Giuseppe
Emeritus
[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]
SURVEILLANCE REPORT
Surveillance of surgical site infections in Europe, 2010?2011
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This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Jolanta Gri?evičienė.
Contributing authors: Jolanta Gri?evičienė and Carl Suetens.
Acknowledgements
We would like to thank Ole Heuer, Dominique L. Monnet, Barbara Albiger, Denis Coulombier and Piotr Kramarz for their kind review of the report and especially all the national SSI surveillance coordination team members, participating hospitals, and other contributing experts for their dedication in collecting and reporting the data, reviewing the draft report or otherwise contributing to the success of this surveillance.
Austria: Alexander Blacky, Hedwig Huber, Elisabeth Presterl; Czech Republic: Dana Hedlova, Vlastimil Jindr?k; Finland: Outi Lyytik?inen, Tommi K?rki, Teemu M?tt?nen; France: Pascal Jarno, Bruno Coignard and the ISO-Raisin Steering group. Institut de veille sanitaire (InVS) and the West Interregional Infection Control Coordinating Centre (CClin Ouest); Germany: Michael Behnke, Ann-Christin Breier, Petra Gastmeier, Luis Alberto Pe?a Diaz; Hungary: Karolina B?r?cz, Katalin Szőnyi, Ida Prantner, Andrea Kurcz; Italy: Network SNICh: Maria Luisa Moro, Massimiliano Marchi, Mita Parenti, Angelo Pan. Network ISChIA: Antonella Agodi, Francesco Auxilia, Daniela D'Alessandro, Ida Mura, Cesira Pasquarella; Lithuania: Jolanta A?embergienė, Rolanda Valintelienė; Malta: Michael Borg, Simeone Zerafa, Elizabeth Scicluna, Claire Farrugia; Netherlands:Mayke Koek, Emma Smid, Sabine de Greeff, Titia Hopmans, Janneke Blok, Jan Wille, Kati Halonen, Wilma Dedecker; Norway: J?rgen Bj?rnholt, Hanne Merete Eriksen, Hege Line L?wer, Hanne N?kleby; Portugal: Elaine Pina, Luis Gabriel Pereira, Maria Jos? Maia; Romania: Roxana Serban, Maria Rosca, Angela Romaniuc, Dana Faraian; Slovakia: Sl?vka Litvov?, M?ria ?tefkovičov?, Daniela Ro?kov?; Spain: Rosa Cano, Angel Asensio, Mercedes Caffaro; United Kingdom: England: Suzanne Elgohari, Northern Ireland: Gerard McIlvenny, Scotland: Christopher Sullivan, Naoma William, Jane McNeish, Abigail Mullings, Jacqui Reilly, Wales: Wendy Harrison and members of the Welsh Healthcare Associated Infection Programme (WHAIP).
Suggested citation: European Centre for Disease Prevention and Control. Surveillance of surgical site infections in Europe 2010?2011. Stockholm: ECDC; 2013.
Stockholm, October 2013 / ISBN 978-92-9193-501-7 / doi 10.2900/90271 / Catalogue number TQ-03-13-543-EN-C
? European Centre for Disease Prevention and Control, 2013
Reproduction is authorised, provided the source is acknowledged
(...)
Executive summary
Surgical site infections (SSI) are among the most common healthcare-associated infections (HAIs), and are associated with longer post-operative hospital stays, additional surgical procedures, treatment in an intensive care unit, and often higher mortality. All patients undergoing surgery are at risk of complications, including SSI. This report presents the results of SSI surveillance in Europe for 2010?2011, as well as the results of trend analysis for 2008?2011. Data for 2010 and 2011 were received from 20 networks in 16 European countries (15 EU Member States and one EEA country) and included 811 468 surgical operations: 796 495 operations reported using the patient-based protocol and 14 973 (<2%) operations using the unit-based protocol. The Czech Republic, Slovakia and Romania submitted HAI-Net SSI data (2011) for the first time, Malta expanded the surveillance by including new types of operation.
Introduction
History
The European Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections (2009/C 151/01) [1], recommends ?performing the surveillance of the incidence of targeted infection types? and ?using, where appropriate, surveillance methods and indicators as recommended by ECDC and case definitions as agreed upon at Community level in accordance with the provisions of Decision No 2119/98/EC [2].?
