Promoting quality through surveillance of surgical site infections: five prevention success stories. A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study. Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia. Reducing colorectal surgical site infections: a novel, resident-driven, quality initiative. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology Risk factors for surgical site infections in older people. Surgical site infections in Italian Hospitals: a prospective multicenter study Incidence and predictors of surgical-site infections in Vietnam. Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam. Outcome of a strategy to reduce surgical site infection in a tertiary-care hospital. Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital. A survey on prevention of surgical infections in operating theaters. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study Risk factors for neurosurgical site infections: an 18-month prospective survey. Diminishing surgical site infections in Australia: time trends in infection rates, pathogens and antimicrobial resistance using a comprehensive Victorian surveillance program, 2002-2013. Prospective surveillance for surgical site infection in St. Petersburg, Russian Federation.
BACKGROUND Public reports of successful quality improvement efforts are useful , but seldom available . We present 5 successful efforts to prevent surgical site infections ( SSIs ) with the use of prospect ively collected surveillance data . METHODS Before- and -after intervention studies were conducted in 5 acute care public hospitals in the national surveillance network for SSI in The Netherl and s from 1992 to 2000 . Patients undergoing surgery for total hip prosthesis ( 3 hospitals ) , knee prosthesis ( 2 hospitals ) , prosthesis of the femur head ( 1 hospital ) , or appendectomy ( 1 hospital ) were included . Included were 1066 patients before intervention , and 1269 patients after intervention . Multidisciplinary evaluation of infection control policy led to subsequent changes of infection control measures , mainly involving the discipline of staff and organization of perioperative infection prevention procedures . RESULTS All 5 hospitals drastically reduced their SSI rates to the national average or below . Absolute declines ranged from 2.1 % to 13.9 % , but not all reductions were statistically significantly different from 0 % . CONCLUSION Surveillance results provide a basis for improvement of infection prevention BACKGROUND  Surgical site infections ( SSIs ) are the most frequent health-care-associated infections in developing countries . Specific prevention measures are highly effective , but are often poorly implemented . We aim ed to establish the effect of a multimodal intervention on SSIs in Africa . METHODS We did a before-after cohort study , between July 1 , 2013 , and Dec 31 , 2015 , at five African hospitals . The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures , combined with an adaptive approach aim ed at the improvement of teamwork and the safety climate . The primary outcome was the first occurrence of SSI , and the secondary outcome was death within 30 days post surgery . Data on adherence to SSI prevention measures were prospect ively collected . The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model , after adjustment for key confounders . FINDINGS Four hospitals completed the baseline and follow-up ; three provided suitable ( ie , sufficient number and quality ) data for the sustainability period . 4322 operations were followed up ( 1604 at baseline , 1827 at follow-up , and 891 in the sustainability period )  . SSI cumulative incidence significantly decreased post intervention , from 8·0 % ( 95 % CI 6·8 - 9·5 ; n=129 ) to 3·8 % ( 3·0 - 4·8 ; n=70 ; p<0·0001 ) , and this decrease persisted in the sustainability period ( 3·9 % , 2·8 - 5·4 ; n=35 ) . A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods . The likelihood of SSI during follow-up was significantly lower than pre-intervention ( odds ratio [ OR ] 0·40 , 95 % CI 0·29 - 0·54 ; p<0·0001 ) , but the likelihood of death was not significantly reduced ( 0·72 , 0·42 - 1·24 ; p=0·2360 ) . INTERPRETATION Implementation of our intervention is feasible in African hospitals . Improvement was observed across all perioperative prevention practice s. A significant effect on the overall SSI risk was observed , but with some heterogeneity between sites . Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes . FUNDING US Agency for Healthcare Research and Quality , WHO OBJECTIVES To estimate the frequency of and risk factors for surgical-site infections ( SSIs ) in Bolivia , and to study the performance of the National Nosocomial Infections Surveillance ( NNIS ) System risk index in a developing country . DESIGN A prospect i ve study with patient follow-up until the 30th postoperative day . SETTING A general surgical ward of a public hospital in Santa Cruz , Bolivia . PATIENTS Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed . RESULTS Follow-up was complete for 91.5 % of 376 surgical procedures . The overall SSI rate was 12 % . Thirty-four ( 75.6 % ) of the 45 SSIs were culture positive . A logistic regression model retained an American Society of Anesthesiologists score of more than 1 ( odds ratio [ OR ] , 1.87 ) , a not-clean wound class ( OR , 2.28 ) , a procedure duration of more than 1 hour ( OR , 1.81 ) , and drain ( OR , 1.98 ) as independent risk factors for SSI . There was no significant association between the NNIS System risk index and SSI rates . However , a " local " risk index constructed with the above cutoff points showed a linear trend with SSI ( P < .001 ) and a relative risk of 3.18 for risk class 3 versus a class of less than 3 . CONCLUSIONS SSIs cause considerable morbidity in Santa Cruz . Appropriate nosocomial infection surveillance and control should be introduced . The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting , but a risk score based on local cutoff points performed substantially better BACKGROUND Surgical site infections ( SSIs ) cause significant patient morbidity and increase costs . This work prospect ively examines our institutional effort to reduce SSIs through a  resident-driven quality initiative . METHODS A general surgery resident-championed , evidence d-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship . National Surgical Quality Improvement Program definitions for SSIs were used . Data were collected prospect ively and bundle compliance was monitored using a checklist . The primary outcome compared SSIs before and after implementation . RESULTS In the 2 years preceding st and ardization , 489 colorectal surgery cases were performed .  SSIs occurred in 68 patients ( 13.9 % SSI rate ) . Following implementation of the bundle , 212 cases were performed with 10 SSIs ( 4.7 % SSI rate , P < .01 ) . Multivariate logistic regression analysis found a decrease in superficial and overall SSIs ( odds ratio .17 , 95 % confidence interval .05 to .59 ; odds ratio .31 , 95 % confidence interval .14 to .68 ) . CONCLUSIONS These data demonstrate that  resident-driven  initiatives to improve quality of care can be a swift and effective way to enact change . We observed significantly decreased SSIs with a renewed focus on evidence -based , st and ardized patient care BACKGROUND Surveillance of surgical site infection ( SSI ) is one of the most effective methods for decreasing the incidence . We determined the risk factors for SSI and the effect of a one-year surveillance program on the rate at a tertiary-care center . METHODS The annual SSI rate before the study period was determined in a preliminary study . Risk factors related to SSI , the bacteria cultured from infected sites , and the effect of surveillance were then analyzed prospect ively . Risk factors were determined by logistic regression analysis , and 95 % confidence intervals were calculated . RESULTS The incidence of SSI decreased from 12.8 % before the study to 8.8 % at the end of the surveillance period . There were 90 SSIs ( 8.8 % ) in 1,017 procedures during the study period , most of which ( 77 ; 69 % ) were detected during the hospital stay . The distribution of superficial incisional , deep incisional , and organ/space SSI was 61.1 % , 33.4 % , and 5.5 % , respectively . Prolonged preoperative hospital stay ( > 8 days ) , abdominal incision , early preoperative hair removal , inappropriate antimicrobial prophylaxis , whole blood transfusion , famotidine treatment , repair with mesh , age > 75 years , wound contamination , high American Society of Anesthesiologists score , malnutrition , diabetes mellitus , emergency surgery , obesity , and coexistent infection proved to be independent risk factors for SSI , whereas the skin closure technique , patient sex , presence of malignancy , smoking history , and duration of operation were not . Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently . Six infected patients ( 5.4 % ) died , four because of SSI . Development of SSI increased hospital expenses by around 600 US dollars per patient . CONCLUSION Surveillance even for one year decreases the incidence of SSI Background Surgical site infections ( SSIs ) lead to increased patient morbidity and healthcare costs . Our objective was to decrease the SSI rate following gynecologic surgery . Methods Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following : patient education ; preoperative antibacterial soap ; appropriate antibiotic prophylaxis ; change of gloves and use of clean instruments at surgical closure ; surgical dressing for 48 h ; and a post-discharge phone call . The baseline SSI rate was determined retrospectively ( 1 April 2014–30 June 2014 ) , while the post-intervention SSI rate was determined prospect ively ( 16 February 2015–15 October 2015 ) . The main outcome was the overall SSI rate with secondary outcomes , including the rate of superficial , deep , incisional and organ space infection , as well as the cost effectiveness of the bundle . Results A total of 232 baseline and 555 post-intervention patients were included in the study . No differences were observed between the baseline and post-intervention groups with regard to median body mass index ( BMI ) , surgical approach , receipt of preoperative chemotherapy and /or radiation therapy , and cases including bowel surgery . Overall , the SSI rate decreased significantly from baseline [ 12.5 % ] to post-intervention [ 7.4 % ] ( odds ratio [ OR ] 0.56 , 90 % confidence interval [ CI ] 0.37–0.85 ; p = 0.01 ) . A 40 % decrease was noted in the rate of superficial and deep infections ( 9.5 vs. 5.9 % ; OR 0.60 , 90 % CI 0.38–0.97 ; p = 0.04 ) and SSIs after open surgery ( 21.4 vs. 13.2 % ; OR 0.56 , 90 % CI 0.34–0.92 ; p = 0.03 ) . The estimated cost of the intervention was $ 19.26/case and the net total amount saved during the post-intervention period was $ 65,625 month . Conclusions This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective . The largest decreases in SSIs were in incisional infections and following open surgery OBJECTIVES To identify risk factors for  surgical site infection ( SSI ) in older people and to test a priori hypotheses regarding particular variables and SSI risk . DESIGN Case-control study . SETTING Duke University Medical Center and seven community hospitals in North Carolina and Virginia . PARTICIPANTS Elderly patients ( > or = 65 ) who underwent surgery between 1991 and 2002 at the study hospitals . Cases were elderly patients with SSI ; controls were elderly operative patients without SSI . Infection control practitioners prospect ively identified patients . MEASUREMENTS Data were collected retrospectively . Case patients who developed SSI were compared with control patients who did not develop SSI . RESULTS Five hundred sixty-nine SSI cases were identified , and 589 uninfected controls were selected . In multivariate analysis , independent predictors of SSI included obesity ( odds ratio (OR)=1.77 , 95 % confidence interval (CI)=1.34 - 2.32 ) , chronic obstructive pulmonary disease ( COPD ) ( OR=1.66 , 95 % CI=1.17 - 2.34 ) , and a wound class classified as contaminated or dirty ( OR=1.65 , 95 % CI=1.01 - 2.72 ) . Having private insurance was associated with lower risk ( OR=0.29 , 95 % CI=0.12 - 0.68 ) . CONCLUSION This study identified several independent predictors of  SSI in older people , including comorbid conditions ( COPD and obesity ) , perioperative variables ( wound class ) , and socioeconomic factors ( private insurance , which was associated with lower risk ) . The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people Background Surgical site infections ( SSI ) remain a major clinical problem in terms of morbidity , mortality , and hospital costs . Nearly 60 % of SSI diagnosis occur in the postdischarge period . However , literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence . A national prospect i ve multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI , and the associated risk factors . Methods In 2002 , a one-month , prospect i ve national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals . Case ascertainment of SSI was carried out using st and ardized surveillance methodology . To assess potential risk factors for SSI we used a conditional logistic regression model . We also reported the odds ratios of in-hospital and postdischarge SSI . Results SSI occurred in 241 ( 5.2 % ) of 4,665 patients , of which 148 ( 61.4 % ) during in-hospital , and 93 ( 38.6 % ) during postdischarge period . Of 93 postdischarge SSI , sixty-two ( 66.7 % ) and 31 ( 33.3 % ) were detected through telephone interview and question naire survey , respectively . Higher SSI incidence rates were observed in colon surgery ( 18.9 % ) , gastric surgery ( 13.6 % ) , and appendectomy ( 8.6 % ) . If considering risk factors for SSI , at multivariate analysis we found that emergency interventions , NNIS risk score , pre-operative hospital stay , and use of drains were significantly associated with SSI occurrence . Moreover , risk factors for total SSI were also associated to in-hospital SSI . Additionally , only NNIS , pre-operative hospital stay , use of drains , and antibiotic prophylaxis were associated with postdischarge SSI . Conclusion Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy . St and ardized postdischarge surveillance detected 38.6 % of all SSI . We also compared risk factors for in-hospital and postdischarge SSI , thus providing additional information to that of the current available literature . Finally , a large amount of postdischarge SSI were detected through telephone interview . The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research OBJECTIVE To determine the incidence of , and risk factors for ,  surgical-site infections ( SSIs ) . DESIGN Prospect i ve observational