Table 1.
Selected studies summary
| Observer | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Source | Study protocol | Focus | Definition of wound infection used | Surgical procedures defined | Wound classification | Duration of surgery | Patient pre/postoperative infection RI | Identified | Independence | Trained/validated | Length of study | Surveillance period |
| Klavs et al. (60) | Prevalence | HAI | CDC | Recorded not specified | N/S | N/S | Severity of illness assessment– McCabe and Jackson | Coordinators– 17 physicians; two ICNs | Hospital‐associated teams led by own hospital coordinators | 4 IDC; 4 CM; 5C with PGIC/no | 1‐day survey; noted procedures carried out ≤30 days | 1 day |
| Lizioli et al. (46) | Prevalence | HAI | CDC | General classifications only | C/CCon/ Con/D | N/S | ASA | Group of investigators for each hospital | Hospital associated | Hospital teams trained separately | 1‐day survey | 1 day |
| Rios et al. (10) | Incidence – case‐case study | SSI | CDC | Yes | N/S | N/S | N/S | ICN | Hospital associated and external | N/S | 2‐year study | Until discharge N/S |
| SCIEH (61) | Prospective/incidence | SSI | CDC | Eight categories of clinically similar ops | NNIS | Yes | NNIS | N/S | N/S | N/S | Annual review | Post discharge in 7/8 categories |
| Eriksen et al. (62) | Prevalence | HAI | Norwegian Health Ministry | N/S | N/S | N/S | N/S | ICN | Hospital associated | Standard survey/N/S | N/S | N/A |
| Gikas et al. (45) | Prevalence | HAI | CDC and CDC surgical wound infection | Recorded not detailed | C/CCon/ C/D | No | N/S | Microbiologist, IDS; ICN | Hospital associated | Individual hospital training with final joint meeting | 1‐day study | 1 day |
| Lallemand et al. (63) | Incidence | Prophylaxis in SSI | CDC | General classification only | C/CCon/ C/D | Yes | ASA NNIS | Surgeon‐ anaesthetist pairs | Hospital associated | N/S | N/S | 30 days |
| Steinbrecher et al. (64) | Incidence | SSI | CDC‐based | 13 specified surgical procedures | NNIS | NNIS | KISS/NNIS | ICN | No | Yes | Ongoing from January 1997 | Until discharge– N/S |
| Thibon et al. (35) | Incidence | SSI– patients lost to follow‐up | CDC/CTIN | General classification only | N/S | N/S | N/S | N/S | Surgeons asked to see each patient post‐op or to obtain follow‐up information | N/S | N/S | Target of 30 days but 59% lost to follow‐up between discharge and 30 days |
| Astagneau et al. (7) | Incidence | SSI | CDC | Yes approximately 30 classifications given | Altemeier | Yes | ASA score; NNIS | Nurses, anaesthetists, surgeons, with ICT | Surgeon used for post discharge assessment | N/S/No | 3 months of each year | 30 days or follow‐up appointment if earlier discharge |
| Azzam and Dramaix (65) | 1‐day prevalence | HAI | CDC 1988–1 sign or symptom of infection | Recorded not detailed | C/CCon/ Con/D | N/S | N/S | Two investigators only—phar‐macist and physician | N/S | N/S/N/S | 1 day | 1 day |
| de Boer et al. (66) | Incidence | SSI in orthopaedic | CDC‐based definition | Yes–two procedures studied–total hip and knee prosthesis | C/CCon/ Con/D 1‐4 | Yes | ASA; NNIS | N/S | N/S | N/S | Over a 3‐year study period | Until discharge– time N/S; unknown number monitored post discharge |
| Mintjes de‐Groot et al. (67) | Prospective –incidence | HAI in ICU –stay >48 h | CDC‐based‐ WIP | General classification only | N/S | No | APACHE II | N/S | N/S | Yes/yes | July 97 to December 99 | Until discharge from ICU–median stay 6 days |
| Plowman et al. (6) | Incidence | HAI | Glenister 1992 not stated as CDC | N/S | N/S | N/S | Cross‐ referenced Glenister (68) | ICT plus six research assistant plus ward staff | Hospital associated | Research assistants– yes/support staff N/S | April 94 to May 95 | Monitored during the inpatient period but this is N/S |
| Reilly et al. (28) | Incidence | SSI in clean, elective surgery | Definitive Glenister 1992 –not stated as CDC | Yes | Clean surgery only | N/S | N/S but data collected from post op wound audit clinics | Cost of audit nurse evaluated– N/S who collected the data | N/S | N/S | 1/11/95‐‐31/3/99 | 30 days |
