Much-noticed measure with few clearly formulated recommendations

Why is surveillance so important for SSI prevention

Data from surveillance systems from different countries have shown that regular participation in a national surveillance system and feedback of own data from SSI together with national reference data lead to a significant reduction in the rate of SSI from 25% to 65%.1

Definition: “Surveillance is the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring health event.”2

Surveillance of healthcare-associated infections is essential for an effective IPC programme. However, defining, recognising, reporting and evaluating HAIs, including SSIs, is challenging and requires expertise, time and resources.3

Surveillance is a much-discussed measure that is mentioned in the various guidelines on SSI prevention. However, there are few recommendations declared as such…


GuidelineRecommendationCategory (if mentioned)
CDC4“Use CDC definitions of SSI without modification for identifying SSI among surgical inpatients and outpatients.”Category IB
“For inpatient case-finding (including readmissions), use direct prospective observation, indirect prospective detection, or a combination of both direct and indirect methods for the duration of the patient’s hospitalization.”Category IB
“When postdischarge surveillance is performed for detecting SSI following certain operations (e.g., coronary artery bypass grafts), use a method that accommodates available resources and data needed.”Category II
“For outpatient case-finding, use a method that accommodates available resources and data needs.”Category IB
“Assign the surgical wound classification upon completion of an operation. A surgical team member should make the assignment.”Category II
For each patient undergoing an operation chosen for surveillance, record those variables shown to be associated with increased SSI risk (e.g., surgical wound class, ASA class, and duration of operation).”Category IB
“Periodically calculate operation-specific SSI rates stratified by variables shown to be associated with increased SSI risk (e.g., NNIS risk index).”Category IB
“Report appropriately stratified, operation-specific SSI rates to surgical team members. The optimum frequency and format for such rate computations will be determined by stratified case-load sizes (denominators) and the objectives of local, continuous quality improvement initiatives.”Category IB
“No recommendation to make available to the infection control committee coded surgeon-specific data.”Unresolved issue


KRINKO1Surveillance of SSI is mandatory.Category IA/IV


Denise Leistenschneider, Senior Clinical Consultant
“Only through regular monitoring can measures be used sensible, optimised and ultimately be effective.”

Surveillance of SSI is mandatory.1

Detection of SSI should take place:4

  • as inpatient case-finding

  • as postdischarge case-finding

  • as outpatient case-finding

Direct prospective observation, indirect prospective detection, or a combination of both should be used for inpatient case-findings (including readmissions).4

A method that accommodates available resources and data needs should be used for postdischarge surveillance and outpatient case-findings.4

For surgeries selected for surveillance, variables associated with an increased risk of SSI should be recorded (e.g. wound class and duration of surgery).4

Surgery-specific SSI rates should be calculated regularly.4

The surgical team should be regularly informed about the existing SSI rates.4

Aim of surveillance3


Although there are only a few recommendations that are clearly declared as such, the KISS (Hospital Infection Surveillance System) of the NRZ (National Reference Centre), for example, also ensures that nosocomial wound infections in German hospitals can be regularly recorded and monitored through its surveillance protocol (Modul OP-Kiss):

  • The focus is on certain indicator operations (e.g. hip prostheses (HPRO), colon operations (COLO), heart operations (CARD) or inguinal hernias (HERN)) that occur frequently and where wound infections are particularly relevant
  • It should be ensured that the indicator surgery is performed frequently enough for the results to be interpretable
  • Based on the specifications and definitions of the NHSN and the CDC
  • Risk stratification using the NNIS risk score (duration of surgery, ASA score of the patient, degree of contamination of the wound)

All content and recommendations listed are to be regarded as extracts from the original literature and do not claim to be exhaustive.

Click to see full list References:
  1. KRINKO (2018) Prävention postoperativer Wundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
  2. Centers for Disease Control (CDC) (1988) Guidelines for Evaluating Surveillance Systems. MMWR Suppl; 37(5): 1–18.
  3. WHO (2018) Global guidelines for the prevention of surgical site infection. World Health Organization 2018.
  4. CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
  5. NICE (2020) Surgical site infections: prevention and treatment. NICE guidelines. Published: 11 April 2019. Last updated: 19 August 2020.
  6. NRZ. Accessed 14.03.2024.

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