English hospitals under-report surgical site infections, survey shows

BMJ 2013; 346 doi: (Published 16 January 2013) Cite this as: BMJ 2013;346:f345

Re: English hospitals under-report surgical site infections, survey shows

We read with interest Prof Tanner et al’s (2012) publication in the Journal of Hospital Infection ‘A benchmark too far: findings from a national survey of surgical site infection surveillance’. We applaud this publication but think that the review could be misleading for the non-specialist reader in that the focus of the paper is on post discharge surveillance (PDS).

We agree that the aim of SSI surveillance is to drive quality improvements and patient outcomes and that comprehensive and accurate data are needed to achieve this. We were surprised that there was little emphasis on the many advantages that national benchmarking via participation in the HPA scheme has (Rochon 2012). When applied impartially and consistently, the HPA protocol and definitions are robust, as is the support offered by the HPA to participating Trusts. Prof Tanner et al’s (2013) article appears to focus disproportionately on post-discharge surveillance whilst the national benchmark relates to inpatient and readmission rates data. National data which includes the post discharge component is developing following the introduction of the PDS component in 2010. Some Trusts, such as ours, may find that high quality PDS requires considerable resources for relatively low yield, and may choose not to contribute PDS data.

A further difficulty that we have with the survey findings is that the data are presented so as not to distinguish between the authors’ survey findings of data submitted to HPA surveillance programme and those of local surveillance activity. Local surveillance activity /SSI data provides timely information on trends, including possible SSI outbreaks, as well as specific information of local interest and interventions to reduce SSI. It is encouraging that a number of Trusts are choosing to include surgical site infection as a quality indicator and/or CQUIN (our trust experience found that this improved patient safety and was financially rewarding). Promoting SSI reporting as a quality indicator increases the likelihood that the surveillance protocol and processes are reviewed and improved by external review for accuracy, validity, reliability, timeliness, relevance, and completeness (Audit Commission 2007). It may also prioritise surveillance, its resourcing and its reporting to drive improvements in clinical practice, patient safety and patient outcomes.

Audit Commission (2007) Improving information to Support Decision Making: Standards for Better Quality Data. London: Audit Commission. Accessed 5 June 2012.
Rochon M. (2012). Wound Healing and Surgical Site Infection. In: Manual of Perioperative Care. Editors Woodhead K and Fudge L. London: Blackwell Publishing.

Competing interests: No competing interests

30 January 2013
Melissa Rochon
Clinical Nurse Specialist in Surveillance
Carlos Morais
Royal Brompton and Harefield NHS Foundation Trust
London SW3 6NP, Harefield UB9 6JH