Promoting quality through surveillance of surgical site infections: five prevention success stories

BACKGROUND: Public reports of successful quality improvement efforts are useful, but seldom available. We present 5 successful efforts to prevent surgical site infections (SSIs) with the use of prospectively collected surveillance data. METHODS: Before-and-after intervention studies were conducted in 5 acute care public hospitals in the national surveillance network for SSI in The Netherlands from 1992 to 2000. Patients undergoing surgery for total hip prosthesis (3 hospitals), knee prosthesis (2 hospitals), prosthesis of the femur head (1 hospital), or appendectomy (1 hospital) were included. Included were 1066 patients before intervention, and 1269 patients after intervention. Multidisciplinary evaluation of infection control policy led to subsequent changes of infection control measures, mainly involving the discipline of staff and organization of perioperative infection prevention procedures. RESULTS: All 5 hospitals drastically reduced their SSI rates to the national average or below. Absolute declines ranged from 2.1% to 13.9%, but not all reductions were statistically significantly different from 0%. CONCLUSION: Surveillance results provide a basis for improvement of infection prevention.