3 Embedding surgical site infection surveillance data within a national clinical audit for hip fracture

Aims The Irish Hip Fracture Database (IHFD) is a national clinical audit established to measure care and outcomes of hip fracture patients since 2012. It is managed by the National Office of Clinical Audit and each year data is collected on almost 4000 patients. In 2022, the IHFD integrated surgical site infection surveillance (SSI) data into the audit. This was conducted in collaboration with the national Anti-Microbial Resistance Infection Control (AMRIC) in the Health Service Executive following publication of their strategy (HSE, 2021)1. In the UK surgical site surveillance is mandatory for many surgical procedures including surgery following a hip fracture since 2004. Embedding this surveillance data set is one of the first steps in achieving this in Ireland (PHE, 2022)3. Methods The dataset incorporates the required data fields as recommended by the European Centre for Disease Control (ECDC, 2017)2 and is benchmarked against other data collection tools used within Public Health England (PHE 2022)3 and Scottish/Northern Irish healthcare systems. AMRIC and the IHFD committee developed a dataset specific to the pathway of care around surgical wounds and SSI. In 2023, following a pilot study with three hospitals the dataset was activated for all hospitals. Questions added included antibiotic use, skin preparation, surgery length of time, wound closure and dressings applied. Data was inputted in the electronic portal used for data entry within the IHFD which captures data on patient’s demographics and journey through the acute hospital stay. Monthly training and education webinars were created and facilitated by the IHFD audit management team including user friendly infographics designed to ensure consistency in SSI diagnosis definitions. Results In May 2024 the first full year of data was received on 3983 patients. The overall incidence of SSI was <1%, the greatest impact from which was on length of stay (from 19 days to 34 days). Development of a national framework for capturing SSI using a standardised defined criteria was published and recommendations for the prevention of SSI are being updated currently. Challenges and facilitators across each site were discussed via monthly webinar. Analysis of the data was conducted using Excel, SPSS and Tableau. Completeness for additional variables ranges from 68 to 100%. Modifications to the dataset were reviewed using a Plan-Do- Act- Study (PDSA) cycle. Updates were presented to the AMRIC/IHFD steering committee and changes implemented within the dataset. Conclusions The use of a national clinical audit as a conduit for a national SSI surveillance programme is a very effective and efficient way of collecting data. Reducing duplication of effort within the Health Service for data collection and building on already established governance for hip fractures. Each participating hospitals have a clinical hip fracture governance committee which now include members of the infection and protection control team. The IHFD furnishes hospitals and AMRIC with quarterly SSI reports as routine outputs from the data and talks have begun about extending this work into other audits with surgical cohorts.