedic literature have highlighted the importance of SSI surveillance and the heterogeneity of surveillance methods. However, details of current orthopaedic SSI surveillance practice has not been described or quantified.


METHODS
All 147 NHS trusts in England were audited using a structured questionnaire. Data was collected in the following categories: data collection; data submission to PHE; definitions used; resource constraints; post-discharge surveillance and SSI rates in the four PHE categories. The response rate was 87.7%.


RESULTS
Variation in practice was clear in all categories in terms of methods and timings of data collection and data submission. There was little agreement on SSI definitions. At least six different definitions were used, some trusts using more than one definition. Post-discharge surveillance was carried out by 62% of respondents but there was again variation in both the methods and staff used. More than half of the respondents felt that SSI surveillance in their unit was limited by resource constraints. SSI rates ranged from 0% to 10%.


CONCLUSIONS
This paper quantifies the heterogeneity of SSI surveillance in England. It highlights the importance of adequate resourcing and the unreliability of relying on voluntary data collection and submission. Conformity of definitions and methods are recommended to enable meaningful SSI data to be collated. Cite this article: Bone Joint J 2017;99-B:171-4.
Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
E K
EK
Tissingh
Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
A
A
Sudlow
Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
A
A
Jones
Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
J F
JF
Nolan
D004739:England / Q000453:epidemiology; D006801:Humans; D008485:Medical Audit; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011159:Population Surveillance; D013222:State Medicine; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires
Arthroplasty; Infection; NHS; Surgical site surveillance