Surveillance of surgical site infections in NHS hospitals in England

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Surveillance of Surgical Site Infections in NHS Hospitals in England 2014/15

Surveillance of Surgical Site Infections in NHS hospitals in England 2014/15

About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England 133-155 Waterloo Road Wellington House London SE1 8UG Tel: 020 7654 8000 http://www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland

Suggested citation: Public Health England. Surveillance of surgical site infections in NHS hospitals in England, 2014/15. London: Public Health England, December 2015. Available from: www.gov.uk/phe Prepared by: S Elgohari with the assistance of C Wloch, A Saei, A Charlett and T Lamagni. We extend thanks to P Harrington and Professor A Johnson, head of the Department of Healthcare Associated Infections and Antimicrobial Resistance for comments. We are also grateful to the administrative staff at PHE’s Surgical Site Infection Surveillance Service, staff within the PHE Software Development Unit and the considerable contribution made by NHS trusts in England who have devoted time and effort in collecting these data. Finally many thanks to hospitals who shared their experience of the SSI surveillance for inclusion in this report. © Crown copyright 2015 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to: [email protected] Published: December 2015 PHE gateway number: 2015520

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Surveillance of Surgical Site Infections in NHS hospitals in England 2014/15

Contents About Public Health England Key points Section 1. Introduction and surveillance methods 1.1 Introduction 1.2 Data collection and feedback

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1.3 Definitions 1.4 Changes to surgical categories under surveillance 1.5 Participation in international surveillance 1.6 Analyses presented in this report Section 2. Overview 2.1 Hospital participation and surgical volumes 2.2 Data quality 2.3 Patient and operation-related characteristics Section 3. Rates of surgical site infection

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3.1 Inpatient and readmission rate by surgical category 3.2 Risk factors for SSI Section 4. Trends in the rate of SSI 4.1 Orthopaedic categories 4.2 Non-orthopaedic categories Section 5. Characteristics of surgical site infections 5.1 Type of SSI 5.2 Causative micro-organisms Section 6. Variation in rates of SSI between NHS hospitals

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6.1 Box and whisker plots 6.2 Funnel plots Section 7. Hospital perspectives Section 8. Conclusions 8.1 Summary of findings in 2014/15 8.2 Variation in the SSI rate between participating hospitals 8.3 Optional post-discharge surveillance 8.4 Microbial aetiology

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8.5 Future directions Section 9. Glossary Section 10. References

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Surveillance of Surgical Site Infections in NHS hospitals in England 2014/15

Key points 

















data on 620,535 procedures comprising 17 surgical categories and 8,516 inpatient and readmission surgical site infections (SSIs) was collected by 232 NHS hospitals and NHS independent sector treatment centres between April 2010 and March 2015 in 2014/15, 138 NHS trusts and eight NHS treatment centres participated in the mandatory orthopaedic SSI surveillance, contributing data on 102,496 procedures. Four eligible NHS trusts did not participate this year. the proportion of hospitals undertaking continuous surveillance was highest in reduction of long bone fracture (62%). A moderate decrease in the corresponding proportion was observed for hip and knee prosthesis in 2014/15 (59% and 56% respectively) compared to 2013/14 (62% each) data completion for age, patient sex, date of admission and procedure code was 100% for records submitted in 2014/15 across all surgical categories and ≥99% for duration of surgery and wound class in most surgical categories. For the ASA score (pre-operative health classification by the American Society of Anesthesiologists), data completion varied between surgical categories (65% to 98%) as was the case for body mass index (9% to 82%) between 2008/09 and 2014/15, a significant decrease in the inpatient/readmission SSI incidence occurred for repair of neck of femur, reaching 1% in 2014/15. No overall trends for hip or knee prosthesis were found and the incidence remained low (