Prevalence of surgical site infections before and after theimplementation of a multimodal infection control programme

Objectives: In order to assess the prevalence of surgical site infections (SSIs) before and after the implementationof a multimodal infection control programme including the realization of a campaign to increasecompliance with guidelines for antimicrobial prophylaxis, we designed and conducted the present study involvingall 20 of the surgical departments of a large teaching hospital in Catania, Italy.Patients and methods: SSI definitions of the Hospital in Europe Link for Infection Control through Surveillance(HELICS) protocol were used in four 1 day point-prevalence surveys. After the first survey, an infection controlprogramme was implemented involving the active commitment of surgeons and infection control staff.Results: Overall, a total of 600 surgical patients were enrolled. A significant decreasing trend in the SSI rate(from 16.4 to 8.2 per 100 surgical patients, P¼0.018) was shown. After multivariate analysis, significant riskfactors for SSI were identified: age .31 years, kidney insufficiency and infection at admission. Taking intoaccount the indication and the timing of administration of antibiotic prophylaxis, in the four surveys prophylaxiswas administered inappropriately in 55.3% of surgical procedures.Conclusions: The approach used in this study remains a feasible method of evaluating the burden of SSIs usingrepeated prevalence surveys. The results provide evidence of a significant decreasing trend in the SSI ratefollowing the infection control intervention. Furthermore, our study underlines the need to develop evidencebasedguidelines in collaboration with surgeons, to achieve consensus before implementation in order toimprove compliance with antimicrobial prophylaxis and, finally, decrease SSI rates.