Surveillance of surgical site infections in elective colorectal surgery. Results of the VINCat Program (2007–2010)

doi:10.1016/S0213-005X(12)70092-7

Enfermedades Infecciosas y Microbiología Clínica

Volume 30, Supplement 3, June 2012, Pages 20-25

https://doi.org/10.1016/S0213-005X(12)70092-7 Get rights and content

Abstract

The VINCat Program is a standardized surveillance program of healthcare infections in Catalonia, Spain. This program includes monitoring of surgical site infections (SSI) of elective colorectal surgery. The aim of this study was to define SSI rates in colorectal surgery among VINCat hospitals over a period of 4 years.

We included consecutive elective colorectal interventions performed in VINCat hospitals from 2007 to 2010. Follow-up visits were performed 30 days after surgery. Prospective monitoring of SSI in colorectal surgery was performed according to standardized VINCat methodology. SSI was defined according to the Centers for Disease Control (CDC) and surgical risk factors according to the National Healthcare Safety Network (NHSN) classification.

From 2007 to 2010, 49 centers performed 10,104 surgical procedures. The cumulative incidence of SSI was 20.8% (95% CI: 20.03–21.63). The annual cumulative SSI incidence rate did not vary significantly over the study period; however, there were significant differences among hospital infection rates. The relative frequency of organ-space infection increased from 25% in 2007 to 40% in 2010 (p < 0.001). Laparoscopic surgery also increased (28% in 2007 to 42% in 2010, p < 0.001). However, no changes were observed in mean surgery duration, ASA score and degree of surgical contamination.

The VINCat Program incorporated a large number of Catalan hospitals that participated in standardized monitoring of colorectal surgery. The cumulative incidence rate of SSI for colorectal surgery was 20.8%, although there were large variations between hospitals.

Resumen

El VINCat es un programa estandarizado de vigilancia de las infecciones nosocomiales en Cataluña, España. Este programa incluye la monitorización de la infección de localización quirúrgica (ILQ) en la cirugía de colon. El objetivo de este estudio ha sido establecer las tasas de ILQ en cirugía colorrectal en los hospitales del Programa VINCat en un período de 4 años.

Se han incluido las intervenciones electivas en cirugía colorrectal practicadas en los hospitales del VINCat desde 2007 a 2010, con un seguimiento de 30 días desde la intervención. La vigilancia de la ILQ se realizó de acuerdo a la metodología estandarizada del programa. Se definió ILQ de acuerdo a los criterios de los Centers for Disease Control (CDC) y el riesgo quirúrgico de acuerdo a la clasificación del National Healthcare Safety Network (NHSN).

Durante el período 2007–2010, 49 hospitales incluyeron 10.104 procedimientos quirúrgicos. La incidencia acumulada de ILQ fue del 20,8% (IC del 95%, 20,03–21,63). La incidencia anual no varió significativamente a lo largo del período de estudio; sin embargo, se observaron diferencias muy marcadas en las tasas de infección entre hospitales. La frecuencia relativa de infección de órgano o espacio se incrementó desde el 25% en 2007 hasta el 40% en 2010 (p < 0,001). La cirugía laparoscópica también se incrementó (del 28% en 2007 al 42% en 2010; p < 0,001). Sin embargo, no se observaron cambios en la duración media de la cirugía, la clasificación ASA y el grado de contaminación de la cirugía.

El Programa VINCat incorpora un elevado número de hospitales de Cataluña que participan en la vigilancia estandarizada de la cirugía colorrectal. La incidencia acumulada de ILQ en cirugía colorrectal fue del 20,8%, aunque se observaron amplias variaciones entre hospitales.

