Quality statement 7: Surveillance

Quality statement

People having surgery are cared for by healthcare providers that monitor surgical site infection rates (including post-discharge infections) and provide feedback to relevant staff and stakeholders for continuous improvement through adjustment of clinical practice.

Rationale

Surveillance data on surgical site infection rates can inform and influence steps taken to minimise the risk of infection, as well helping to clearly communicate the risks to patients. Some infections take time to develop and may not become apparent until after the patient has been discharged from hospital. Therefore surveillance for infections in hospitalised patients only is likely to underestimate the true infection rate – a problem exacerbated by the increasing trend towards shorter postoperative hospital stays and day surgery. Therefore, systems that identify surgical site infection after patients leave hospital enhance the value of surveillance and the provider's ability to deliver interventions to reduce the risk of infections based on their own results, leading to continuous quality improvement.

Quality measures

Structure

a) Evidence of local arrangements to ensure the existence of surveillance systems that capture inpatient and post-discharge surgical site infections.

Data source: Local data collection. Also contained within Prevention and control of healthcare-associated infections (NICE public health guidance 36): quality improvement statement 3, evidence of achievement 6.

b) Evidence of local arrangements to ensure surveillance data on surgical site infection rates (including post-discharge infections) are fed back to relevant staff and stakeholders.

Data source: Local data collection. Prevention and control of healthcare-associated infections (NICE public health guidance 36): quality improvement statement 3, evidence of achievement 13.

c) Evidence of local arrangements to ensure that surveillance data on surgical site infection rates (including post-discharge infections) are used for continuous improvement through adjustment of clinical practice.

Data source: Local data collection.

Outcome

Readmissions for surgical site infection.

Data source: Local data collection. Data collected as part of the Surgical Site Infection Surveillance Service (SSISS) are published by Public Health England in annual reports available through their website. This includes readmissions data from individual hospitals, collected as part of the Department of Health's mandatory surveillance scheme (orthopaedic surgery).

What the quality statement means for service providers, healthcare professionals, public health practitioners and commissioners

Service providers ensure that systems are in place to monitor surgical site infection rates (including post-discharge infections) and provide feedback to their clinical and non-clinical staff and stakeholders for continuous improvement through adjustment of clinical practice.

Healthcare professionals and public health practitioners act on information provided to them on surgical site infection rates (including post-discharge infections) to adjust clinical practice for continuous improvement.

Commissioners commission services from service providers that can demonstrate that they monitor surgical site infection rates (including post-discharge infections) and provide feedback to relevant staff and stakeholders for continuous improvement through adjustment of clinical practice.

What the quality statement means for patients, service users and carers

People having an operation are cared for by healthcare services that monitor surgical site infection rates, share this information with patients and relevant staff, and use it to help improve services and minimise future infection rates.

Source guidance

Healthcare-associated infections: prevention and control (2011) NICE public health guidance 36, quality improvement statement 3

Definitions of terms used in this quality statement

Surgical site infection

The presence of a surgical site infection can be determined using the Surgical Site Infection Surveillance Service (SSISS) definitions: Protocol for the surveillance of surgical site infection: surgical site infection surveillance service, which are modified from those used by the US Centers for Disease Control (CDC). Other measures that are also based on clinical signs and symptoms are available. The term does not include colonisation.

Surgical site infection rates (including post-discharge)

Many surgical site infections present after discharge from hospital. Comparison of post-discharge surveillance data is difficult because it depends on the methods used to detect infections. The method of surveillance should be clear so that comparisons can be made. A Protocol for the surveillance of surgical site infection: surgical site infection surveillance service is available from Public Health England. The Department of Health UK five year antimicrobial resistance strategy highlights access to and use of surveillance data in the context of bacterial resistance.

Staff and stakeholders

Staff may include the board and individual clinical units in a hospital setting. Stakeholders include patients, GPs, commissioners and other local health and social care organisations [adapted from NICE public health guidance 36: quality improvement statement 3].