1. Orthopaedic SSI Surveillance in BSH Cork

2. Orthopaedic SSI Surveillance in BSH Cork
A system for surgical site infection (SSI) surveillance of patients undergoing orthopaedic implant surgery was developed in the BSHC and commenced in February 2009.
SSI rates are reported by procedure category.
As the surveillance period is one-year post operatively, rates are subject to change.
Rates are benchmarked against published international SSI rates. Data is also collected on patient demographics and risk factors for patients undergoing surgery.

3. Orthopaedic SSI Surveillance in BSH Cork
4691 procedures to date
Hips 2357
Knees 2334

4. Orthopaedic SSI Surveillance in BSH Cork
Total Number of Hip Infections
2009 = 1
2010 = 9
2011 = 8
2012 = 4
2013 = 3
2014 = 1
2015 = 0
2016 = 0 (to date)
Total Number of Knee Infections
2009 = 3
2010 = 3
2011 = 2
2012 = 4
2013 = 3
2014 = 4
2015 = 3
2016 = 1 (to date)

7. Types of SSI Superficial Incisional Deep Incisional Organ / Space
09 -16: 5,5,5,5,3,3,0,1
1,5,3,1,3,1,3,0
2,1,2,1

9. So how do we do it??
Patients are made aware of the programme by information in their booklet given to them by the Consultant in rooms preoperatively
Data mart lists produced each month with details on all patients to be included in the orthopaedic surgical site surveillance programme.
Forms are commenced at ward level by ward staff ,continued into theatre and back to ward

10. So how do we do it??
All surgical site surveillance forms checked by IPCN at ward level for completion, rewritten and checked every month by the infection control secretary.
All surveillance forms rechecked for transcription errors
Daily PIMS (patient information system) and MISYs (laboratory information system) checks by the ICNs on any patients readmitted to the hospital (follow up for one year post op)

11. So how do we do it??
ICNs notified daily by the microbiology department of any new significant positive microbiology reports
Automatic data mart lists (extracted from MISYs) sent via E mail to the ICNs every two days on any new S aureus positive microbiology cultures.
All SSI called are reconfirmed by the consultant microbiologist.
Medical charts reviewed on all SSI and outliner results.

12. Orthopaedic SSI Surveillance in BSH Cork
Root Cause Analysis of infections led to
Introduction of SSI Care bundles
Skin Prep
Temp Control
Antibiotic appropriateness & Timing
Diabetic Control &
Dressings
Daily Auditing of Consultants Hand Hygiene at ward level
Change in practices re ice packs
Updating of patient information pre and post discharge etc……..

13. References
National Nosocomial Infections Surveillance Manual. U.S. Department of Health and Human Services, Public Health Service, Centres for Disease Control and Prevention, Atlanta, Georgia, USA, 1999.
Culver DH, et al. Surgical site infection rates by wound class, Operative procedure and Patient Risk Index. American Journal of Medicine, 1991; 91 Suppl. 3B: 152s-157s.
Del Pozo, J.L and Patel, R. (2009) Infection Associated with Prosthetic Joints. The New England Journal of Medicine, 361; 8: 787 – 794.
Guebbels, E.L.P.E., Nagelkerke, N.J.D., Mintjes-De-Groot, A.J., Vandenbroucke-Grauls, M.J.E., Grobbee, D.E. and De Boer, A. (2006) Reduced risk of surgical site infection through surveillance in a network. International Journal for Quality in Healthcare 18; 2:
Health Protection Surveillance Centre / Strategy for the control of Antimicrobial Resistance in Ireland (SARI) (2008) Recommendations for Surveillance of Surgical Site Infection. SARI health – care associated Infection Surveillance Sub – committee. May 2008.
Expert Review of Anti Infective Therapy, vol,. 8. issue, 6. pp

14. References
Horan, T.C. Andrus, M. & Dudeck, M.A. (2008). CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control American, 36; . 5:
Protocol for Surgical site Surveillance England Version , The health protection agency
The surveillance of surgical site infection in Orthopaedic surgery, manual May 2003, HISC, The Northern Ireland Healthcare associated infection surveillance centre.
Uckay, I. Harbarth, S. Peter, R.Lew, D. Hoffmeyer, P & Pittet, D (2010) Preventing Surgical Site Infections.