| Stockley et al. (34) | Incidence | SSI | NINSS* | Yes–five representative procedures | N/S | N/S | NINSS*– some in‐house measures also | Infections control audit nurse; post discharge GPs and DNs | Hospital associated/GPs, DNs in the community | YeS/N/S | Over a 5‐year period | 25‐35 days including post discharge and telephone call |
| Andersen et al. (69) | Repeated point‐prevalence 4/year for 3 years | HAI CAI | Modified CDC–12 types specified | N/S | N/S | N/S | N/S | ICN and/or clinicians responsible for infection control | Hospital associated | N/S/N/S | Same day and hour in all hospitals | Repeated 1‐day studies |
| FPSSG (13) | Prevalence | HAI | CDC modified | Recorded not detailed | N/S | N/S | N/S | Team including ICP and ICNs–data collection supported by doctors and nurses | Hospital associated | Trained by coordinator from hospital local training offered | Same day for unit; within 7 days for hospital; over 1 month for study | 1‐7 days |
| Geubbels et al. (14) | Prospective multicentre incidence | SSI | CDC in Dutch translation | Yes but of 18 063 procedures, 7336 classed as 'other'; Dutch ICD‐9‐CM | C/CCon/ Con/D; 1‐‐4 | Yes–data not given linking to SSI rate– good correlation reported | ASA; wound class; data not detailed linking to SSI rate– good correlation reported | ICP and/or clinician; not specified in 1 | Hospital associated | Hospital linked/validation carried out by blinded team of 4 | June 96 to May 97 | All patients followed at least until discharge –but actual time not specified |
| Mintjes‐de Groot et al. (70) | Active surveillance over 13 years | HAI | Modified CDC | Classified according to NMR but not detailed | N/S | N/S | Patient‐related risk factors assessed but not specified; | One ICP; missing data provided by CRF, nurse or doctor | Hospital associated | N/S/sensitivity/specificity assessed from a multi‐centre study | Conducted over 13 years | Over 9‐month period– until patient discharge–N/S |
| Pavia et al. (71) | Prevalence | HAI | CDC | Recorded not detailed | C/CCon/ Con/D | No | N/S | No | Hospital associated | Yes/No | 1‐day study over a 2‐week period | 1 day |
| Asensio and Torres (29) | Two incidence observation studies– matched and versus controls | Deep SSI | CDC definition– deep SSI only | Open heart– with additional classification | Clean/non‐ clean | Yes | Clean/non‐clean | N/S | N/S | N/S/N/S | January 89 to December 99 | To discharge but no standardised period |
| Golliot et al. (72) | Incidence– prospective cohort study | SSI | Altemeier classification, CDC and CTIN* | 35 procedures classified– eight general linked to NNIS and SSI rate | C/CCon/Con /D | Yes–fully detailed for all procedures | ASA; NNIS; not linked to SSI rate | Surgeon and hygiene control nurse | Hospital associated | N/S | 1 month postoperatively | 1 month postoperatively |
| Pittet et al. (73) | Period prevalence– over 1 week | HAI | CDC– asymptomatic bacteriuria not categorised as an NI | N/S | No | No | McCabe and Jackson assessment; Charlson index; Karnofsky index | One study coordinator but CRFs filled in by physicians and nurses involved in care | Two independent observers checked % of records | N/S/yes | 1 week with operation in past 30 days or 1 year with implant documented | Documented within 30 days post‐operatively or 1 year with implant |
| Scheel and Stormark (47) | 1‐day prevalence | HAI | Modified CDC | Recorded not detailed | N/S | No | N/S | 'Contact' doctor and/or ward nurses and doctors | Hospital‐associated staff | N/S | 1 day | 1 day |
| Vaqué et al. (12) | 1990‐97– 1997 data cited–point prevalence | HAI | CDC | Recorded not detailed | Recorded not detailed– clean surgery data only | Recorded not detailed | N/S | Physicians or nurses in ICT | Under the direction of each individual hospital ICT | Uniform standardised protocol by CRF/N/S | 2‐week data collection in May over an 8‐year period | 1 day |
