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Table 1 Review of the suggested protocols for surgical site infection

From: Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria

Core value

Dedication, commitment, consistency, and leadership support


The same definition of SSI should be used across all sites and time periods

In LMICs: definitions based on clinical signs and symptoms should be prioritized


Government, society, patient, patient family, hospitals, and payers

Surveillance methods

Direct, prospective in-hospital and post hospital discharge

In LMICs: possible mobile phone contact

Surveillance duration

Continuous surveillance of SSI rates per patient case and per surgical procedure

In LMICs: At least 3 to 6 month

Patient follow –up


30-days or up to 90 days post-discharge

One year for surgical procedures that requires an implant

Surveillance team

Core team: surgical staff, theater staff and IPC staff

Surveillance team qualifications

Highly trained on surveillance method

High level of competency for data management and analysis

Basic background in epidemiology, microbiology, and communicable diseases

Surveillance protocol

Detailed written plan including elements of the surveillance process integrated into a comprehensive infection control risk assessment process

Training materials and information sheets

Detailed method of data validation

Constant intensity of surveillance for an area of interest


Detailed patient inclusion and exclusion criteria

Stratifying by patient characteristicsa

Date of onset of infection, isolate results, antibiotic code, antimicrobial susceptibility testing results; microorganisms and antimicrobial resistance data

Data sources

Medical records and human resources records

Financial services and Information services

Ancillary service reports; admission diagnoses reports; administrative/management reports; public health reports; marketing reports

Surgical database

Other sources: quality/utilization management; risk management; community agencies; occupational/employee health; communication with caregivers

Data entry

Preferably electronic support previously tested for accuracy and reliability

Data collection tools

Hospital size, type, location, code, surveillance period start

Post-discharge surveillance: READM; REPSURG; REPGP; REPPAT; ICSURG; ICGP; CPAT

Data analysis

Present risk-adjusted SSI incidence; crude estimates; NNIS risk index

Ethical issues

Patient, hospital, and unit confidentiality

A pre-discharge patient education and engagement with a signed assent

  1. READM = detection at readmission (= passive post-discharge surveillance): patient is readmitted with SSI, often because of the SSI; REPSURG = reporting on surgeon’s initiative: surgeon actively reports post-discharge infections detected at outpatient clinic or private clinic follow-up to the hospital surveillance staff, e.g., using standardized forms, web-based system, e-mail, or telephone; REPGP = reporting on GP’s initiative: general practitioner (GP) reports post-discharge infections detected at follow-up consultation to the hospital surveillance staff, e.g., using standardized forms, web-based system, e-mail or telephone; REPPAT = reporting on patient’s initiative: e.g., form send to hospital surveillance staff; ICSURG = obtained by IC staff from surgeon: the hospital surveillance staff—usually infection control (IC) staff—obtains information from surgeon using telephone, additional questionnaire, visit to surgeon or patient chart review; ICGP = obtained by IC staff from GP: hospital surveillance staff obtains information from general practitioner using telephone, additional questionnaire or visit; CPAT = obtained by IC staff from patient: hospital surveillance staff obtains information from patient using telephone or additional questionnaire References: [5, 68, 78, 90]
  2. aAge; sex; type of surgical procedure; whether elective or emergency surgery; the American Society of Anesthesiologists (ASA) score; timing and choice of antimicrobial prophylaxis; preoperative skin preparation; other indicators, e.g., protocol for intensive perioperative blood glucose control used and blood glucose levels monitored; implant in place; multiple operations during the same session or not; endoscopic procedure or not; duration of the operation; and wound contamination class; site of infection and type of SSI (superficial, deep, organ/space); number of OR openings; microbiology confirmation; outcome from hospital; patient discharge date; readmission date