study of all patients undergoing surgery during a 3-month period . SETTING Two urban hospitals in Hanoi , Vietnam . PATIENTS All 697 patients admitted for emergent and elective surgery . METHODS Data were collected on all patients undergoing surgery during a 3-month period at each hospital . We stratified the data by type of surgery , wound class , and Study on the Efficacy of Nosocomial Infection Control ( SENIC ) risk index . The analysis was done with the data sets from each hospital separately and with the combined data . The risk factors for SSI were identified using a logistic-regression model . RESULTS During the period of observation , 10.9 % of 697 patients had SSI . The SSI rate was 8.3 % for clean wounds , 8.6 % for clean-contaminated , 12.2 % for contaminated , and 43.9 % for dirty wounds . The lowest rate of SSI ( 2.4 % ) was found in obstetric-gynecologic procedures and the highest rate ( 33.3 % ) in cardiothoracic operations . Using the SENIC risk index , the incidence of SSI in low-risk patients was 5.1 % ; for medium-risk patients , 13.5 % , and high-risk patients , 24.2 % . In a logistic-regression model , abdominal surgery ( odds ratio [ OR ] , 4.46 ; P<.01 ) and wound class IV ( OR , 5.67 ; P<.01 ) were significant predictors of SSI . All patients were treated with prolonged courses of perioperative antibiotics . Overall infection control practice s were poor as a result of deficient facilities , limited surgical instruments , and a lack of proper supplies for wound care and personal hygiene . CONCLUSIONS There was a higher incidence of  SSI  in low-risk patients in Vietnam compared with developed countries . Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance . Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques . These interventions also should reduce the incidence of SSI and its associated morbidity and costs OBJECTIVE We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based h and sanitizer on surgical site infection ( SSI ) rates among neurosurgical patients in Ho Chi Minh City , Vietnam . DESIGN A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15 , 2000 ( before the intervention ) , and July 14 and August 18 , 2001 ( after the intervention ) . A h and sanitizer with 70 % isopropyl alcohol and 0.5 % chlorhexidine gluconate was introduced , and healthcare workers were trained in its use on ward A in September 2000 . No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used . Patient SSI data were collected on st and ardized forms and were analyzed using Stata software ( Stata ) . RESULTS A total of 786 patients were enrolled : 377 in the period before intervention ( 156 in ward A and 221 in ward B ) and 409 in the period after intervention ( 159 in ward A and 250 in ward B ) . On ward A after the intervention , the SSI rate was reduced by 54 % ( from 8.3 % to 3.8 % ; P=.09 ) , and more than half of superficial SSIs were eliminated ( 7 of 13 vs 0 of 6 in ward B ; P=.007 ) . On ward B , the SSI rate increased by 22 % ( from 7.2 % to 9.2 % ; P=.8 ) . In patients without SSI , the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A ( both from 8 to 6 days ; P<.001 ) but not on ward B. CONCLUSIONS Our study demonstrates that introduction of a h and sanitizer can both reduce SSI rates in neurosurgical patients , with particular impact on superficial SSIs , and reduce the overall postoperative length of stay and the duration of antimicrobial use . H and hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes BACKGROUND Surgical site infection ( SSI ) is a preventable complication . Achieving a zero SSI rate for all clean operations should be the goal of all surgeons . AIM We aim ed to reduce our SSI rate by 50 % for patients undergoing elective gastrointestinal and hernia operations . METHODS The study was conducted in a tertiary-care hospital department of surgery from January 2006 to December 2007 for all clean and clean-contaminated elective gastrointestinal and hernia operations . Four interventions targeted at reducing SSI were implemented in January 2006 : Use of clippers instead of shavers for surgical site hair removal ; st and ardized prophylactic antibiotic regimen and antibiotic administration within 30 min before incision ; st and ardized glucose monitoring for diabetics ; and maintenance of postoperative normothermia . Prospect i ve data were collected and compared with historical data from January to December 2005 . RESULTS A total of 2,408 patients underwent elective gastrointestinal and hernia operations from January 2006 to December 2007 . After implementation , we were able to achieve 91 % , 87 % , 89 % , and 76 % overall compliance with the respective interventions , but postoperative normothermia was achieved in only 44 % of our patients . With the bundle of interventions , our overall SSI rate was reduced from 3.1 % to 0.5 % ( p < 0.001 ) , an 84 % reduction within two years . The incidence of SSI was 1.7 % in colorectal