• David Y Ming, Luke F Chen, Becky A Miller, and Deverick J Anderson.
• Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, NC 27710, USA.
• Infect Control Hosp Epidemiol. 2012 Mar 1; 33 (3): 276-82.

ObjectiveTo describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI.DesignRetrospective cohort study.SettingThirty-seven community hospitals in the southeastern United States.PatientsConsecutive sample of patients undergoing surgical procedures between July 1, 2007, and December 31, 2008.MethodsANOVA was used to compare rates of SSIs, and the F test was used to compare the distribution of rates of SSIs. Wilcoxon Signed Rank test [corrected] was used to test for differences in performance rankings of hospitals.ResultsFollowing 177,706 surgical procedures, 1,919 SSIs were identified (incidence, 1.08 per 100 procedures). Sixty-four percent (1,223 of 1,919) of these were identified as complex SSIs; 87% of the complex SSIs were diagnosed in inpatient settings. The median proportion of superficial-incisional SSIs was 37% (interquartile range, 29.6%-49.5%). Postdischarge SSI surveillance was variable, with 58% of responding hospitals using surgeon letters. As reporting focus was narrowed from all SSIs to complex SSIs (incidence, 0.69 per 100 procedures) and, finally, to complex SSIs diagnosed in the inpatient setting (incidence, 0.51 per 100 procedures), variance in rates changed significantly ([Formula: see text]). Performance ranking of individual hospitals, based on rates of SSIs, differed significantly, depending on the reporting method utilized ([Formula: see text]).ConclusionsInconsistent reporting methods focused on variable depths of infection and healthcare location at time of diagnosis significantly impact rates of SSI, distribution of rates of SSI, and hospital comparative-performance rankings. We believe that public reporting of SSI rates should be limited to complex SSIs diagnosed in the inpatient setting.

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