Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals

• Published in: Antimicrobial resistance & infection control 2023-11, Vol.12 (1), p.134-134, Article 134
• Main Authors: Eder, Marcus, Sommerstein, Rami, Szelecsenyi, Arlette, Schweiger, Alexander, Schlegel, Matthias, Atkinson, Andrew, Kuster, Stefan P, Vuichard-Gysin, Danielle, Troillet, Nicolas, Widmer, Andreas F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Body mass index; Colon; Disease prevention; Female; Hair removal; Health aspects; Heart surgery; Hospitals; Humans; Incidence; Infection; Intervention; Methicillin; Middle Aged; Multimodal intervention bundles; Orthopedic surgery; Patients; Preoperative management; Prevention; Prophylaxis; Prospective Studies; Quality improvement; Quality standards; Skin disinfection; Surgical site infection; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Surveillance; Switzerland - epidemiology
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-023-01336-7

In Switzerland, the national surgical site infection (SSI) surveillance program showed a modest decrease in SSI rates for different procedures over the last decade. The study aimed to determine whether a multimodal, targeted intervention program in addition to existing SSI surveillance is associated with decreased SSI rates in the participating hospitals. Prospective multicenter pre- and postintervention study conducted in eight Swiss acute care hospitals between 2013 and 2020. All consecutive patients > 18 years undergoing cardiac, colon, or hip/knee replacement surgery were included. The follow-up period was 30 days and one year for implant-related surgery. Patients with at least one follow-up were included. The intervention was to optimize three elements of preoperative management: (i) hair removal; (ii) skin disinfection; and (iii) perioperative antimicrobial prophylaxis. We compared SSI incidence rates (main outcome measure) pre- and postintervention (three years each) adjusted for potential confounders. Poisson generalized linear mixed models fitted to quarter-yearly confirmed SSIs and adjusted for baseline differences between hospitals and procedures. Adherence was routinely monitored through on-site visits. A total of 10 151 patients were included, with a similar median age pre- and postintervention (69.6 and IQR 60.9, 76.8 years, vs 69.5 and IQR 60.4, 76.8 years, respectively; P = 0.55) and similar proportions of females (44.8% vs. 46.1%, respectively; P = 0.227). Preintervention, 309 SSIs occurred in 5 489 patients (5.6%), compared to 226 infections in 4 662 cases (4.8%, P = 0.09) postintervention. The adjusted incidence rate ratio (aIRR) for overall SSI after intervention implementation was 0.81 (95% CI, 0.68 to 0.96, P = 0.02). For cardiac surgery (n = 2 927), the aIRR of SSI was 0.48 (95% CI, 0.32 to 0.72, P