Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T18:29:00.624Z Has data issue: false hasContentIssue false
  • English
  • Français

Seasonal Variation of Common Surgical Site Infections: Does Season Matter?

Published online by Cambridge University Press:  26 May 2015

Michael J. Durkin ,
Kristen V. Dicks ,
Arthur W. Baker ,
Sarah S. Lewis ,
Rebekah W. Moehring ,
Luke F. Chen ,
Daniel J. Sexton  and
Deverick J. Anderson
Michael J. Durkin*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Kristen V. Dicks
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Arthur W. Baker
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Sarah S. Lewis
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Duke Program for Infection Prevention and Healthcare Epidemiology, Durham, North Carolina
*
Address correspondence to Michael J. Durkin, MD, Duke University Medical Center, Box 102359, Rm 181 Hanes House, Durham, NC 27710 (michael.durkin@dm.duke.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To evaluate seasonal variation in the rate of surgical site infections (SSI) following commonly performed surgical procedures.

DESIGN

Retrospective cohort study.

METHODS

We analyzed 6 years (January 1, 2007, through December 31, 2012) of data from the 15 most commonly performed procedures in 20 hospitals in the Duke Infection Control Outreach Network. We defined summer as July through September. First, we performed 3 separate Poisson regression analyses (unadjusted, multivariable, and polynomial) to estimate prevalence rates and prevalence rate ratios of SSI following procedures performed in summer versus nonsummer months. Then, we stratified our results to obtain estimates based on procedure type and organism type. Finally, we performed a sensitivity analysis to test the robustness of our findings.

RESULTS

We identified 4,543 SSI following 441,428 surgical procedures (overall prevalence rate, 1.03/100 procedures). The rate of SSI was significantly higher during the summer compared with the remainder of the year (1.11/100 procedures vs 1.00/100 procedures; prevalence rate ratio, 1.11 [95% CI, 1.04–1.19]; P=.002). Stratum-specific SSI calculations revealed higher SSI rates during the summer for both spinal (P=.03) and nonspinal (P=.004) procedures and revealed higher rates during the summer for SSI due to either gram-positive cocci (P=.006) or gram-negative bacilli (P=.004). Multivariable regression analysis and sensitivity analyses confirmed our findings.

CONCLUSIONS

The rate of SSI following commonly performed surgical procedures was higher during the summer compared with the remainder of the year. Summer SSI rates remained elevated after stratification by organism and spinal versus nonspinal surgery, and rates did not change after controlling for other known SSI risk factors.

Infect. Control Hosp. Epidemiol. 2015;36(9):1011–1016

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 9 , September 2015 , pp. 1011 - 1016
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in part: IDWeek 2014; Philadelphia, Pennsylvania; October 10, 2014 (Abstract 47427). A subset of this data (<15%; specifically including laminectomy and spinal fusion procedures) was analyzed and published by the Journal of Neurosurgery: Spine.

