Post-discharge surveillance for surgical site infections (SSI) is critical for procedures with short hospital stays. We describe SSI rates for Caesarean sections (C/S) with six years of surveillance data using conventional and innovative approaches to post-discharge surveillance.
At an acute care hospital in Vancouver, Canada, C/S SSI surveillance was routinely performed from April 1, 2009 to March 31, 2015. A 30 day post-discharge component was implemented starting April 1, 2012. In the first year of post-discharge surveillance, patient self-reported infections via traditional mail surveys; in the second year, an Infection Control Practitioner (ICP) initiated phone calls to patients (in addition to mail surveys); in the third year, electronic follow-up via email was initiated. We examined SSI rates, response rates and time spent by an ICP engaging with patients for responses. Chi-squared tests were applied to comparisons of the three years with and without post-discharge surveillance.
In the first three years, 1939 C/S and in the final three years, 1947 C/S were performed, respectively. The SSI rate in the first three years was 0.36 per 100 procedures (6 superficial and 1 deep). In the final three years, the SSI rate was 1.39 per 100 procedures (19 superficial, 1 deep, 7 organ space). Significantly more infections were captured (p < 0.001) and a significantly higher number of organ space and deep incisional infections were identified (p = 0.020) with post-discharge surveillance. Response rates improved significantly, from 20% to 46% with mail and phone calls. Response rates with email were 73% email (p < 0.001). Time spent by ICP engaging with patients for responses for post-discharge surveillance varied from 24.9 hours in 2012/13 (711 C/S) to 40.5 hours in 2013/14 (654 C/S) to 35.7 hours in 2014/15 (582 C/S) with the corresponding response rates of 20%, 46% and 73%.
Post-discharge surveillance for patients who undergo C/S detected significantly more SSI, including deep incisional and organ space infections. Email follow-up was an efficient and effective method of post-discharge surveillance and should be included routinely in a SSI surveillance program for procedures associated with short hospital lengths of stay.
M. Mcnaughton, None
M. G. Romney, None
V. Leung, None