Background

Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale.

Aim

To determine the time-trend of SSI rates in surveillance networks.

Methods

SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept.

Findings

Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63–0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis.

Conclusion

In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.

中文翻译：

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参与手术部位感染监测网络的影响：一项大型国际队列研究的结果

背景

监视手术部位感染（SSI）是有效的感染控制措施的核心组成部分，尽管其影响尚未得到大规模量化。

目的

确定监视网络中SSI速率的时间趋势。

方法

SSI监视网络提供了有关SSI和操作数量的特定过程数据，并按医院参与监视的年份进行分层，以记录参与时间的长短作为暴露。进行汇总的和特定于过程的随机效应进行泊松回归，以获得具有95％置信区间（CI）的年率比（RR），并将监视网络包括为随机截距。

发现

在36个受邀网络中，来自亚洲，澳大利亚和欧洲15个高收入国家的17个网络参加了该研究。收集了有关17种外科手术程序（心血管，消化，妇产科，神经外科和骨科）的汇总数据，得出的数据涉及5,831,737例手术和113,166例SSI。随着监视时间的推移，总体SSI率显着降低，导致在包括监视的第九年（最后）降低了35％（RR：0.65； 95％CI：0.63-0.67）。特定于手术的趋势存在很大差异，但在结直肠手术，疝气，剖腹产，髋关节假体和膝关节假体中观察到了强烈的一致下降。

结论

在这项大型的国际队列研究中，加入SSI监视网络后，合并的SSI率与稳定且可持续的下降相关。尽管未经证实，但因果关系是可能的。特定于过程的趋势存在异质性。这些发现支持了监测在降低感染率中的关键作用，并呼吁在高收入国家广泛实施基于医院的SSI监测。