The Journal of Hospital Infection - Supplement 1

ID: 4947

Are there differences in risk factors for organ space surgical site

infections in patients undergoing elective colon or rectal surgery?

Aina Gomila

, Josep Maria Badia

, Evelyn Shaw

, Carmen Nicolás

Marta Piriz

, Montse Brugués

, Fina Obradors

, Enric Limón

Francesc Gudiol

, Miquel Pujol

, On behalf of Vincat Program

Bellvitge University Hospital,

Fundació Hospital Asil de Granollers,

Hospital Universitari de Bellvitge,

Hospital Universitari Mutua de

Terrassa,

Hospital Parc Taulí Sabadell,

Consorci Sanitari de l

’

Anoia,

Fundació Althaia de Manresa

Background:

Surgical site infection (SSI), particularly organ space

infection (OE), is the most frequent and serious complication after

colorectal surgery.

Aim(s)/Objective(s):

To determine differences between risk factors for

OE-SSI in patients submitted to colon or rectal surgery

Method(s):

Multicenter prospective cohort study of patients under-

going elective colorectal surgery in 10 Spanish hospitals from January

2011 to December 2014. Follow-up: from day of surgery to 30 days

after.

Results:

Overall, 3,701 patients were included, 2,518 (68%) after colon

surgery and 1,183 (32%) after rectal surgery. Mean age was 68 (SD:12)

years and 2,289 (61.8%) were male. Main indication for surgery was

neoplasia (94.6%). Overall, 669 (18.1%) patients developed a SSI, 414

(16.4%) after colon surgery and (21.6%) after rectal surgery and 336

(9.1%) were organ space. In colon surgery, male sex (OR:1.57,95%

CI:1.14

–

2.15) and stoma (OR:2.65,95%CI:1.8

–

3.92) were independent

risk factors for OE infection while laparoscopic surgery (OR:0.5,95%

CI:0.38

–

0.69) and oral prophylaxis (OR:0.7,95%CI:0.51

–

0.97) were

protective. In rectal surgery, male sex (OR:2.11,95%: CI:1.34

–

3.31) and

surgery duration (OR:1.49,95%CI:1.03

–

2.15) were independent risk

factors for OE infection while oral prophylaxis (OR:0.49,95%CI:0.32

–

0.73) was protective. Readmission (8.1% vs 4.7%, p 0.001) and length of

stay (13d ± 14d vs 11d ± 12d, p < 0.001 were significantly higher in

rectal compared to colon surgery. There were no differences in clinical

cure and mortality rate between groups.

Discussion and/or Conclusion(s):

Colon and rectal surgery differ in

incidence and risk factors for organ space SSI although clinical cure

and mortality rate were no significantly different.

ID: 4948

First 3 years surveillance of organisation-wide surgical site

surveillance in a UK NHS Trust

Vanessa Whatley, Claire Hayward.

Royal Wolverhampton NHS Trust

Background:

Surgical site infections (SSI) account of up to 20% of

HCAI, and cost on average £2,100 per case with reports of increased

mortality and morbidity. A dedicated SISS Team was introduced in

September 2012. All knife-to-skin procedures in in-patients were

surveyed, with post discharge surveillance at 30 or 90 days.

Aim(s)/Objective(s):

To present one Trusts first 3 years results

following the introduction a whole system approach to surgical site

infection surveillance (SSIS) exceeding national UK expectations.

Method(s):

Data was collected using a combination of electronic and

manual methods in elective and emergency patients excluding day

cases. Monthly feedback was given to surgeons on individual SSI rates

and by procedure with comparison to specialty performance.

Results:

From September 12 to September 15 an average of 509

patients per month were surveyed with a total of 18,338 in the period.

The SSI rate for confirmed infections fell from 10% to 2.6% during the

period with varying results in specialities. A positive impact on length

of stay and number of readmissions was also identified. Expanded

results will be presented in the poster.

Discussion and/or Conclusion(s):

Investment in the SSIS Team and

procurement of a surveillance system, with subsequent feedback of

results has resulted in reductions in SSI. This has impacted positively

on Trust resources and patient safety.

ID: 4949

Audit of antimicrobial prophylaxis in spinal surgery as part of SSI

surveillance and improvement activity

Manjusha Narayanan.

Royal Victoria Infirmary, Newcastle upon Tyne

NHS FT

Background:

Data collected as part of SSI surveillance of spinal

infections with a view to improve practice on all fronts to reduce SSI

rates. New protocol for antibiotic prophylaxis in spinal surgery was

introduced last year and it was agreed at SSI meetings to audit this.

Aim(s)/Objective(s):

Aim: To audit use of antibiotic prophylaxis in

spinal surgery

–

to look at timing (time difference from KTS), extended

dose of antibiotic in operations lasting more than 3 hours and choice of

the antibiotic agents used. Data collected as part of SSI surveillance of

spinal infections with a view to improve practice.

Method(s):

Retrospective data collection of various elements of

antibiotic prescribing in relation to the antibiotic protocol was

carried out for a period of 4 weeks.

Results:

Data for timing of antibiotic administration in relation to

KTS (knife to skin), choice of antibiotics, repeated doses of cephalos-

prin in prolonged operations and post op antibiotic cover was

analysed.

Discussion and/or Conclusion(s):

Timing of antibiotic administration

was poor overall (within 30

–

60 min of KTS), there was unnecessary

administration of antibiotics post op, choice of antibiotics used as per

protocol was satisfactory.

Detailed analysis of data is being fed back to relevant anaesthetic and

surgical teams to help address change in practice.

Data collection was difficult as it was documented in many different

places

–

surginet checklist, WHO checklist, E record, but not very often

on intra op anaesthetics paper chart.

To share the audit with other surgical teams.

ID: 5007

Mapping current and future priority areas for surgical site

infection (SSI) prevention and surveillance locally and nationally

Rachael Troughton

, SusanHopkins

, AlisonHolmes

, Gabriel Birgand

Imperial College London,

Public Health England

Background:

National surveillance of surgical site infections (SSI) in

England is coordinated by the Surgical Site Infection Surveillance

Service (SSISS) at Public Health England (PHE). A survey of NHS Trusts

commissioned by PHE in 2014 showed that priorities for Trusts are

mismatched with the sugical categories currently under surveillance

in the SSISS.

Aim(s)/Objective(s):

This study aims to map surgical procedures

that have the highest associated SSI burden (in terms of volume, risk

and cost) with current surveillance activities to shape current and

future surveillance priorities, both on a national and a local level.

Method(s):

This mapping study compares multiple surgery types by

patient volume, infection rate, excess length of stay and excess costs

attributable to SSI, proportion of hospitals currently undertaking

surveillance, and mean priority ranking as reported in the 2014 PHE

survey of Trusts. For the national mapping, the study uses data from

Hospital Episode Statistics, SSISS, and from the literature. At a local

level, the patient volume, risk, and cost are calculated from laboratory

data, patient administrative data and financial data, and these figures

compared with local surveillance arrangements.

Results:

The results are displayed in a matrix using heat mapping.

Colour matching along rows indicates a high degree of agreement

between risk, burden, cost, and current and future priorities.

Caesarean section (CS) has low agreement.

Discussion and/or Conclusion(s):

There are some significant mis-

matches between SSI burden and current surveillance, particularly

for caesarean section which has a high SSI risk and patient volume but

no national surveillance, while many Trusts indicate CS is a priority

area.

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S114