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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 valueDedication, commitment, consistency, and leadership support
FundamentalThe 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
StakeholdersGovernment, society, patient, patient family, hospitals, and payers
Surveillance methodsDirect, prospective in-hospital and post hospital discharge
In LMICs: possible mobile phone contact
Surveillance durationContinuous surveillance of SSI rates per patient case and per surgical procedure
In LMICs: At least 3 to 6 month
Patient follow –upIn-hospital
30-days or up to 90 days post-discharge
One year for surgical procedures that requires an implant
Surveillance teamCore team: surgical staff, theater staff and IPC staff
Surveillance team qualificationsHighly trained on surveillance method
High level of competency for data management and analysis
Basic background in epidemiology, microbiology, and communicable diseases
Surveillance protocolDetailed 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
DataDetailed 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 sourcesMedical 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 entryPreferably electronic support previously tested for accuracy and reliability
Data collection toolsHospital size, type, location, code, surveillance period start
Post-discharge surveillance: READM; REPSURG; REPGP; REPPAT; ICSURG; ICGP; CPAT
Data analysisPresent risk-adjusted SSI incidence; crude estimates; NNIS risk index
Ethical issuesPatient, 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