A benchmark too far: findings from a national survey of surgical site infection surveillance.

BACKGROUND: The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. AIM: To audit SSI definitions and data collection methods used by hospital trusts in England. METHOD: All 156 hospital trusts in England were sent questionnaires that focused on aspects of SSI definitions and data collection methods. FINDINGS: Completed questionnaires were received from 106 hospital trusts. There were considerable differences in data collection methods and data quality that caused wide variation in reported SSI rates. For example, the SSI rate for knee replacement surgery was 4.1% for trusts that used high-quality postdischarge surveillance (PDS) and 1.5% for trusts that used low-quality PDS. Contrary to national protocols and definitions, 10% of trusts did not provide data on superficial infections, 15% of trusts did not use the recommended SSI definition, and 8% of trusts used inpatient data alone. Thirty trusts did not submit a complete set of their data to the national surveillance service. Unsubmitted data included non-mandatory data, PDS data and continuous data. CONCLUSION: The national surveillance service underestimates the prevalence of SSIs and is not appropriate for benchmarking. Hospitals that conduct high-quality SSI surveillance will be penalized within the current surveillance service.

Patient narratives of surgical site infection: implications for practice.

BACKGROUND: Exploring patients' experiences has been used widely within healthcare to improve clinical service delivery. To date there has been minimal patient input of this kind into aspects of surgical site infection (SSI), such as surveillance or prevention interventions. AIM: To obtain information from patients' experiences of SSIs to improve clinical practice. METHODS: Narrative interviews with 17 patients with SSIs (four deep, 12 organ space and one superficial) from three hospitals in England were conducted followed by thematic content analysis. RESULTS: Patients lacked overall awareness, concern and understanding of SSIs. Seven patients did not know that they had SSIs and, judging from patients' accounts, staff may have contributed to the lack of awareness by not informing patients of SSIs or downplaying their existence. The use of primary care resources was considerable and six of the patients were absent from work for two to four months. CONCLUSIONS: SSIs have a low profile among patients which, if it were raised, could increase compliance with preventive interventions. This study confirms the appropriateness of using patient self-assessment post-discharge surveillance questionnaires to identify SSI symptoms, and highlights the need to identify total costings including to primary care, patients and the economy.