Anne Savey

Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system.

Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire - Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria, and several risk factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration, elective/emergency surgery, and type of surgery. From 1999 to 2006, 14,845 SSIs were identified in 964,128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude overall SSI incidence decreased from 2.04% to 1.26% (P<0.001; relative reduction: -38%) and the National Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% (P<0.001; relative reduction: -33%). The most significant SSI incidence reduction was observed for hernia repair and caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy. Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI incidence.

Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program

Purpose To describe trends of urinary catheter-related infections (UCRIs) acquired by patients hospitalized in intensive care units (ICU) in relation with an infection control program. Materials and methods Prospective surveillance in one ICU of a university hospital in Lyon (France) between 1995 and 2004. Results A 66% reduction of urinary catheter-related infections (UCRIs) acquired by patients hospitalized was observed between 1995 and 2004 after adjustement on age, gender, antibiotic use at admission, and duration of exposure to urinary catheter. Conclusions These results, obtained by continuous epidemiological monitoring of nosocomial infections, are encouraging with regard to the improvement of infection control measures and the evolution of medical practices. Further studies in ICUs are needed to confirm this trend.

Effect of Standardized Surveillance of Intensive Care Unit–Acquired Infections on Ventilator-Associated Pneumonia Incidence

In a multicenter surveillance of intensive care unit (ICU)-acquired infections, adjusted ventilator-associated pneumonia (VAP) incidence diminished by -1.0% per year (95% confidence interval [CI], -1.8 to -0.2; P = .02) in ICUs with continuous surveillance but increased by +16.1% (95% CI, 0.5%-34.1%; P = .04) in the year following surveillance disruption, suggesting a preventive effect of surveillance on VAP.

Use of surveillance data to calculate the sample size and the statistical power of randomized clinical trials testing Staphylococcus aureus vaccine efficacy in orthopedic surgery

BACKGROUND Patients undergoing primary total hip arthroplasty (THA) would be a worthy population for anti-staphylococcal vaccines. The objective is to assess sample size for significant vaccine efficacy (VE) in a randomized clinical trial (RCT). METHODS Data from a surveillance network of surgical site infection in France between 2008 and 2011 were used. The outcome was S. aureus SSI (SASSI) within 30 days after surgery. Statistical power was estimated by simulations repeated for theoretical VE ranging from 20% to 100% and for sample sizes from 250 to 8000 individuals per arm. RESULTS 18,688 patients undergoing THA were included; 66 (0.35%) SASSI occurred. For a 1% SASSI rate, the sample size would be at least 1316 patients per arm to detect significant VE of 80% with 80% power. CONCLUSION Simulations with real-life data from surveillance of hospital acquired infections allow estimation of power for RCT and sample size to reach the required power.