| Frankart et al. (74) | 3‐day prevalence | HAI | CDC | General classification only | C/CCon/Con /D | N/S | ASA | Surgeon, hygiene specialist | Hospital associated | N/S/yes; independent validator | 3 days | Documented within 30 days post‐operatively or 1 year with implant |
| Gastmeier et al. (30) (NIDEP) | 1‐day prevalence | HAI | CDC | General classification only | C/CCon/Con /D | N/S | ASA | Physicians jointly trained in diagnosis of HAI– sensitivity and specificity figures given | Yes | Yes/four independent external investigators– independent | All patients assessed in the same ward on the same day | 1 day |
| Cainzos et al. (75) | Incidence in a 3‐month period | SSI | CDC | Biliary tract stone with specific WHO class | C/CCon/Con /D | No | CC/Con/D | N/S | N/S | N/S | 3 months | 30 days post surgery |
| Medina et al. (76) | Prospective surveillance | SSI | CDC | Herniorrhaphy | C/CCon/Con /D | Yes | ASA; McCabe NNIS/SENIC index | Hospital‐associated teams– follow‐up by post and outpatient clinics | N/S but surgeon infection risk assessed | N/S/N/S | November 92 to June 94 | 1‐month post discharge |
| Rüden et al. (15) (NIDEP) | Prevalence | HAI | CDC | N/S | N/S | N/S | N/S | Yes | Yes | Yes/yes | 1 day | 1 day |
| Emmerson et al. (11) | Prevalence | HAI CAI | N/S–cross referenced | General classification only | N/S | N/S | N/S–cross referenced | N/S–cross referenced | N/S–cross referenced | N/S–cross referenced | May 93 to July 94 in 2‐month study sessions | N/S |
| Kampf et al. (31) (NIDEP) | Prevalence | HAI | CDC | 11 procedures specified | 1‐‐4 | Yes | Yes–wound 1‐4; | Doctors trained in diagnosis of HAI– sensitivity and specificity figures given | Four independent external investigators– independent | Yes/yes | 10‐month study | 1 day (not specified in paper but based on NIDEP) |
| Ronveaux et al. (8) | incidence | SSI over a 3‐month recording period | CDC– occurring ≤30 days; not including stitch abscesses | ≤6 classes of surgery recorded ICD‐9‐ CM codes; 10 detailed | C/CCon/C/D | Yes | ASA and NNIS | Recommended that theatre staff at time of surgery record denominator data prospectively | Hospital associated | Hospitals allowed to customise data forms | October 92 to June 93 | Until discharge–N/S –post discharge surveillance optional– mean follow‐up 13·7 days |
| Vaqué et al. (50) | Prospective prevalence– 1994 data | HAI | CDC | Recorded not detailed | Recorded not detailed–only clean surgery | Recorded not detailed | N/S | Physicians or nurses in ICT | Directed by each individual hospital ICT | Standardised protocol by CRF | 2‐week period in May–data from 1990 to 1994 | 2‐week period each year over 5 years |
| Erbaydar et al. (77) | Incidence– prospective cohort study | SSI | CDC/WHO | General surgery patients | N/S | N/S | N/S | Yes–ICB | Hospital associated | Yes/N/S | 2‐year study | Until discharge N/S– study period 2 years |
| Sartor et al. (78) | Period prevalence at two time points | HAI–UTI, LRTI, SSI, BSI | CDC–May; CSHPF— November | Recorded not detailed | Clean surgery and other | No | College of American Surgeons | Ten investigators from micro‐biology or ICD | Worked within surveyed hospital | 4 h training/N/S | May; November 1992 | Two 1‐day studies |
| Byrne et al. (52) | Incidence | SSI | ASEPSIS >10 (27% fully scored by this method); | N/S | N/S | N/S | C/CC/D | N/S for hospital– post discharge GPs and DNs | Hospital associated | N/S/N/S | 32‐month period | ≤6 weeks post discharge— follow‐up postal questionnaire |
| Merten et al. (79) | Incidence | SSI | NSIH protocol and CDC | Various study populations allowed–ICD‐9‐ CM codes used | C/CCon/ C/D | Yes | Based on NNIS including ASA and C/CCon/C/D; | ICN and ICP obligatory in every hospital | Hospital associated | Roles and education defined, courses in place | October 14 to December 13 1991 | Post discharge surveillance encouraged but time N/S; 32 did post discharge follow‐up |
