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Dear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
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http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
Dear Heather
I have checked the CDC’s official NHSN surveillance page for you and the definitions are attached above.
It appears that the definition for a superficial infection is 28 days and a “deep incisional” infection is 30-90 days.
It is important always to remember that with NHSN definitions (and probably many of the definitions used in other countries for formal surveillance that they are surveillance/ classification definitions not for diagnostic purposes) ie. they are used for case-counting and as such can be subject to error but not used for making treatment decisions like antimicrobial interventions. This anomaly is most evident if we look deeply at CLABSI and CR-BSI definitions and try to tease out the differences.
I haven’t followed the CDC SSI definition too closely but my best guesses without doing research for you would be that the change came from a simplification of the surveillance method to meet changes in government requirements and also to take into account the ways, places and systems that and in which surgery is now performed compared to the early 1970s when NNIS, NHSN’s predecessor began. Also CDC and CMS (their Federal govt agency which is a bit like a hybrid of our ACSQHC and Medicare and Dept. of Human Services ) have made many refinements to HAI monitoring and reporting with set targets and public access to meaningful data (unlike Australia :() so all of these factors will periodically lead to definitional change.
Changing the definitions, (I actually haven’t checked the historic definition so am assuming you have correctly observed a change) of course plays havoc with measuring long-term change and improvement which again can be a subtle way for stakeholders on many levels to look like there is improvement when maybe there isn’t. (sorry for cynicism) This was recently the case for CAUTI in HNSN definitions.
Have you looked for any recent published US articles on SSI that argue for a change in definition and give an explanation?
If you would like me to I would happily pass on your query to many of my mates in the US who either run NHSN or are NHSN users as I am sure that they would have better responses. Let me know.
It’s great that you question this issue and I would love to know what other epidemiologists have to say about this question so I hope they respond as well.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auDear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
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Hi Heather,
In New Zealand the national programme for SSI surveillance (http://www.hqsc.govt.nz/our-programmes/infection-prevention-and-control/projects/surgical-site-infection-improvement/) now uses this 90 day CDC surveillance for its deep and organ space infections for joint surgery and cardiac surgery surveillance programmes. Superficial SSIs are only counted up to 30 days post surgeryI believe that the rationale taken by the NZ Clinical leads (and this may be the CDC rationale) was that it would be difficult to attribute a deep or organ space infection at one year back to the original surgery even if it is a joint piece of metalwork.
Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Dear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Heather,
All Victorian public hospitals contribute data to VICNISS, including SSI data where relevant. VICNISS implemented this change several years ago for a number of surgery types. Perhaps if you contacted VICNISS directly they may be able to provide you with feedback.
I suspect that infection data won’t be greatly affected by the change as the majority of infections, including deep/organ space joint infections, occur within a couple of months of the surgery. In my experience, very few infections, if any, first occurred later than 90 days post surgery. The other problem with a very long follow up period is how attributable the infection really is to the original surgery. Could an infection of an implant have been seeded from another infection site source?
Regards,
Donna
………………………………………………………………………..
Donna Cameron | Infection Control Consultant
Microbiological Diagnostic Unit
Public Health Laboratory | Department of Microbiology & Immunology
The University of Melbourne, Building 248, Level 1, 792 Elizabeth Street, Melbourne, 3010, VIC
Telephone +61 3 8344 3574 | Fax +61 3 8344 7833
Website http://www.mduphl.unimelb.edu.au/
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This email and any attachments may contain personal information or information that is otherwise confidential or the subject of copyright. Any use, disclosure or copying of any part of it is prohibited. The University does not warrant that this email or any attachments are free from viruses or defects. Please check any attachments for viruses and defects before opening them. If this email is received in error please delete it and notify us by return email.Dear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Heather
The Healthcare Infection Surveillance Western Australian (HISWA) program adopted these NHSN/CDC definitions in 2013 – so they are not new.
We welcomed the change at the time and our data showed that 91% of hip SSIs and 70% of knee SSIs were detected within 30 days of the initial procedure and 100% of hip SSIs and 92% of knee SSIs were detected within 4 months.Kind regards
Allison
Allison Peterson HISWA / Healthcare Associated Infection Unit | Communicable Disease Control Directorate
Department of Health
Grace Vaughan House, 227 Stubbs Tce, SHENTON PARK WA 6008
* +61 8 9388 4808 | 7 +61 8 9388 4888
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Dear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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