operations , 1.2 % in upper gastrointestinal operations , 0.3 % in hepatopancreaticobiliary operations , and zero in inguinal and ventral hernia operations . The estimated cost saving for both the patients and the hospital was S$208,562 ( US$ 147,967 ) . CONCLUSIONS Surgical site infections could be reduced with the bundle of interventions . With these encouraging results , the good practice s should be sustained and promulgated . Such a SSI prevention program must be embedded in the work processes for all surgical disciplines BACKGROUND Abdominal surgical site infections ( SSI ) cause substantial morbidity and mortality for patients undergoing operative procedures . We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo ( UCCK ) . METHODOLOGY Prospect i ve surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006 . CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance ( HELICS ) protocol . RESULTS A total of 253 surgical interventions in 225 patients were evaluated . The median age of patients was 42 years and 55.1 % of them were male . The overall incidence rate of SSI was 12 % . Follow-up was achieved for 84.1 % of the procedures . For patients with an SSI , the median duration of hospitalization was 9 days compared with 4 days for those without an SSI ( p2 , use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001 . The SSI rates for the NNIS System risk classes 0 , 1 and 2 - 3 were 4.2 % , 46.7 % and 100 % , respectively . CONCLUSIONS SSI caused considerable morbidity among surgical patients in UCCK . Appropriate active surveillance and infection control measures should be introduced during preoperative , intra-operative , and postoperative care to reduce infection rates BACKGROUND It is well known that surgical site infections ( SSIs ) contribute significantly to the cost of nosocomial infections . Although many guidelines and recommendations exist , research has demonstrated that practice s for preventing SSIs in operating theaters ( OT ) vary . AIM The purpose of this study was to describe the current infection control practice s for SSIs , formerly called surgical wound infections , in OTs , and compare these findings with evidence -based practice guidelines . METHODS In order to accomplish the purpose , a prospect i ve , cross-sectional descriptive survey was conducted . Data were collected by interviewing the charge nurses in 24 OTs of 11 hospitals in the city of Izmir , Turkey . The results were tabulated and compared with an evidence -based guideline . RESULTS Data showed that there is a lack of adherence to the guideline . The most compliant areas to the guideline were h and /forearm antisepsis and the use of surgical gowns and drapes . IMPLICATION S It is suggested that increased compliance to infection control guidelines for surgical infections in OTs would facilitate providing best practice and evidence -based care . There is a need for further research to determine why there is a difference between what is practice d and what guidelines indicate should be practice Abstract Background : Abdominal surgeries have high rates of surgical site infections ( SSIs ) , contributing to increased morbidity and mortality and costs for hospitalization . The aim of this study was to determine the SSI incidence rates and risk factors after  abdominal surgeries .  Methods : This prospect i ve cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya , Israel .  SSI incidence rates were calculated per 100 operations . Odds ratios ( ORs ) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models . Results : Among 302 patients in the study cohort , the total SSI incidence rate was 22.2 % . The univariate analysis defined 13 variables significantly associated with SSI : age > 60 years , lower functional status , diabetes mellitus , congestive heart failure , immunocompromising underlying disease , treatment with chemotherapy and other immunosuppressive medications , impaired immune system open cholecystectomy , laparotomy , an American Society of Anesthesiologists ( ASA ) score > 2 , drain insertion , and ‘ dirty wound ’ classification . In multivariate regression analysis , treatment with immunosuppressive medications ( OR = 2.5 , 95 % confidence interval ( CI ) = 1.099–143.443 ) , open cholecystectomy ( OR = 2.25 , 95 % CI = 2.242–40.109 ) , and dirty wound classification ( OR = 2.179 , 95 % CI = 3.80–20.551 ) were significantly associated with SSI . Conclusions : The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI . Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates OBJECT The purpose of this study was to determine the incidence rate and risk factors of surgical site infections ( SSIs ) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class . METHODS The authors undertook an exhaustive 18-month prospect i ve survey including patients who underwent neurosurgery .  