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- Title
Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals.
- Authors
Eder, Marcus; Sommerstein, Rami; Szelecsenyi, Arlette; Schweiger, Alexander; Schlegel, Matthias; Atkinson, Andrew; Kuster, Stefan P.; Vuichard-Gysin, Danielle; Troillet, Nicolas; Widmer, Andreas F.; Balmelli, Carlo; Berthod, Delphine; Buetti, Niccolò; Harbarth, Stephan; Jent, Philipp; Marschall, Jonas; Sax, Hugo; Senn, Laurence; Sutter, Sarah Tschudin; Wolfensberger, Aline
- Abstract
Background: In Switzerland, the national surgical site infection (SSI) surveillance program showed a modest decrease in SSI rates for different procedures over the last decade. The study aimed to determine whether a multimodal, targeted intervention program in addition to existing SSI surveillance is associated with decreased SSI rates in the participating hospitals. Methods: Prospective multicenter pre- and postintervention study conducted in eight Swiss acute care hospitals between 2013 and 2020. All consecutive patients > 18 years undergoing cardiac, colon, or hip/knee replacement surgery were included. The follow-up period was 30 days and one year for implant-related surgery. Patients with at least one follow-up were included. The intervention was to optimize three elements of preoperative management: (i) hair removal; (ii) skin disinfection; and (iii) perioperative antimicrobial prophylaxis. We compared SSI incidence rates (main outcome measure) pre- and postintervention (three years each) adjusted for potential confounders. Poisson generalized linear mixed models fitted to quarter-yearly confirmed SSIs and adjusted for baseline differences between hospitals and procedures. Adherence was routinely monitored through on-site visits. Results: A total of 10 151 patients were included, with a similar median age pre- and postintervention (69.6 and IQR 60.9, 76.8 years, vs 69.5 and IQR 60.4, 76.8 years, respectively; P = 0.55) and similar proportions of females (44.8% vs. 46.1%, respectively; P = 0.227). Preintervention, 309 SSIs occurred in 5 489 patients (5.6%), compared to 226 infections in 4 662 cases (4.8%, P = 0.09) postintervention. The adjusted incidence rate ratio (aIRR) for overall SSI after intervention implementation was 0.81 (95% CI, 0.68 to 0.96, P = 0.02). For cardiac surgery (n = 2 927), the aIRR of SSI was 0.48 (95% CI, 0.32 to 0.72, P < 0.001). For hip/knee replacement surgery (n = 4 522), the aIRR was 0.88 (95% CI, 0.52 to 1.48, P = 0.63), and for colon surgery (n = 2 702), the aIRR was 0.92 (95% CI, 0.75 to 1.14, P = 0.49). Conclusions: The SSI intervention bundle was associated with a statistically significant decrease in SSI cases. A significant association was observed for cardiac surgery. Adding a specific intervention program can add value compared to routine surveillance only. Further prevention modules might be necessary for colon and orthopedic surgery. Keypoints: Question Is a targeted surgical site infection (SSI) intervention bundle on top of an existing national surveillance system associated with lower SSI incidence? Findings In this multicenter intervention study involving 10 151 patients, the introduction of an SSI bundle with three elements to optimize preoperative management (hair removal, skin disinfection, and perioperative antimicrobial prophylaxis) was associated with a significant (19%) decrease in the overall SSI incidence rate ratio. For specific procedure types, the bundle was associated with a significant SSI decrease in cardiac surgery. Meaning The Swiss surveillance system has been fundamental in characterizing SSI epidemiology and defining priorities for decreasing SSI rates over the past decade. Adding an SSI intervention module at a national level can contribute to lowering SSI incidence and eliminating the preventable proportion of SSIs.
- Subjects
SWITZERLAND; SURGICAL site infections; TOTAL knee replacement; HOSPITAL care; KNEE surgery; CARDIAC surgery; RATINGS of hospitals; HAIR removal; ORTHOPEDIC surgery
- Publication
Antimicrobial Resistance & Infection Control, 2023, p1
- ISSN
2047-2994
- Publication type
Article
- DOI
10.1186/s13756-023-01336-7