Surgical site infection surveillance in orthopedic patients in the Military Medical Academy, Belgrade

Srđan Starčević; Staša Munitlak; Biljana Mijović; Dragan Mikić; Vesna Šuljagić

doi:10.2298/5557

Srđan Starčević Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Staša Munitlak Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
Biljana Mijović Faculty of Medicine, University of East Sarajevo, Foča, Republic of Srpska, Bosnia and Herzegovina
Dragan Mikić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Infectious and Tropical Deseases, Military Medical Academy, Belgrade, Serbia
Vesna Šuljagić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

DOI: https://doi.org/10.2298/5557

Keywords: orthopedic procedures, surgical wound infection, risk factors, serbia,

Abstract

Background/Aim. Active surveillance is an important component of surgical site infection (SSI) reduction strat-egy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. Methods. A 4-year prospective cohort study was performed to identify the in-cidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding pa-tients characteristics, health care and micro-organisms iso-lated in SSI. The National Nosocomial Infection Surveil-lance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Preven-tion criteria were used for the diagnosis of SSI. Results. Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0 – the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1 – the incidence rate of 3.1%; 7.3% (281) patients with risk 2 – the incidence rate of 11.7%; 0.1% (3) patients with risk 3 – without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaminated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. Conclusion. The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

Author Biography

Srđan Starčević, Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Zamenik načelnika Klinike za ortopedsku hirurgiju i traumatologiju VMA, ortopedski hirurg

References

Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC. National Healthcare Safety Network (NHSN) Re-port, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008; 36(9): 609−26.

Surveillance of surgical site infections in Europe, 2008-2009. Stockholm: ECDC; 2012.

Suljagić V, Jevtic M, Djordjevic B, Jovelic A. Surgical site infections in a tertiary health care center: prospective cohort study. Surg Today 2010; 40(8): 763−71.

Whitehouse JD, Friedman N, Kirkland KB, Richardson WJ, Sexton DJ. The Impact of Surgical-Site Infections Following Orthopedic Surgery at a Community Hospital and a University Hospital: Adverse Quality of Life, Excess Length of Stay, and Extra Cost. Infect Control Hosp Epidemiol 2002; 23(4): 183−9.

Mabit C, Marcheix PS, Mounier M, Dijoux P, Pestourie N, Bonnevialle P, et al. Impact of a surgical site infection (SSI) surveillance program in orthopedics and traumatology. Orthop Traumatol Surg Res 2012; 98(6): 690−5.

Health Protection Agency. Sixth report of the mandatory surveil-lance of surgical site infection in orthopedic surgery, April 2004 to March 2010. London: Health Protection Agency; 2010. Available from: www.hpa.org.uk

Health Protection Agency. Surveillance of surgical site infections in NHS hospitals in England, 2011/2012. London: Health Protection Agency; 2012. Available from: www.hpa.org.uk

Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985; 121(2): 206−15.

Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure and patient risk index: National Nosocomial Infections Surveillance System. Am J Med 1991; 91(Suppl 38): S152−7.

National Academy of Sciences/National Research Council. Postopera-tive wound infections the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 1964; 160(Suppl 2): 1−132.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16(3): 128−40.

Horan TC, Gayner RP, Martone WJ, Jarvis WR, Emori TC. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical infections. Infect Control Hosp Epidemiol 1992; 13: 606−8.

Koneman WE, Allen DS, Janda WM, Schreckenberger PC, Winn W. Color Atlas and Textbook of Diagnostic Microbiology. Philadelphia: Lippincott-Raven Publishers; 1997.

Ercole FF, Franco LM, Macieira TG, Wenceslau LC, de Resende HI, Chianca TC. Risk of surgical site infection in patients undergoing orthopedic surgery. Rev Lat Am Enfermagem 2011; 19(6): 1362−8.

Schneeberger PM, Smits MH, Zick RE, Wille JC. Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery. J Hosp Infect 2002; 51(3): 179−84.

Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006; 27(12): 1347−51.

National Nosocomial Infections Surveillance System. National No-socomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued Oc-tober 2004. Am J Infect Control. 2004; 32(8): 470−85.

Health Protection Scotland. Surveillance of Surgical Site Infection Independent Hospital Report, For procedures carried out from the 1 February 2004 to 30 June 2011. Glasgow: Health Protection Scotland; 2012.

Yi M, Edwards JR, Horan TC, Berrios-Torres IS, Fridkin SK. Im-proving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2008; 29(10): 941−6.

Marković-Denić, Šuljagić V, Bilanović D, Mandarić D, Milićević M. Prevention of the surgical-site infections. Beograd: Institut za zaštitu zdravlja Srbije "Dr Milan Jovanović Batut", Mini-strarstvo zdravlja Republike Srbije. 2005. (Serbian).

Durand F, Berthelot P, Cazorla C, Farizon F, Lucht F. Smoking is a risk factor of organ/space surgical site infection in or-thopaedic surgery with implant materials. Int Orthop 2013; 37(4): 723−7.

Cordero-Ampuero J, de Dios M. What are the risk factors for in-fection in hemiarthroplasties and total hip arthroplasties. Clin Orthop Relat Res 2010; 468(12): 3268−77.

Yuan K, Chen H. Obesity and surgical site infections risk in orthopedics: a meta-analysis. Int J Surg 2013; 11(5): 383−8.

Department of Health. Screening for Meticillin-resistant Staphylococcus aureus (MRSA) colonisation - a strategy for NHS Trusts: A summary of best practice. London: Department of Health; 2007.

Suljagić V, Jevtić M, Djordjević B, Romić P, Ilić R, Stanković N, et al. Epidemiology of nosocomial colonization/infection caused by Acinetobacter spp. in patients of six surgical clinics in war and peacetime. Vojnosanit Pregl 2011; 68(8): 661−8.

Huotari K, Lyytikäinen O. Impact of postdischarge surveillance on the rate of surgical site infection after orthopedic surgery. Infect Control Hosp Epidemiol 2006; 27(12): 1324−9.