In particular , a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant , and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant . The Centers for Disease Control definition of SSI was used . Univariate and multivariate analyses were conducted ; all dependent variables found in univariate analysis were entered in the multiple regression model . A stepwise multiple logistic regression method was used . RESULTS Of the 844 patients studied , 35 SSIs were diagnosed , yielding an incidence rate of 4.1 % ( 95 % confidence interval 3.6 - 4.5 ) . Independent predictive risk factors for infection were cerebrospinal fluid leakage , external shunt , Altemeier class , and further neurosurgery . A lack of antibiotic prophylaxis was not found to be a risk factor . CONCLUSIONS Infection risk factors occur mainly during the postoperative period OBJECTIVE To evaluate time trends in  surgical site infection ( SSI ) rates  and SSI pathogens in Australia . DESIGN Prospect i ve multicenter observational cohort study . SETTING A group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System ( VICNISS ) . PATIENTS All patients underwent surgeries performed between October 1 , 2002 , and June 30 , 2013 .  National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals . INTERVENTION Procedure-specific risk-adjusted SSI rates  were calculated . Pathogen-specific and antimicrobial-resistant ( AMR ) infections were modeled using multilevel mixed-effects Poisson regression . RESULTS A total of 183,625 procedures were monitored , and 5,123 SSIs were reported . Each year of observation was associated with 11 % risk reduction for superficial SSI ( risk ratio [ RR ] , 0.89 ; 95 % confidence interval [ CI ] , 0.88 - 0.90 ) , 9 % risk reduction for deep SSI ( RR , 0.91 ; 95 % CI , 0.90 - 0.93 ) , and 5 % risk reduction for organ/space SSI ( RR , 0.95 ; 95 % CI , 0.93 - 0.97 ) . Overall , 3,318 microbiologically confirmed SSIs were reported . Of these SSIs , 1,174 ( 35.4 % ) were associated with orthopedic surgery , 827 ( 24.9 % ) with coronary artery bypass surgery , 490 ( 14.8 % ) with Caesarean sections , and 414 ( 12.5 % ) with colorectal procedures . Staphylococcus aureus was the most frequently identified pathogen , and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed ( RR , 1.37 ; 95 % CI , 1.10 - 1.70 ) . CONCLUSIONS St and ardized SSI surveillance methods have been implemented in Victoria , Australia . Over an 11-year period , diminishing rates of SSIs have been observed , although AMR infections increased significantly . Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology OBJECTIVE To assess the risk-adjusted incidence and predictors of  surgical site infections ( SSIs ) .  DESIGN Prospect i ve , multicenter , observational cohort study . SETTING Seven surgical departments at 3 urban academic hospitals in St. Petersburg , Russian Federation . PATIENTS All patients had surgery performed between January 15 and May 12 , 2000 . A total of 1,453 surgical procedures were followed up . Medical records were unavailable for less than 3 % of all patients ; patients were not excluded for any other reason . The mean patient age was 49.3 years , 61 % were female , and 34 % had an American Society of Anesthesiologists physical status classification ( hereafter , " ASA classification " ) of at least 3 . Surgery for 45 % of the patients was emergent . RESULTS In all , 138 patients ( 9.5 % ) developed SSI , for a rate that was approximately 3.5 times the risk-stratified rates in the United States . Male sex ( odds ratio [ OR ] , 1.54 ) , ASA classifications of 3 ( OR , 3.7 ) or 4 ( OR , 5.0 ) , longer duration of surgery ( OR , 2.2 ) , and wound classes of 3 ( OR , 5.5 ) or 4 ( OR , 14.3 ) were associated with increased SSI risk in multivariate analysis . Endoscopic surgery was associated with a lower risk of SSI ( OR , 0.23 ) .  Antibiotic prophylaxis  was used in 0%-33 % of operations , and 69 % of uninfected patients received antibiotics after the operation . CONCLUSIONS The SSI rates are significantly higher than previously reported . Although this finding may be attributable to inadequate antibiotic prophylaxis , local infection control and surgical practice s may also be contributors . Use of antibiotic prophylaxis should be encouraged and the effect of local practice s further investigated . Active SSI surveillance should be exp and ed to other parts of the Russian Federation
From the patient ’s perspective , an infection delays healing , can increase time away from work or family , and can cause additional pain and complications ( eg , sepsis , long-term disabilities , death ) .
urgical site infections ( SSIs ) continue to cause significant patient harm despite many advances in Sinfection prevention .
The negative effects of SSIs on morbidity , mortality , and the cost of care has kept SSI reduction a top priority for health care organizations worldwide .
A 2011 systematic review found that approximately 55 % of SSIs in the United States may be preventable by using evidence -based guidelines .