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Las infecciones de localización quirúrgica (ILQ) son un importante problema que limita los beneficios de las intervenciones quirúrgicas. Se evaluó la incidencia acumulada de ILQ en cirugía de colon y el cumplimiento de la profilaxis antibiótica, así como las causas de su incumplimiento.
Estudio prospectivo observacional multicéntrico entre los años 2012 y 2019 en 7 hospitales del Servicio Canario de Salud mediante un sistema de vigilancia epidemiológica activa. Se definió ILQ de acuerdo con los criterios de los Centers for Disease Control and Prevention.
En el año 2019 la incidencia acumulada de ILQ fue del 10,6% (n = 80), lo que supone mantener la tendencia descendente desde el año 2012. La aparición de ILQ fue más frecuente durante el ingreso (76%). La profilaxis quirúrgica fue adecuada en el 81,2%, siendo las principales causas de inadecuación la duración excesiva de la prescripción del antimicrobiano (49%) y los fallos en la indicación (33%). La incidencia ha sido superior en el grupo de ILQ órgano-espacio (53,75% del total) en comparación con las superficiales o profundas.
La incidencia acumulada de ILQ obtenida es similar a la calculada en otros estudios realizados en condiciones semejantes. La quimioprofilaxis preoperatoria fue adecuada en la mayoría de intervenciones.
Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated.
Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention.
In 2019, the cumulative incidence of SSIs was 10.6% (n = 80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections.
The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions.
Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections. A systematic review
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Citation Excerpt :
However, there was significant heterogeneity (Tau2 = 0.22; Chi2 = 25.87, df = 11; (p = 0.007; I2 = 57%) among included studies (see Fig. 2). CRR are associated with high SSIs with a reported incidence of up to 20% [38–40], which is also considered the highest among elective operations [41]. Therefore, several precautions and measures were developed -pre, intra and post-operatively- over the past years to reduce the risk of post operative infections.
The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) are associated with reduced risk of surgical site infections (SSI).
Analysis was conducted according to PRISMA guidelines. With the help of expert local librarians, systematic search of medical databases like MEBASE, MEDLINE and PubMed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan version 5.
Twelve RCT on 2425 patients fulfilled the inclusion criteria. There were 1216 patients in the WP group and 1209 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.60, 95% CI (0.41–0.90), z = 2.49, P = 0.01]. However, there was significant heterogeneity (Tau² = 0.22; Chi² = 25.87, df = 11; (p = 0.007; I² = 57%) among included studies.
Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.
What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations
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Antes de planificar estrategias de mejora, es crucial conocer el grado de implementación de las medidas preventivas de infección postoperatoria. Se presentan los resultados agregados de 3 encuestas realizadas por el Observatorio de Infección en Cirugía a miembros de 11 asociaciones de cirugía y de enfermería quirúrgica. Las preguntas fueron dirigidas a determinar el conocimiento de la evidencia científica, las creencias personales y el uso real de las principales medidas. De 2.295 encuestados, el 45,1% no recibe información de la tasa de infección de su unidad. Se observó un conocimiento insuficiente de algunas de las principales recomendaciones de prevención y unas tasas de utilización, en ocasiones, inquietante. Se indagó sobre las estrategias preferidas para mejorar el cumplimiento de las pautas preventivas y su grado de implementación. Se confirmó la brecha existente entre la evidencia científica y la práctica clínica en la prevención de infecciones en diferentes especialidades quirúrgicas.
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.
An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008–2019)
2022, International Journal of Surgery
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Surgical site infections (SSIs) are among the most common health care-related infections [1], and colorectal surgery has the highest incidence of SSIs after elective abdominal procedures, ranging from 9% to 20% [2–4].
Colorectal surgery is associated with the highest rate of surgical site infection (SSI). This study analyses the effectiveness of an interventional surveillance program on SSI rates after elective colorectal surgery.
Cohort study showing temporal trends of SSI rates and Standardized Infection Ratio (SIR) in elective colorectal surgery over a 12-year period. Prospectively collected data of a national SSI surveillance program was analysed and the effect of specific interventions was evaluated. Patient and procedure characteristics, as well as SIR and SSI rates were stratified by risk categories and type of SSI analysed using stepwise multivariate logistic regression models.
