215 Surgical site infection surveillance in France: a bench-marking experience through a network during the last decade

Background Surgical site infection (SSI) is one of the most frequent healthcare-associated infections. Since 1999, French authorities have set up a coordination of the regional surveillance networks to gather national SSI incidence data. In parallel, a national campaign was implemented to promote benchmarking through the network and guidelines on SSI preventive measures. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse temporal trends. Methods Surgery patients were enrolled by voluntary participating surgical wards in a yearly 3-month incidence survey. In each ward, 100 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard international criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Regional and national reports were edited yearly feeding back the overall results of the network to all participants including the rank of surgery units. Temporal variation of incidence risk was tested using chi-square for linear trends and multivariate logistic regression model. Results Since 1999, 1 179 418 operations (35 626 300 operated patients-days follow-up; median post-operative follow-up: 29 days). The overall crude SSI incidence rate was 1.47%. Organ space and deep incisional SSI accounted for 42.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.84% for National Nosocomial Infections Surveillance system (NNIS)-0 patients to 5.94% for NNIS-2 and 3 patients. The SSI incidence varied from 0.49% for knee prosthesis to 9.24% for colon surgery. From 1999 to 2007, NNIS-0 SSI incidence decreased from 1.10 to 0.80 for 100 operated patients. Over the last 4 years (2004–2007), 65% of surgery wards had SSI incidence rate lower than the median reference value in 2004. The decrease was the most significant for hernia repair (−68%) and cholecystectomy (−62%) NNIS-0 incidence rates. Multivariate analysis showed a -29.5% relative decrease of SSI risk over the study period. Conclusion These encouraging results demonstrate the potential impact of the national policy on SSI reduction in France, although efforts have to be maintained for some specific surgery. Introduction Les infections de site operatoire (ISO) sont parmi les infections associees aux soins (IAS) les plus frequentes. Depuis 1999, la France a mis en place une coordination des reseaux de surveillance interregionaux afin d’evaluer l9incidence des ISO. Pendant la meme periode, une campagne nationale de promotion des mesures de prevention des ISO et d9incitation a la surveillance en reseau a ete mise en place. Le but de cette etude etait de decrire la plus grosse base de donnees sur les ISO existant en France et d9analyser ses tendances evolutives. Methodes Les services de chirurgie volontaires incluaient les patients operes dans la surveillance 3 mois par an. Chaque service devait inclure au moins 100 interventions consecutives, et chaque patient devait etre suivi au moins 30 jours apres l9intervention. Les ISO etaient definies selon les criteres standard internationaux. Pour chaque patient etaient recueillis les facteurs de risque d9ISO comprenant l’âge, le score ASA, la duree d9intervention, la classe de contamination d9Altemeier, le type d9intervention, la notion d9urgence, le recours a la videochirurgie. Chaque annee les services etaient informes de leurs propres resultats et des resultats regionaux et nationaux du reseau, leur permettant de se situer. Les variations temporelles ont ete analysees avec le test de chi-2 pour les tendances lineaires et une regression logistique pour l9analyse multivariee. Resultats Depuis 1999, 1.179.418 interventions (35.626.300 jours de suivi;mediane de suivi 29 jours) ont ete colliges. Le taux brut d9incidence des ISO etait de 1,47%. Les ISO profondes et d9organe/espace en representaient 42,7% avec des variations selon le type de chirurgie. L9incidence des ISO variait de 0,84% en NNIS-0 a 5,94% en NNIS-2, 3 et de 0,49% pour les poses de prothese de genou a .9,24% pour la chirurgie colorectale. De 1999 a 2007 l9incidence des ISO en NNIS-0 a diminue de 1,10% a 0,80%. Sur les quatre dernieres annees 1999–2007, 65% des services avaient un taux d9incidence des ISO inferieur au taux median de 2004. La decroissance etait particulierement sensible pour les cures de hernie (−68%), les cholecystectomies (−62%) en NNIS-0. L9analyse multivariee a montre une decroissance relative de 29,5% du risque d9ISO pendant la periode d’etude. Conclusions Ces resultats encourageants montrent l9impact potentiel d9une politique de reduction des ISO en France. Cependant l9effort doit etre maintenu pour certains types de chirurgie.