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Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate?

      Summary

      Background

      In 2011–2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs).

      Aim

      To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data.

      Methods

      In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS.

      Findings

      The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40).

      Conclusion

      Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.

      Keywords

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      References

        • Gravel D.
        • Taylor G.
        • Ofner M.
        • Johnston L.
        • Loeb M.
        • Roth V.R.
        • et al.
        Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals.
        J Hosp Infect. 2007; 66: 243-248
        • Ustun C.
        • Hosoglu S.
        • Geyik M.F.
        • Parlak Z.
        • Ayaz C.
        The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey.
        Int J Infect Dis. 2011; 15: e684-e687
        • Haley R.W.
        Surveillance by objective: a new priority-directed approach to the control of nosocomial infections. The National Foundation of Infectious Diseases lecture.
        Am J Infect Control. 1985; 13: 78-89
        • European Centre for Disease Prevention and Control
        Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011–2012.
        ECDC, Stockholm2013 (Available at:) ([last accessed June 2019])
        • European Centre for Disease Prevention and Control
        Surveillance of surgical site infections in Europe 2010–2011.
        ECDC, Stockholm2013 (Available at:) ([last accessed June 2019])
        • European Centre for Disease Prevention and Control
        Annual epidemiological report for 2015: surgical site infections.
        ECDC, Stockholm2017 (Available at:) ([last accessed June 2019])
        • Llata E.
        • Gaynes R.P.
        • Fridkin S.
        Measuring the magnitude of hospital-associated infection in the United States: the value of prevalence surveys.
        Clin Infect Dis. 2009; 48: 1434-1440
        • Gastmeier P.
        • Sohr D.
        • Rath A.
        • Forster D.H.
        • Wischnewski N.
        • Lacour M.
        • et al.
        Repeated prevalence investigations on nosocomial infections for continuous surveillance.
        J Hosp Infect. 2000; 45: 47-53
        • Rhame F.S.
        • Sudderth W.D.
        Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections.
        Am J Epidemiol. 1981; 113: 1-11
        • Gastmeier P.
        • Bräuer H.
        • Sohr D.
        • Geffers C.
        • Forster D.H.
        • Daschner F.
        • et al.
        Converting incidence and prevalence data of nosocomial infections: results from eight hospitals.
        Infect Control Hosp Epidemiol. 2001; 22: 31-34
        • Berthelot P.
        • Garnier M.
        • Fascia P.
        • Guyomarch S.
        • Jospé R.
        • Lucht F.
        • et al.
        Conversion of prevalence survey data on nosocomial infections to incidence estimates: a simplified tool for surveillance?.
        Infect Control Hosp Epidemiol. 2007; 28: 633-636
        • Graves N.
        • Nicholls T.M.
        • Wong C.G.S.
        • Morris A.J.
        The prevalence and estimates of the cumulative incidence of hospital-acquired infections among patients admitted to Auckland District Health Board Hospitals in New Zealand.
        Infect Control Hosp Epidemiol. 2003; 24: 56-61
        • Kanerva M.
        • Ollgren J.
        • Virtanen M.J.
        • Lyytikäinen O.
        Estimating the annual burden of health care-associated infections in Finnish adult acute care hospitals.
        Am J Infect Control. 2009; 37: 227-230
        • Magill S.S.
        • Edwards J.R.
        • Bamberg W.
        • Beldavs Z.G.
        • Dumyati G.
        • Kainer M.A.
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208
        • Cassini A.
        • Plachouras D.
        • Eckmanns T.
        • Abu Sin M.
        • Blank H.P.
        • Ducomble T.
        • et al.
        Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.
        PLoS Med. 2016; 13e1002150
        • Reilly J.
        • Stewart S.
        • Allardice G.
        • Noone A.
        • Robertson C.
        • Walker A.
        • et al.
        NHS Scotland national HAI prevalence survey. Final report.
        Health Protection Scotland, Glasgow2007 (Available at:) ([last accessed June 2019])
        • Meijs A.P.
        • Ferreira J.A.
        • de Greef S.C.
        • Vos M.C.
        • Koek M.B.G.
        Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals.
        Epidemiol Infect. 2017; 145: 970-980
        • European Centre for Disease Prevention and Control
        Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals – protocol version 4.3.
        ECDC, Stockholm, Sweden2012 (Available at:) ([last accessed June 2019])
        • McCabe W.R.
        • Jackson G.G.
        Gram-negative bacteremia: I. Etiology and ecology.
        Arch Intern Med. 1962; 110: 847-853
        • Centers for Disease Control and Prevention
        Surgical site Infections (SSI).
        January 2017 (Available at:) ([last accessed June 2019])
        • European Centre for Disease Prevention and Control
        Surveillance of surgical site infections in European hospitals – HAISSI protocol. Version 1.02.
        ECDC, Stockholm2012 (Available at:) ([last accessed June 2019])
        • Tuite A.R.
        • Greer A.L.
        • Fisman D.N.
        Effect of latitude on the rate of change in incidence of Lyme disease in the United States.
        CMAJ Open. 2013; 1: E43-E47
        • Mosteller F.
        • Tukey J.W.
        Data analysis and regression; a second course in statistics.
        Addison-Wesley, Reading, MA1977
        • Rossello-Urgell J.
        • Rodriguez-Pla A.
        Behaviour of cross-section surveys in the hospital setting: a simulation model.
        Infect Control Hosp Epidemiol. 2005; 26: 362-368
        • Mu Y.
        • Edwards J.R.
        • Horan T.C.
        • Berrios-Torres S.I.
        • Fridkin S.K.
        Improving risk-adjusted measures of surgical site infection for the national healthcare safety network.
        Infect Control Hosp Epidemiol. 2011; 32: 970-986
        • Fukuda H.
        • Kuroki M.
        The development of statistical models for predicting surgical site infections in Japan: toward a statistical model-based standardized infection ratio.
        Infect Control Hosp Epidemiol. 2016; 37: 260-271
        • Nationales Referenzzentrum für Surveillance von Nosokomialen Infektionen
        Model OP-KISS Referentzdaten, Berechnungszeitraum: Januar 2005 bis Dezember 2009.
        NRZ, Berlin2010 (Available at:) ([last accessed June 2019])
        • Nationales Referenzzentrum für Surveillance von Nosokomialen Infektionen
        Model OP-KISS Referenzdaten, Berechnungszeitraum: Januar 2011 bis Dezember 2015.
        NRZ, Berlin2016 (Available at:) ([last accessed June 2019])
        • National Center for Epidemiology [Internet]
        Budapest: Hungarian national healthcare associated Infections surveillance system. A Nemzeti Nosocomialis surveillance Rendszer (NNSR) eredményei.
        2010–2014 (Available at:) ([last accessed June 2019])
        • National Institute of Public Health and the Environment
        Prevention of healthcare associated Infections through surveillance (Prezies). Referentiecijfers module POWI 2002–2011. Bilthoven.
        RIVM, The Netherlands2014 (Available at:) ([last accessed June 2019])
        • National Institute of Public Health and the Environment
        Prevention of Healthcare Associated Infections through surveillance (Prezies). Referentiecijfers 2001 t/m 2011: Postoperatieve wondinfecties na hartchirurgie.
        RIVM, Bilthoven, The Netherlands2014 (Available at:) ([last accessed June 2019])