In a cohort of 42,330 operations, overall cumulative SSI incidence was 16.31%, and organ-space SSI (O/S–SSI) was 8.59%. There was a 61.63% relative decrease in SSI rates (rho = −0.95804). The intervention which achieved the greatest SSI reduction was a bundle of 6 measures. SSI in pre-bundle period was 19.73% vs. 11.10% in post-bundle period (OR 1.969; IC 95% 1.860–2.085; p < 0.0001). O/S–SSI were 9.08% vs. 6.06%, respectively (OR 1.547; IC 95% 1.433–1.670; p < 0.0001). Median length of stay was 7 days, with a significant decrease over the studied period (rho = −0.98414). Mortality of the series was 1.08%, ranging from 0.35% to 2.0%, but a highly significant decrease was observed (rho = −0.67133).
Detailed analysis of risk factors and postoperative infection in colorectal surgery allows strategies for reducing SSI incidence to be designed. An interventional surveillance program has been effective in decreasing SIR and SSI rates.
Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017-2019
2021, Cirugia Espanola
El Complejo Hospitalario de Navarra, centro sanitario de tercer nivel, implementó a partir de 2016 un nuevo sistema de vigilancia y control de infecciones relacionadas con la asistencia sanitaria según metodología de la Red Nacional de Vigilancia Epidemiológica. Las infecciones del lugar quirúrgico constituyen uno de los efectos adversos más relevantes, siendo la cirugía de colon un procedimiento de vigilancia obligatoria. Este sistema permitirá al hospital conocer sus tasas de infección quirúrgica, contrastarlas periódicamente para vigilar su tendencia y compararlas con las de otras instituciones sanitarias nacionales y europeas.
Cuatrocientos dieciséis pacientes intervenidos de colon durante 2017-2019 fueron estudiados prospectivamente durante su hospitalización y hasta los 30 días post-cirugía y estratificados según el riesgo de infección quirúrgica mediante el «índice NHSN» (National Health Safety Network). Se realizó un análisis estadístico descriptivo univariante y se calculó la incidencia acumulada de infección de lugar quirúrgico, global y por subgrupos según factores de riesgo.
La incidencia acumulada global de infección del lugar quirúrgico fue del 10,6% (n = 44), con mayor incidencia en subgrupos de alto riesgo quirúrgico: un 25,0% en la categoría 2 del índice NHSN y un 42,9% en la categoría 3.
La incidencia acumulada de infección del lugar quirúrgico obtenida es similar a la calculada en otros estudios realizados en condiciones semejantes, pero existe una diversidad metodológica que hace compleja la interpretación.
Navarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels.
416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30 days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated.
The cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories 2 and 3.
The incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.
Effects of the application of vitamin E and silicone dressings vs conventional dressings on incisional surgical site infection in elective laparoscopic colorectal surgery: a prospective randomized clinical trial
2019, Journal of Hospital Infection
Citation Excerpt :
Surgical site infection (SSI) is a frequent complication after surgery, resulting in decreased health-related quality of life, increased risk of re-admission and prolonged hospital stay, leading to increased hospital costs [1,2].
To compare the effect of conventional wound dressings (CD) with vitamin E and silicone (E-Sil) dressings on incisional surgical site infection (SSI) in patients undergoing elective colorectal laparoscopic surgery.
A prospective, randomized study was performed. Patients were assigned at random into two groups: an E-Sil group and a CD group. Incisional SSI, postoperative pain and acute phase reactants were investigated.
In total, 120 patients were included in this study (60 in each group). The incisional SSI rate was 3.4% in the E-Sil group and 17.2% in the CD group (P = 0.013). Bacteroides fragilis alone grew in the cultures of infected wounds in the E-Sil group, while cultures for infected wounds in the CD group were polymicrobial. Mean postoperative pain 48 h after surgery was 27.1 [standard deviation (SD) 10.7] mm in the E-Sil group and 41.6 (SD 16.9) mm in the CD group (P < 0.001). White blood cell (WBC) count and C-reactive protein (CRP) level were lower in the E-Sil group, even after the exclusion of patients presenting with postoperative complications.
Use of an E-sil dressing to cover the Pfannestiel wound after elective laparoscopic colorectal surgery leads to a reduction in the incisional SSI rate, lower postoperative pain, and a decrease in CRP level and WBC count.

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Surveillance of surgical site infections in elective colorectal surgery. Results of the VINCat Program (2007–2010)Monitorización de la infección de localización quirúrgica en cirugía colorrectal electiva. Resultados del Programa VINCat (2007–2010)

Abstract

Resumen

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