| Poulsen et al. (80) | Incidence | SSI in selected groups | Danish guidelines | Yes | N/S | N/S | Danish guidelines | N/S | N/S | N/S | January 85 to December 88 | Until discharge– time period N/S |
| Coello et al. (5) | Matched control study– incidence | SSI | CDC–various sources/modifications | General surgical classifications only | N/S | N/S | N/S | Research nurse in association with ward staff and from CRF | Hospital associated | N/S/NS | Between March and November 1988 | Continuous surveillance until discharge |
| Vegas et al. (81) | Matched control prospective study– incidence | HAI in surgical patients | CDC | ICD‐9‐CM codes for diagnosis and surgical procedure– recorded not detailed | C/CCon/ Con /D | Yes | No | Nurse | Hospital associated | Yes/N/S | First 7 months of 1990 | Until discharge–N/S |
| Aavitsland et al. (82) | 1 day | HAI* | Slightly adapted CDC | N/S | N/S | N/S | N/S | ICN or clinician | Hospital associated | N/S/N/S | 1 day | 1 day |
| Kappstein et al. (83) | Prospective cohort study incidence | SSI | CDC–clearly defined | Yes | C/CCon only | Recorded not detailed | N/S | Yes | Hospital doctor not involved in patients treatment | N/S/N/S | November 88 to September 89 | Until discharge not specified |
| Kappstein et al. (84) | Incidence prospective cohort studies | SSI/LRTI in ICU | CDC–clearly defined | 3 specified | C/CCon/ C/D | N/S | N/S | Physician not involved in the treatment of the patients | Yes | N/S/N/S | June 88 to September 89 | Until discharge (time not specified) or death |
| Moro et al. (49) | Incidence | SSI | CDC | Orthopaedic* and general surgery; data for ten most frequent ops | C/CCon/C/D –NRC definition | Yes | N/S | Surgeon or ICN | Hospital associated, wounds ranked by operating surgeon | N/S/N/S | 6‐month period | Until discharge |
| Di Palo (85) | Prospective incidence | SSI | N/S | General classification | C/CCon/C/D | N/S | N/S | N/S | Hospital associated | Yes/N/S | 1980‐88 | 30 days post surgery |
| Kjaersgaard et al. (48) | Incidence | SSI | CDC | Operations coded–ten most common | C/CCon/C/D | Yes | N/S | Surgeons; ward staff N/S; GPs post discharge | Hospital associated | N/S | 1/3/87 to 31/7/88 | Approximately 30 day follow‐up |
Altemeier classification – clean/clean‐contaminated/contaminated/dirty; ASA, American Society of Anaesthesiologists; ASEPSIS, Additional treatment, the presence of Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, the Isolation of bacteria and the duration of inpatient Stay; BS, blood stream infection; C/CC/Con/D, clean/clean‐contaminated/contaminated/dirty; CAI, community‐associated infection; CDC, Center for Disease Control; CMs, clinical microbiologists; CRF, case record form; CSHPF, Conseil Supérieur d'Hygiène Publique de France; CTIN, Comité Technique National des Infections Nosocomiales; DNs, district nurses; GPs, general practitioners; HAI, health care‐associated infection; ICD, infections control department; ICN, infections control nurse or equivalent; ICP, infections control physician/practitioner; ICT, infections control team; ICU, intensive care unit; IDS, infectious disease specialist; LRTI, lower respiratory tract infection; N/A, not applicable; NI, nosocomial infection; N/S, not stated; NINSS, UK Nosocomial Infection National Surveillance Scheme; NMR, National Medical Registry (Netherlands); NNIS, National Nosocomial Infection Surveillance; NRC, National Research Council; NSIH, National Program for the Surveillance of Hospital Infections; PGIC, postgradutate infectious control training; RI, risk assessment; SENIC, four risk factors – duration of intervention >2 hours: ≥3 conditions on admission: abdominal surgery and a contaminated or dirty‐infected wound; SSI, surgical site infection; UTI, urinary tract infection; WIP, Werkgroep Infectiepreventie.
*
The coding file of the DANOP‐DATA system included only four categories for orthopaedic operations.