Patient reporting of SSI is scientific – and here is why.

Over the past few months, I’ve been immersing myself in the field of surgical site infection (SSI) surveillance. (Fortunately, I didn’t start the project until after my hip replacement, as there have been plenty of patient stories that might have put me off.)

We’ve had quite a few clients start using our platform to survey surgical patients post-discharge, to ask them about their wound symptoms. In the UK, these are mainly NHS hospitals surveying women who have had caesarians. In NZ, private hospitals are surveying patients for a broader range of surgeries. Interestingly all our clients are already reporting to the national SSI registries run by the UK Health Security Agency (UKHSA) Surgical Site Infection Surveillance Service in the UK and the Health Quality and Safety Commission (HQSC) in NZ. Still, it’s commonly understood that surveillance systems based solely on hospital readmission data and pathology lab results significantly under-report the true SSI incidence.

I now understand the impact of SSI on patients – ranging from pain and discomfort through to being readmitted to the hospital, permanent disability and, in the case of older patients, sometimes even death. It is not unknown that people who get a new hip or knee must have their implant removed, have months of treatment to control the infection and then have another operation to put a new implant in. Awful.

As part of my research project, I’ve spoken to Quality and IPC leads in four countries, and a question that has come up several times is, ‘how scientific is patient reporting of SSI?’. We still get asked this question about other patient-reported outcome measures (PROMs) too.

I ask you, how likely is it if you had an operation within the last 30 days and have experienced pain, swelling and pus around the wound and if you went to your GP and were prescribed antibiotics, that you wouldn’t be able to respond to these questions in a survey accurately?

If you were readmitted to the hospital within 30 days of your surgery (or 90 days if you had an implant), and you received antibiotics, had your wound scraped or had a general anaesthetic and a further operation connected to the initial surgery, would this be hard to report in a survey?

Adding to this, in most patient-reported cases, the SSI has been clinically validated by prescribing antibiotics within 30 days. As one of our NHS clients reported, “I’ve used the standardised NHS SSI survey for ten years and identified over 1,000 SSI. 93% of these patient-reported SSI have actually been clinically validated, as the patient was prescribed antibiotics for their wound.”

Some of our clients (especially in the UK) would only consider surveying patients with the with the NHS standardised SSI questionnaire. Their view is that well-validated, standardised survey tools are scientific. This questionnaire is a great starting point, but there are additional questions that can be considered. These additional questions add value to our understanding of risk factors and behaviours. They enable us to consistently gather ethnicity and other demographic questions, or questions about care bundles and improvement initiatives that allow us to track and refine new clinical practices over time.

Formal surveillance systems based on hospital readmissions are costly to set up and run. They underreport the actual rate of SSI by missing the ones treated in the community. Patient-reported SSI surveillance is a chance to cost-effectively step into new clinical areas like caesareans without burdening the workforce with arduous data recording tasks. This approach is not designed for public reporting and benchmarking; it’s about providing your IPC team with an accurate picture of what is happening so that quality and clinical improvement can be targeted and measured.

We have a modular set of questions, incorporating the NHS standardised questions. Please get in touch if you’d like to review them.

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