Two years of surgical site infection surveillance in Western Australia: analysing variation between hospitals

We would like to thank and acknowledge the contribution of the following hospitals: Armadale-Kelmscott Memorial Hospital, Fremantle Hospital, Hollywood Private Hospital, Royal Perth Hospital, Saint John of God Hospital Murdoch, Saint John of God Hospital Subiaco, Sir Charles Gairdner Hospital, Mount Hospital and Joondalup Health Campus.

[1] Hebert CK,  Williams RE,  Levy RS,  Barrack RL. Cost of treating an infected total knee replacement. Clin Orthop Relat Res 1996; 331 140–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [verified May 2009].

[6] Wilson J,  Ramboer I,  Suetens C,  HELICS-SSI working group Hospitals in Europe link for infection control through surveillance (HELICS). Inter-country comparison of rates of surgical site infection – opportunities and limitations. J Hosp Infect 2007; 65 165–70.
| Crossref | GoogleScholarGoogle Scholar | [verified May 2009].

[13] Goggin L,  van Gessel H,  McCann R,  Peterson A. Validation of surgical site infection surveillance in Perth, Western Australia. Healthcare Infect 2009; 14
[verified May 2009].

[22] Agabiti N,  Picciotto S,  Cesaroni G,  Bisanti L,  Forastiere F,  Onorati R, et al. The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study. Int J Qual Health Care 2007; 19 37–44.
| Crossref | GoogleScholarGoogle Scholar | [verified May 2009].

[25] Friedman ND,  Russo PL,  Bull A,  Richards MJ,  Kelly H. Validation of coronary artery bypass graft surgical site infection surveillance data from a state-wide surveillance system in Australia. Infect Control Hosp Epidemiol 2007; 28 812–17.
| Crossref | GoogleScholarGoogle Scholar | [accessed March 2009].

[31] Health Protection Agency. Third report of the mandatory surveillance of surgical site infection in orthopaedic surgery. April 2004 to March 2007. London: Health Protection Agency; 2007. Available online at: http://www.hpa.org.uk/ [verified May 2009].

[32] Ferguson JK,  van Gessel H. Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change. MJA 2008; 188 62.
[verified May 2009].

[38] Department of Health, Western Australia. Safety and Quality Investment for Reform (SQuIRe). Available online at: http://www.safetyandquality.health.wa.gov.au/squire/index.cfm [verified May 2009].

Definitions of surgical site infection for Healthcare Infection Surveillance Western Australia surveillance system

• Involves only skin and subcutaneous tissue.

• Occurs within 30 days of the operative procedure.

• Meets one of the following criteria from the incision:

• 1. purulent discharge (not stitch abscess);

  2. organisms are isolated from aseptically collected culture of fluid or tissue;

  3. diagnosis of infection or antimicrobial treatment by the operating surgeon or registrar;

  4. displays any of the following signs and symptoms at the incision site: pain or tenderness, localised swelling, redness or heat AND the incision is deliberately explored by the surgeon resulting in a positive wound culture.

• Infection involves deep soft tissues (e.g. fascial and muscle layers) and/or organ spaces opened or manipulated during an operation.

• Occurs within 30 days after the operative procedure if implant not present or within 1 year if implant in situ.

• Exhibits either one or both of the following:

• purulent drainage from deep soft tissue or drain that is placed through a stab wound into the organ/space;

• fever >38°C, localised pain or tenderness with culture-positive specimen. A culture-negative finding does not meet this criterion unless the patient was on antibiotics immediately prior to the wound being explored and/or the culture being taken.

• 1. purulent drainage from deep soft tissue or drain that is placed through a stab wound into the organ/space;

  2. spontaneous dehiscence at the incision site or the wound is deliberately explored by a surgeon with the patient showing evidence of one or more of the following signs or symptoms:

  3. 1. fever >38°C, localised pain or tenderness with culture-positive specimen. A culture-negative finding does not meet this criterion unless the patient was on antibiotics immediately prior to the wound being explored and/or the culture being taken.

     2. organisms isolated from aseptically obtained culture of fluid or tissue obtained from an organ/space.

     3. an abscess or other evidence of infection involving a deep/organ space is found on direct examination, during re-operation, or by histopathologic or radiologic examination.

     4. diagnosis of, or antimicrobial treatment of, a deep incisional or organ/space SSI by the operating surgeon or registrar.

• Specific sites of an organ/space SSI include: osteomyelitis, joint or bursa.

• All elective arthroplasty procedures: total, revision and partial.

• Revision procedures performed to remove an already infected joint.

• Emergency arthroplasty procedures (e.g. hemiarthroplasty of neck of femur).

• SSIs detected and treated as outpatients.