Structure and process indicators for the prevention of surgical site infections: results of a European pilot survey

Transcription

1 Structure and process indicators for the prevention of surgical site infections: results of a European pilot survey Carl Suetens, Tommi Kärki European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden NVKVV Studiedag verpleegkundigen infectiebeheersing, 19 maart 2018

2 Introduction In 2013, the European Commission requested that ECDC collects additional data on structure and process indicators for healthcareassociated infections based on the ECDC point prevalence survey results in accordance with Council recommendation 2009/C 151/01 In , ECDC discussed with the surveillance networks the addition of a set of internationally recommended and feasible structure and process indicators to the ECDC surveillance protocols In 2016, ECDC organised a pilot survey of structure and process indicators for surgical site infection prevention

3 Objectives To improve healthcare-associated infection prevention through surveillance increase awareness through inter-hospital and inter-country comparisons of structure and process indicators for prevention Objectives of the pilot survey, in order to routinely monitor the indicators in the future: To assess feasibility of collecting the structure and process indicator data as a part of the continuous surveillance of surgical site infections; To assess overall compliance with the selected structure and process indicators.

4 Methods: Selection of structure and process indicators for surgical site infection prevention Structure and process indicators to be included in the pilot survey discussed in ECDC meetings A set of six evidence-based and feasible indicators was selected, used evidence: Dutch PREZIES surgical care bundle (since 2008) US guidelines (2014 update, ICHE) WHO guidelines (2016)

5 Methods: Selected structure and process indicators for surgical site infection prevention 1. Administration of perioperative antibiotic prophylaxis within 60 minutes before incision 2. Discontinuation of perioperative antibiotic prophylaxis within 24 hours after incision 3. No hair removal, or if hair removal is necessary, the use of clippers 4. Alcohol-based skin antisepsis in the operating room 5. Patient normothermia within an hour after the operation 6. Glucose monitoring performed in the perioperative period

6 Methods: Data collection Participants were allowed to choose the type of surgical procedure under ECDC surveillance for which they collected data: Coronary artery bypass graft Cardiac surgery Cholecystectomy Colon surgery Caesarean section Hip prosthesis Knee prosthesis Laminectomy Rectum surgery Eight EU Member States collected data in October-December 2016

7 Indicators in HAI-Net SSI protocol

8 Results: Pilot survey participation and data N COUNTRIES 8 HOSPITALS 14 SURGICAL PROCEDURES 401 Cholecystectomy 83 Caesarean section 74 Coronary artery bypass graft 70 Knee prosthesis 50 Hip prosthesis 37 Colon surgery 34 Cardiac surgery 32 Laminectomy 12 Rectum surgery 9

9 Results: Compliance with the structure and process indicators Overall compliance in all types of surgical procedures varied from 97% for no hair removal to 64% for glucose monitoring performed in the perioperative period Most structure and process indicator data referred to cholecystectomies (n=81 surgical procedures) Median hospital compliance for cholecystectomies varied from 100% for alcohol-based skin antisepsis to 1.7% for glucose monitoring performed in the perioperative period Four countries reported that their national or local guidelines differed from the internationally recommended practices

10 Results: Median and interquartile range of hospital compliance with structure and process indicators after cholecystectomies (three hospitals)

11 Increase of compliance in PREZIES POWI network Source: M. Koek et al. PLoS One Sep 6;12(9) 14-37% SSI risk reduction

12 Num ber of door-movements Hygiene discipline: number of OR door openings: example Deuren open intervention Consecutive surgeries Source: M. Koek. HAI-Net SSI meeting Oct 2013

13 Conclusions The data collection for the structure and process indicators was feasible, although not all countries collected data for all of the selected indicators For each of the selected indicators, compliance varied especially between types of surgical procedure, but also between hospitals for the same surgical procedure Variations in the hospital compliance within the same type of surgical procedure room for improvement

14 Recommendations To further improve the prevention of surgical site infections, national and local guidelines should be updated with the internationally recommended infection prevention practices Collection of the structure and process indicator data is recommended as part of the EU surveillance: to facilitate the identification of outlier hospitals; to improve prevention practices at both national and local level

15 ECDC HAI-Net SSI: protocol, software, results HAI-Net SSI protocol HelicsWin.Net software

16 Acknowledgements Participating hospitals HAI-Net SSI pilot survey group: Luigi Segagni Lusignani (Austria), Dana Hedlova (Czech Republic), Pille Märtin (Estonia), Ida Prantner (Hungary), Dace Vigante (Latvia), Agne Plentaite and Rolanda Valinteliene (Lithuania), Mayke Koek and Anouk Meijs (the Netherlands), Gerry McIlvenny (UK-Northern Ireland) HAI-Net surgical site infections surveillance network colleagues and the protocol meeting participants Tommi Kärki (ECDC) and ECDC HAI-Net colleagues (past and present)