References

1. Anderson, DJ, Pyatt, DG, Weber, DJ, Rutala, WA, North Carolina Department of Public Health HAI Advisory Group. Statewide costs of health care-associated infections: estimates for acute care hospitals in North Carolina. Am J Infect Control 2013;41:764–768.Google Scholar
2. Magill, SS, Hellinger, W, Cohen, J, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 2012;33:283–291.Google Scholar
3. Centers for Disease Control and Infection. Surgical site infection (SSI) event. CDC procedure-associated module SSI. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published January 2015. Modified April 2015. Accessed May 6, 2015.Google Scholar
4. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.Google Scholar
5. Gruskay, J, Smith, J, Kepler, CK, et al. The seasonality of postoperative infection in spine surgery. J Neurosurg Spine 2013;18:57–62.CrossRefGoogle ScholarPubMed
6. Kane, P, Chen, C, Post, Z, Radcliff, K, Orozco, F, Ong, A. Seasonality of infection rates after total joint arthroplasty. Orthopedics 2014;37:e182–e186.Google Scholar
7. Durkin, MJ, Dicks, KV, Baker, AW, et al. Postoperative infection in spine surgery: does the month matter? J Neurosurg Spine 2015; Epub ahead of print.Google Scholar
8. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315–322.CrossRefGoogle Scholar
9. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
10. Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27:228–232.Google Scholar
11. Kaye, KS, Sloane, R, Sexton, DJ, Schmader, KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006;54:391–396.Google Scholar
12. Anderson, DJ, Richet, H, Chen, LF, et al. Seasonal variation in Klebsiella pneumoniae bloodstream infection on 4 continents. J Infect Dis 2008;197:752–756.Google Scholar
13. Perencevich, EN, McGregor, JC, Shardell, M, et al. Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients. Infect Control Hosp Epidemiol 2008;29:1124–1131.CrossRefGoogle ScholarPubMed
14. Eber, MR, Shardell, M, Schweizer, ML, Laxminarayan, R, Perencevich, EN. Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients. PLOS ONE 2011;6:e25298.Google Scholar
15. Falagas, ME, Peppas, G, Matthaiou, DK, Karageorgopoulos, DE, Karalis, N, Theocharis, G. Effect of meteorological variables on the incidence of lower urinary tract infections. Eur J Clin Microbiol Infect Dis 2009;28:709–712.Google Scholar
16. Cho, Y, Badve, SV, Hawley, CM, et al. Seasonal variation in peritoneal dialysis-associated peritonitis: a multi-centre registry study. Nephrol Dial Transplant 2012;27:2028–2036.Google Scholar
17. Freeman, JT, Anderson, DJ, Sexton, DJ. Seasonal peaks in Escherichia coli infections: possible explanations and implications. Clin Microbiol Infect 2009;15:951–953.Google Scholar
18. Edrington, TS, Callaway, TR, Ives, SE, et al. Seasonal shedding of Escherichia coli O157:H7 in ruminants: a new hypothesis. Foodborne Pathog Dis 2006;3:413–421.CrossRefGoogle ScholarPubMed
19. Barben, J, Hafen, G, Schmid, J; Swiss Paediatric Respiratory Research Group. Pseudomonas aeruginosa in public swimming pools and bathroom water of patients with cystic fibrosis. J Cyst Fibros 2005;4:227–231.Google Scholar
20. Ramos, GP, Rocha, JL, Tuon, FF. Seasonal humidity may influence Pseudomonas aeruginosa hospital-acquired infection rates. Int J Infect Dis 2013;17:e757–e761.Google Scholar
21. Leekha, S, Diekema, DJ, Perencevich, EN. Seasonality of staphylococcal infections. Clin Microbiol Infect 2012;18:927–933.CrossRefGoogle ScholarPubMed
22. Wang, X, Towers, S, Panchanathan, S, Chowell, G. A population based study of seasonality of skin and soft tissue infections: implications for the spread of CA-MRSA. PLOS ONE 2013;8:e60872.Google Scholar
23. Mermel, LA, Machan, JT, Parenteau, S. Seasonality of MRSA infections. PLOS ONE 2011;6:e17925.CrossRefGoogle ScholarPubMed
24. McBride, ME, Duncan, WC, Knox, JM. The environment and the microbial ecology of human skin. Appl Environ Microbiol 1977;33:603–608.Google Scholar
25. Hens, N, Ayele, GM, Goeyvaerts, N, et al. Estimating the impact of school closure on social mixing behaviour and the transmission of close contact infections in eight European countries. BMC Infect Dis 2009;9:187.Google Scholar
26. Skull, SA, Krause, V, Coombs, G, Pearman, JW, Roberts, LA. Investigation of a cluster of Staphylococcus aureus invasive infection in the top end of the Northern Territory. Aust N Z J Med 1999;29:66–72.CrossRefGoogle ScholarPubMed
27. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2011;32:970–986.CrossRefGoogle ScholarPubMed