Impact of participation in a surgical site infection surveillance network: results from a large international cohort study

BACKGROUND

Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale.

AIM

To determine the time-trend of SSI rates in surveillance networks.

METHODS

SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept.

FINDINGS

Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis.

CONCLUSION

In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.

[Prevalence of hearing loss in elderly individuals over 65 years of age: a pilot study in Lombardia (Italy)]

A cross sectional study was performed to determine the prevalence of hearing loss in individuals over age 65 years presenting to a medical centre in Lombardia (Italy). The aim was to assess the feasibility of performing a survey to evaluate the prevalence of hearing loss in the entire region. Audiometric testing was performed in each enrolled subject, to reveal losses in hearing levels at 250 to 8000 Hz; hearing levels were measured in decibels. Prevalences of mild, moderate, severe, and profound hearing impairment were found to be 39%, 17.4%, 2.9% and 0.6% respectively when using the WHO classification, and 59.9%, 25.6%, 2.9%, and 0.6% respectively when using the classification of the Bureau International d'Audiophonologie (BIAP).This study has shown that a relevant part of the study population is affected by hearing impairment and has served as a pilot study for a larger-scale study to be performed in the Lombardia region.