The Hospitals in Europe Link for Infection Control through Surveillance (HELICS) network was created in 2000 in the context of Decision 2119/98/EC, as a network for the surveillance of healthcare-associated infections (HAIs) and funded by the European Commission?s Directorate-General for Health and Consumers. From 2000 to 2002, HELICS standardised the European methodology for the surveillance of surgical site infections (SSI) and nosocomial infections in intensive care units. From 2003 onwards, the HELICS project collected data from national networks for the surveillance of HAIs. In 2005, HELICS surveillance became a part of the Improving Patient Safety in Europe (IPSE) network, which from 2005 to 2008 was the dedicated European surveillance network for the surveillance of HAIs. The scope of the IPSE network included the development of the existing national surveillance initiatives and other approaches for supporting infection control efforts in Europe. In July 2008, coordination of HAI surveillance in Europe was transferred to ECDC and the surveillance network became the Healthcare-Associated Infections Surveillance Network (HAI-Net) [3]. In 2009 and 2010, ECDC continued surveillance of SSI following the former IPSE/HELICS protocol and methods until this type of surveillance was fully integrated into The European Surveillance System (TESSy) in October 2010.
Objectives
The objectives of European surveillance of SSI are:
Data collection and technical notes
Data collection 2010?2011
Surveillance data of SSI in 2010 and 2011 (with partial follow-up for orthopaedic operations until 31 December 2012) were collected using TESSy, after the integration of the HAI surveillance dataset in October 2010. These data were collected by ECDC from Member States until 31 July 2013.
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SURVEILLANCE REPORT
Surveillance of surgical site infections in Europe, 2010?2011
__
This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Jolanta Gri?evičienė.
Contributing authors: Jolanta Gri?evičienė and Carl Suetens.
Acknowledgements
We would like to thank Ole Heuer, Dominique L. Monnet, Barbara Albiger, Denis Coulombier and Piotr Kramarz for their kind review of the report and especially all the national SSI surveillance coordination team members, participating hospitals, and other contributing experts for their dedication in collecting and reporting the data, reviewing the draft report or otherwise contributing to the success of this surveillance.
Austria: Alexander Blacky, Hedwig Huber, Elisabeth Presterl; Czech Republic: Dana Hedlova, Vlastimil Jindr?k; Finland: Outi Lyytik?inen, Tommi K?rki, Teemu M?tt?nen; France: Pascal Jarno, Bruno Coignard and the ISO-Raisin Steering group. Institut de veille sanitaire (InVS) and the West Interregional Infection Control Coordinating Centre (CClin Ouest); Germany: Michael Behnke, Ann-Christin Breier, Petra Gastmeier, Luis Alberto Pe?a Diaz; Hungary: Karolina B?r?cz, Katalin Szőnyi, Ida Prantner, Andrea Kurcz; Italy: Network SNICh: Maria Luisa Moro, Massimiliano Marchi, Mita Parenti, Angelo Pan. Network ISChIA: Antonella Agodi, Francesco Auxilia, Daniela D'Alessandro, Ida Mura, Cesira Pasquarella; Lithuania: Jolanta A?embergienė, Rolanda Valintelienė; Malta: Michael Borg, Simeone Zerafa, Elizabeth Scicluna, Claire Farrugia; Netherlands:Mayke Koek, Emma Smid, Sabine de Greeff, Titia Hopmans, Janneke Blok, Jan Wille, Kati Halonen, Wilma Dedecker; Norway: J?rgen Bj?rnholt, Hanne Merete Eriksen, Hege Line L?wer, Hanne N?kleby; Portugal: Elaine Pina, Luis Gabriel Pereira, Maria Jos? Maia; Romania: Roxana Serban, Maria Rosca, Angela Romaniuc, Dana Faraian; Slovakia: Sl?vka Litvov?, M?ria ?tefkovičov?, Daniela Ro?kov?; Spain: Rosa Cano, Angel Asensio, Mercedes Caffaro; United Kingdom: England: Suzanne Elgohari, Northern Ireland: Gerard McIlvenny, Scotland: Christopher Sullivan, Naoma William, Jane McNeish, Abigail Mullings, Jacqui Reilly, Wales: Wendy Harrison and members of the Welsh Healthcare Associated Infection Programme (WHAIP).
Suggested citation: European Centre for Disease Prevention and Control. Surveillance of surgical site infections in Europe 2010?2011. Stockholm: ECDC; 2013.
