English hospitals under-report surgical site infections, survey shows

BMJ 2013; 346 doi: (Published 16 January 2013) Cite this as: BMJ 2013;346:f345
  1. Susan Mayor
  1. 1London

Patients develop wound infections after surgery far more often than is usually reported, show the results of a survey of English hospital trusts that reveal wide variations in how different hospitals collect and report this information.1

The researchers have called for a complete overhaul of the national surgical site infection surveillance system, a voluntary reporting scheme run by the Health Protection Agency, to improve its reliability. Their findings show that hospitals that conduct high quality surveillance of surgical site infections are penalised in the current surveillance service.

The research group sent questionnaires to all 156 hospital trusts in England, asking how they collect and report data for the national surveillance scheme. Replies from 106 trusts showed “worrying inconsistencies” in data collection and quality that led to wide variation in reported infection rates.

The rate of surgical site infections was much higher (4.1%) in trusts that used high quality post-discharge surveillance, including active follow-up by phone calls to patients and outpatient clinics, than in trusts with poorer quality surveillance after discharge (1.5%).

“The harder you look, the more that you find. Common sense tells you this, and now we have demonstrated that with this study,” said Judith Tanner, professor of clinical nursing research at De Montfort University, Leicester. “Perversely, hospitals that conduct robust and high quality surveillance are penalised under the current system.”

Nine trusts (8%) reported only early infections that developed before patients left hospital; 24 trusts (22%) used inpatient and readmission follow-up data; while 73 (68%) reported inpatient, readmission, and post-discharge follow-up data, providing the most accurate figures for postsurgical infection rates.

Many trusts failed to use national protocols and definitions in tracking surgical site infections. A 10th of the trusts failed to provide data on superficial infections despite evidence that these can develop into deep infections, and 15% did not use the recommended definition of wound infections.

“The national surgical site infection surveillance system in England consistently under-reports the true scale of surgical infection and gives a false sense of security,” said Tanner. “This study shows there are so many inconsistencies that it’s not possible to benchmark hospitals against the English national surgical site infection data.”

The research group suggests that a clear and standardised system be introduced for hospitals to report more surgical infections more accurately. This should include contacting patients after hospital discharge by letter or phone within 30 days of their surgery.

They point out that surgical wound infections are among the commonest healthcare associated infections and among the easiest to prevent, making it worthwhile for hospitals to improve benchmarking as part of efforts to reduce infection rates. And they note that commissioners will commission surgery from trusts with lower infection rates and so they need accurate data on which to base decisions.


Cite this as: BMJ 2013;346:f345