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

The European Centre for Disease Prevention and Control (ECDC) read with great interest the recent correspondence regarding surveillance of surgical site infections (SSIs) in England, and more particularly post-discharge surveillance (PDS) of these infections.

In their recent response, Tanner et al. made a statement that “Even the European Centers for Disease Control says the English SSI surveillance system ‘lags’ behind the rest of Europe”. After carefully checking ECDC reports, we could not find the quote that is attributed to ECDC and this statement is therefore incorrect.

In its Annual Epidemiological Report 2011 (page 194), ECDC pointed to the fact that inter-country comparisons of SSI rates should be made with caution because of differences, among others, in PDS methods. A few countries such as Norway and The Netherlands are performing intensive PDS. This is reflected in the percentage of SSIs reported by these countries to ECDC as being diagnosed after hospital discharge. For data from England reported to ECDC, PDS data are included in the form of SSIs detected at re-admission, which was introduced as a requirement to all hospitals in July 2008. ECDC understands that other methods of voluntary PDS are undertaken in England, but that the data collected through these methods are not reported to ECDC. Other participating countries are at different stages of implementing PDS of SSIs. The statement by Tanner et al. in their original article that “according to the latest European report, England lags behind the rest of Europe with regard to PDS” is based on their own interpretation and must not be attributed to ECDC.

Differences in the intensity of PDS exist not only between countries, but even between hospitals within a country. While in-hospital practices and case-finding methods for SSI surveillance are usually comparable, PDS methods are difficult to standardise.

ECDC hopes that the current debate will raise awareness about the importance of actively looking for SSIs after hospital discharge, but also on the difficulties of standardising PDS. In the meantime and as mentioned in the ECDC report on surveillance of SSIs in Europe, 2008-2009 (page 4), ECDC proposes that the incidence density of in-hospital SSIs per 1,000 post-operative patient-days – thus excluding SSIs diagnosed after discharge from the hospital – is used for inter-hospital and inter-country comparisons of SSI rates.

Competing interests: No competing interests

30 January 2013
Carl Suetens
Senior Expert
Andrea Mendez, Jolanta Griškevičienė, Dominique L. Monnet
European Centre for Disease Prevention and Control (ECDC)
SE-171 83 Stockholm, Sweden