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Rates of Surgical Site Infection After Hip Replacement as a Hospital Performance Indicator: Analysis of Data From the English Mandatory Surveillance System

Published online by Cambridge University Press:  02 January 2015

J. Wilson ,
A. Charlett ,
G. Leong ,
C. McDougall  and
G. Duckworth
J. Wilson*
Affiliation:
Departments of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, United Kingdom
A. Charlett
Affiliation:
Statistics, Modelling, and Bioinformatics, Health Protection Agency, London, United Kingdom
G. Leong
Affiliation:
Departments of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, United Kingdom
C. McDougall
Affiliation:
Departments of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, United Kingdom
G. Duckworth
Affiliation:
Departments of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, United Kingdom
*
Department of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, Centre for Infections, Colindale Avenue, London NW9 5EQ, United Kingdom (jennie.wilson@hpa.org.uk)
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Abstract

Objective.

To describe rates of surgical site infection (SSI) after hip replacement and to use these data to provide a simple mechanism for identifying poorly performing hospitals that takes into account variations in sample size.

Design.

Prospective surveillance study.

Setting.

A total of 125 acute care hospitals in England that participated in mandatory SSI surveillance from April 1, 2004 through March 31, 2005.

Patients.

Patients who underwent total hip replacement (THR) or hip hemiarthroplasty (HH).

Methods.

A standard data set was collected for all eligible operations at participating hospitals for a minimum of 3 months annually. Defined methods were used to identify SSIs that occurred during the inpatient stay. Data were checked for quality and accuracy, and funnel plots were constructed by plotting the incidence of SSI against the number of operations.

Results.

Data were collected on 16,765 THRs and 5,395 HHs. The cumulative SSI incidence rates were 1.26% for THR and 4.06% for HH; the incidence densities were 1.38 SSIs per 1,000 postoperative inpatient days for THR and 2.3 SSIs per 1,000 postoperative inpatient days for HH. The risk of infection associated with revision surgery was significantly higher than that associated with primary surgery (2.7% [95% confidence interval, 2.0%-3.5%] vs. 1.1% [95% confidence interval, 1.0%-1.2%];P = .003). Rates varied considerably among hospitals. Nineteen hospitals had rates above the 90th percentile. However, the use of funnel plots to adjust for the precision of estimated SSI rates identified 7 hospitals that warranted further investigation, including 2 with crude rates below the 90th percentile.

Conclusions.

Funnel plots of rates of SSI after hip replacement provide a valuable method of presenting hospital performance data, clearly identifying hospitals with unusually high or low rates while adjusting for the precision of the estimated rate. This information can be used to target and support local interventions to reduce the risk of infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 3 , March 2008 , pp. 219 - 226
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Emmerson, AM, Enstone, JE, Griffin, M, et al.The Second National Prevalence Survey of infection in hospitals: overview of the results. J Hosp Infect 1996;32:175–190.CrossRefGoogle ScholarPubMed
2.Gastmeier, P, Kampf, G, Wischnewski, N, et al.Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 1998;38:37–49.Google Scholar
3.Plowman, R, Graves, N, Griffin, MA, et al.The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198–209.CrossRefGoogle ScholarPubMed
4.Coello, R, Charlett, A, Wilson, J, et al.Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93–103.Google Scholar
5.Bratzler, DW, Hunt, DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43:322–330.CrossRefGoogle ScholarPubMed
6.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US Hospitals. Am J Hosp Epidemiol 1985;121:182–205.Google Scholar
7.Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10 year prospective study of 62939 wounds. Surg Clin North Am 1980;60:27–40.Google Scholar
8.Horan, TC, Gaynes, R. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004:1659–1702.Google Scholar
9.Wilson, J, Ramboer, I, Suetens, C; on behalf of the HELICS-SSI working group. Inter-country comparison of rates of surgical site infection: opportunities and limitations. J Hosp Infect 2007;65:165–170.CrossRefGoogle ScholarPubMed
10.Wilson, JA, Ward, VP, Coello, R, et al.A user evaluation of the Nosocomial Infection National Surveillance System: surgical site infection module. J Hosp Infect 2002;52:114–121.CrossRefGoogle ScholarPubMed
11.Geubbels, E, Bakker, HG, Houtman, P, et al.Promoting quality through surveillance of surgical site infections: five prevention success stories. Am J Infect Control 2004;32:424–430.Google Scholar
12.Gastmeier, P, Sohr, D, Brandt, C, et al.Reduction of orthopaedic wound infections in 21 hospitals. Arch Orthop Trauma Surg 2005;125:526–530.Google Scholar
13.Rioux, C, Grandbastien, B, Astagneau, P. Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. J Hosp Infect 2007;66:217–223.Google Scholar
14.McKibben, L, Horan, TC, Tokars, JI, et al.Guidance on public reporting of healthcare-associated infections: recommendations of the healthcare infection control practices advisory committee. Infect Control Hosp Epidemiol 2005;26:580–587.Google Scholar
15.Chief Medical Officer. Winning Ways: Working Together to Reduce Healthcare Associated Infection in England. London, England: Department of Health; 2003.Google Scholar
16.Bird, SM, Cox, D, Farewell, VT, Goldstein, H, et al.Performance indicators: good, bad and ugly. J R Stat Soc 2005;168(pt 1):1–27.CrossRefGoogle Scholar
17.Culver, DH, Horan, TC, Gaynes, RP, et al.Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S–157S.CrossRefGoogle ScholarPubMed
18.Leong, G, Wilson, J, Charlett, A. Duration of operation as a risk factor for surgical site infections: comparison of English and US data. J Hosp Infect 2006;63:255–262.CrossRefGoogle ScholarPubMed
19.Armitage, P, Berry, G, Matthews, J. Statistical Methods in Medical Research. 4th ed. Oxford, England: Blackwell Scientific Publications; 2002.Google Scholar
20.Benneyan, JC. Statistical quality control methods in infections control and hospital epidemiology, part 1: introduction and basic theory. Infect Control Hosp Epidemiol 1998;19:194–214.Google Scholar
21.Speilgelhalter, DJ. Funnel plots for comparing institutional performance. Stat Med 2005;24:1185–1202.Google Scholar
22.Ridgeway, S, Wilson, J, Charlett, A, et al.Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005;87:844–850.CrossRefGoogle ScholarPubMed
23.Reilly, J, Noone, A, Gift, A, et al.A study of telephone screening and direct observation of surgical wound infections after discharge from hospital. J Bone Joint Surg Br 2005;87:997–999.Google Scholar
24.Huenger, F, Schmachtenberg, A, Haefner, H, et al.Evaluation of post-discharge surveillance of surgical site infections after total hip and knee arthroplasty. Am J Infect Control 2005;33:455–462.CrossRefGoogle Scholar