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Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals
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 i...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668371/ https://www.ncbi.nlm.nih.gov/pubmed/37996935 http://dx.doi.org/10.1186/s13756-023-01336-7 |
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author | Eder, Marcus Sommerstein, Rami Szelecsenyi, Arlette Schweiger, Alexander Schlegel, Matthias Atkinson, Andrew Kuster, Stefan P. Vuichard-Gysin, Danielle Troillet, Nicolas Widmer, Andreas F. |
author_facet | Eder, Marcus Sommerstein, Rami Szelecsenyi, Arlette Schweiger, Alexander Schlegel, Matthias Atkinson, Andrew Kuster, Stefan P. Vuichard-Gysin, Danielle Troillet, Nicolas Widmer, Andreas F. |
author_sort | Eder, Marcus |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01336-7. |
format | Online Article Text |
id | pubmed-10668371 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106683712023-11-24 Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals Eder, Marcus Sommerstein, Rami Szelecsenyi, Arlette Schweiger, Alexander Schlegel, Matthias Atkinson, Andrew Kuster, Stefan P. Vuichard-Gysin, Danielle Troillet, Nicolas Widmer, Andreas F. Antimicrob Resist Infect Control Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-023-01336-7. BioMed Central 2023-11-24 /pmc/articles/PMC10668371/ /pubmed/37996935 http://dx.doi.org/10.1186/s13756-023-01336-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Eder, Marcus Sommerstein, Rami Szelecsenyi, Arlette Schweiger, Alexander Schlegel, Matthias Atkinson, Andrew Kuster, Stefan P. Vuichard-Gysin, Danielle Troillet, Nicolas Widmer, Andreas F. Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title | Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title_full | Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title_fullStr | Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title_full_unstemmed | Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title_short | Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals |
title_sort | association between the introduction of a national targeted intervention program and the incidence of surgical site infections in swiss acute care hospitals |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668371/ https://www.ncbi.nlm.nih.gov/pubmed/37996935 http://dx.doi.org/10.1186/s13756-023-01336-7 |
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