Surgical site infection surveillance in France: the first 1999–2004 trend analysis

Abstract number: 1732_7

Astagneau P., Olivier M., Grandbastien B., L'Heriteau F., Jost J., Seguier J., Tronel H., Senechal H., Metzger M., Parneix P., Coignard B.

Background: Surgical site infection (SSI) is one of the most frequent nosocomial infections. Since 1999, a national coordination of regional networks has been implemented to gather SSI incidence data according to standardised method. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse a 6-year temporal trend.

Methods: Surgery patients were enrolled by voluntary participating wards in a yearly 3-month incidence survey. In each ward, 200 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard CDC criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed.

Results: During 6 years, the study included 620,176 operations (17,430,253 operated patient–days follow-up; median post-operative follow-up: 28 days). The overall SSI incidence rate was 1.68%. Organ space and deep incisional SSI accounted for 41.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.91% [0.88–0.94%] for NNIS-0 patients to 13.8% [12.5–15.2%] for NNIS-2, 3 patients. The SSI incidence varied from 1.15% for herniorraphy to 9.2% for colon surgery. In NNIS-0 patients, emergency surgery increased the SSI risk for C-section whereas videoscopy surgery was at lower risk for cholecystectomy. From 1999 to 2004, NNIS-0 SSI incidence decreased from 1.1 to 0.9 for 100 operated patients (relative difference: -18%). According to procedure, the trend remained significant only for herniorraphy.

Conclusion: This database provided thorough standardised estimate of SSI incidence according to various surgery procedures. Impact of the national policy on SSI incidence remains to be further evaluated, although encouraging results were evidenced for specific surgery.