SUR-2015-073-ver9-Hung_1P 1..7

Background: Surgical site infections (SSIs) are the most common healthcare-associated infections (HAI) in lower-income countries. This is the first study to report the results of surveillance on SSI stratified by surgical procedure in seven Vietnamese cities. Methods: This was a prospective, active SSI surveillance study conducted from November 2008–December 2010 in seven hospitals using the U.S. Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC-NHSN) definitions and methods. Surgical procedures (SPs) were classified into 26 types according to the International Classification of Diseases Edition 9 criteria. Results: We recorded 241 SSIs, associated with 4,413 SPs (relative risk [RR] 5.5%; 95% confidence interval [95% CI] 4.8–6.2). The highest SSI rates were found for limb amputation (25%), colon surgery (33%), and small bowel surgery (21%). Compared with CDC-NHSN SSI report, our SSI rates were higher for the following SPs: Limb amputation (25% vs. 1.3%; RR 20.0; p= 0.001); appendix surgery (8.8% vs. 3.5%; RR 2.54; 95% CI 1.3–5.1; p= 0.001); gallbladder surgery (13.7% vs. 1.7%; RR 7.76; 95% CI 1.9–32.1; p= 0.001); colon surgery (18.2% vs. 4.0%; RR 4.56; 95% CI 2.0–10.2; p= 0.001); open reduction of fracture (15.8% vs. 3.4%; RR 4.70, 95% CI 1.5–15.2; p= 0.004); gastric surgery (7.3% vs. 1.7%; RR 4.26; 95% CI 2.2–8.4, p= 0.001); kidney surgery (8.9% vs. 0.9%; RR 10.2; 95% CI 3.8–27.4; p= 0.001); prostate surgery (5.1% vs. 0.9%; RR 5.71; 95% CI 1.9–17.4; p = 0.001); small bowel surgery (20.8% vs. 6.7%; RR 3.07; 95% CI 1.7–5.6; p= 0.001); thyroid or parathyroid surgery (2.4% vs. 0.3%; RR 9.27; 95% CI 1.0–89.1; p= 0.019); and vaginal hysterectomy (14.3% vs. 1.2%; RR 12.3; 95% CI 1.7–88.4; p = 0.001). Conclusions: Our SSIs rates were significantly higher for 11 of the 26 types of SPs than for the CDC-NHSN. This study advances our knowledge of SSI epidemiology in Vietnam and will allow us to introduce targeted interventions. It is difficult to ignore the burden posed by surgical site infections (SSIs) on patient safety in terms of pain, suffering, delayed healing, increased use of antibiotics, bacterial resistance, revision surgery, longer hospital stays, morbidity, and death, which also are reflected in excess health care costs [1]. It recently was estimated that SSI represents 31% of the healthcare-acquired infections (HAI) in a U.S. hospital, making them the most common type of HAI [2]. Similarly, SSIs are the most common type of HAI in lower-income countries [3]. According to the World Bank’s categorization, 68% of the world’s countries are low-income and lower middle-income economies—which also can be referred as developing countries. Today, such countries account for more than 75% of the world’s population [4]. However, the incidence of SSIs in limited-resource countries has not been assessed systematically [5,6]. Surveillance programs focused on HAIs—including SSIs—are essential tools to reduce their incidence and their Bach Mai Hospital, Hanoi, Vietnam. Viet Duc Hospital, Hanoi. International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. Ministry of Health, Hanoi. SURGICAL INFECTIONS Volume 17, Number 2, 2016 a Mary Ann Liebert, Inc. DOI: 10.1089/sur.2015.073 1 SUR-2015-073-ver9-Hung_1P SUR-2015-073-ver9-Hung_1P.3d 02/01/16 4:07pm Page 1