Surgical Site Infection Surveillance: Accomplishments and Pitfalls

Background: Surgical site infection (SSI) surveillance is an important facet of hospital infection control processes, serving an important information-gathering function. However, emphasis on surgical outcome improvements and hospital cost containment may engender misleading interpretations of accumulated data unless thoughtful protocols and organized interpretation protocols are in place Results: For many types of operations, the lowest rate of SSI that is achievable by state-ofthe- art prevention measures is not zero; some infections are unavoidable. Moreover, it is flawed to assume (or assert) that all SSIs are the "fault" of the surgeon or some perceived shortcoming of process; host factors (e.g., obesity, diabetes mellitus) may predominate in some cases. Observational studies yield flawed interpretations (if not flawed data) in the absence of rigid scientific protocols, courtesy of the post-hoc fallacy. Observation-mode SSI rates from two time periods may bear no true relation one to another, even if an "intervention" occurred in between. Furthermore, outcome data alone cannot specify which process or structure to alter if remediation is necessary. Accurate identification of remediable flaws requires direct observation of actual work Conclusions: Surgeons of all specialty areas fight a continuous battle to avoid infection complications. Complex processes of SSI prevention must be executed to perfection; even then, SSI may occur. Unfortunately, the pursuit of near-perfect future outcomes must be modulated using imperfect knowledge of past events