Stockholm, October 2013 / ISBN 978-92-9193-501-7 / doi 10.2900/90271 / Catalogue number TQ-03-13-543-EN-C
? European Centre for Disease Prevention and Control, 2013
Reproduction is authorised, provided the source is acknowledged
(...)
Executive summary
Surgical site infections (SSI) are among the most common healthcare-associated infections (HAIs), and are associated with longer post-operative hospital stays, additional surgical procedures, treatment in an intensive care unit, and often higher mortality. All patients undergoing surgery are at risk of complications, including SSI. This report presents the results of SSI surveillance in Europe for 2010?2011, as well as the results of trend analysis for 2008?2011. Data for 2010 and 2011 were received from 20 networks in 16 European countries (15 EU Member States and one EEA country) and included 811 468 surgical operations: 796 495 operations reported using the patient-based protocol and 14 973 (<2%) operations using the unit-based protocol. The Czech Republic, Slovakia and Romania submitted HAI-Net SSI data (2011) for the first time, Malta expanded the surveillance by including new types of operation.
- Coronary artery bypass graft
- A total of 41 725 coronary artery bypass graft (CABG) operations and 1 467 (3.5%) SSI were reported within 30 days of the operation. Of these, 745 (51%) were superficial incisional SSI, 495 (34%) were deep incisional SSI, 222 (15%) were organ/space SSI and five (<1%) were of unknown type. Sixty-two per cent of SSI were detected during hospitalisation. The incidence density was 1.9 in-hospital SSI per 1 000 post-operative patient-days. The majority of reported microorganisms were Gram-positive cocci (61%) followed by Enterobacteriaceae (22%). The overall CABG trend analysis in networks contributing data for at least three years during 2008?2011 showed no significant trends.
- Cholecystectomy
- A total of 80 563 cholecystectomy (CHOL) operations and 1 149 (1.4%) SSI were reported within 30 days of the operation. Of these, 679 (59%) were superficial incisional SSI, 258 (22%) were deep incisional SSI, 201 (17%) were organ/space SSI and for 11 (1%) the type of SSI was unknown. A lower cumulative incidence (1.0%) of SSI was reported in laparoscopic CHOL operations compared to non-endoscopic CHOL operations (4.1%). Forty-eight per cent of SSI were detected during hospitalisation. The incidence density was 1.5 in-hospital SSI per 1 000 post-operative patient-days. The most frequently isolated microorganisms were Enterobacteriaceae (50%) followed by Gram-positive cocci (37%). The overall CHOL trend analysis in countries contributing data for all years 2008?2011 showed a significant decreasing trend for the incidence density of SSI, but no significant trend for the cumulative incidence of SSI.
- Colon surgery
- A total of 51 526 colon surgery (COLO) operations and 4 893 (9.5%) SSI were reported within 30 days of the operation. Of these, 2 466 (50%) were superficial incisional SSI, 1 446 (30%) were deep incisional SSI, 958 (20%) were organ/space SSI and 23 (<1%) were of unknown type. Eighty per cent of SSI were detected during hospitalisation. The incidence density was 6.2 in-hospital SSI per 1 000 post-operative patient-days. Enterobacteriaceae (47%) were the most frequently reported microorganisms followed by Gram-positive cocci (30%). The overall COLO trend analysis in countries contributing data for all years 2008?2011 showed a significant decrease for the incidence density of SSI, but no significant trend for the cumulative incidence of SSI.
- Caesarean section
- A total of 167 202 caesarean section (CSEC) operations and 4 894 (2.9%) SSI were reported within 30 days of the operation. Of these, 4 247 (87%) were superficial incisional SSI, 485 (10%) were deep incisional SSI, 143 (3%) were organ/space SSI and 19 (<1%) were of unknown type. Sixteen per cent of SSI were detected during hospitalisation. The incidence density was 0.8 in-hospital SSI per 1 000 post-operative patient-days. The most frequently isolated microorganisms were Gram-positive cocci (54%) followed by Enterobacteriaceae (29%). The overall CSEC trend analysis in countries contributing data for all years 2008?2011 showed a significant decrease of both the cumulative incidence of SSI and the incidence density of SSI.
- Hip prosthesis
- A total of 267 985 hip prosthesis (HPRO) operations and 2 788 (1.0%) SSI were reported within one year of the operation. Of these, 1 086 (39%) were superficial incisional SSI, 1 080 (39%) were deep incisional SSI, 602 (22%) were organ/space SSI and 20 (<1%) were of unknown type. Forty per cent of SSI were detected during hospitalisation. The incidence density was 0.5 in-hospital SSI per 1 000 post-operative patient-days. Gram-positive cocci (66%) were the most frequently reported microorganisms, followed by Enterobacteriaceae (18%). The overall HPRO trend analysis in countries contributing data for all years 2008?2011 showed a statistically significant decrease of both the cumulative incidence of SSI and the incidence density of SSI.
- Knee prosthesis
- A total of 187 786 knee prosthesis (KPRO) operations and 1 340 (0.7%) SSI were reported within one year of the operation. Of these, 621 (46%) were superficial incisional SSI, 429 (32%) were deep incisional SSI, 274 (20%) were organ/space SSI and 16 (1%) were of unknown type. Only 30% of SSI were detected during hospitalisation. The incidence density was 0.3 in-hospital SSI per 1 000 post-operative patient-days. The most frequently reported microorganisms were Gram-positive cocci (74%) followed by Enterobacteriaceae (12%). The overall KPRO trend analysis in countries contributing data for all four years (2008?2011) showed a statistically significant decrease of the cumulative incidence but an increase of the incidence density of SSI.
- Laminectomy
- A total of 14 681 laminectomy (LAM) operations and 122 (0.8%) SSI were reported within 30 days of the operation. Of these, 53 (43%) were superficial incisional SSI, 38 (31%) were deep incisional SSI, 27 (22%) were organ/space SSI and 4 (3%) were of unknown type. Forty-seven per cent of SSI were detected during hospitalisation. The incidence density was 0.7 in-hospital SSI per 1 000 post-operative patient-days. The most frequently reported microorganisms were Gram-positive cocci (57%) followed by Enterobacteriaceae (23%) and non-fermentative Gram-negative bacilli (14%). The overall LAM trend analysis in countries contributing data for all four years (2008?2011) showed significant decrease for the cumulative incidence of SSI.
Introduction
History
The European Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections (2009/C 151/01) [1], recommends ?performing the surveillance of the incidence of targeted infection types? and ?using, where appropriate, surveillance methods and indicators as recommended by ECDC and case definitions as agreed upon at Community level in accordance with the provisions of Decision No 2119/98/EC [2].?
The Hospitals in Europe Link for Infection Control through Surveillance (HELICS) network was created in 2000 in the context of Decision 2119/98/EC, as a network for the surveillance of healthcare-associated infections (HAIs) and funded by the European Commission?s Directorate-General for Health and Consumers. From 2000 to 2002, HELICS standardised the European methodology for the surveillance of surgical site infections (SSI) and nosocomial infections in intensive care units. From 2003 onwards, the HELICS project collected data from national networks for the surveillance of HAIs. In 2005, HELICS surveillance became a part of the Improving Patient Safety in Europe (IPSE) network, which from 2005 to 2008 was the dedicated European surveillance network for the surveillance of HAIs. The scope of the IPSE network included the development of the existing national surveillance initiatives and other approaches for supporting infection control efforts in Europe. In July 2008, coordination of HAI surveillance in Europe was transferred to ECDC and the surveillance network became the Healthcare-Associated Infections Surveillance Network (HAI-Net) [3]. In 2009 and 2010, ECDC continued surveillance of SSI following the former IPSE/HELICS protocol and methods until this type of surveillance was fully integrated into The European Surveillance System (TESSy) in October 2010.
Objectives
The objectives of European surveillance of SSI are:
- to work towards comparable surveillance methods and analyse inter-country differences
- to draw up European reference tables for inter-hospital comparisons of risk-adjusted SSI rates
- to contribute to the extension of SSI surveillance in the European Union (EU)
- to follow up and report on long-term trends in SSI rates throughout the EU and in the Member States, as well as trends in the occurrence of microorganisms associated with SSI, including trends in antimicrobial resistance.
Data collection and technical notes
Data collection 2010?2011
Surveillance data of SSI in 2010 and 2011 (with partial follow-up for orthopaedic operations until 31 December 2012) were collected using TESSy, after the integration of the HAI surveillance dataset in October 2010. These data were collected by ECDC from Member States until 31 July 2013.
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