Browsing by Author "Leaper, David"

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    A benchmark too far: findings from a national survey of surgical site infection surveillance
    (Elsevier, 2013) Tanner, Judith; Padley, Wendy; Kiernan, Martin; Leaper, David; Norrie, Peter; Baggott, Rob
    Background The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. Aim To audit SSI definitions and data collection methods used by hospital trusts in England. Method All 156 hospital trusts in England were sent questionnaires that focused on aspects of SSI definitions and data collection methods. Findings Completed questionnaires were received from 106 hospital trusts. There were considerable differences in data collection methods and data quality that caused wide variation in reported SSI rates. For example, the SSI rate for knee replacement surgery was 4.1% for trusts that used high-quality postdischarge surveillance (PDS) and 1.5% for trusts that used low-quality PDS. Contrary to national protocols and definitions, 10% of trusts did not provide data on superficial infections, 15% of trusts did not use the recommended SSI definition, and 8% of trusts used inpatient data alone. Thirty trusts did not submit a complete set of their data to the national surveillance service. Unsubmitted data included non-mandatory data, PDS data and continuous data. Conclusion The national surveillance service underestimates the prevalence of SSIs and is not appropriate for benchmarking. Hospitals that conduct high-quality SSI surveillance will be penalized within the current surveillance service.
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    Do surgical care bundles reducethe risk of surgical site infectionsin patients undergoing colorectalsurgery? A systematic review andcohort meta-analysis of 8,515 patients
    (Elsevier, 2015-04) Tanner, Judith; Padley, Wendy; Assadian, O.; Leaper, David; Kiernan, Martin
    BACKGROUND: Care bundles are a strategy that can be used to reduce the risk of surgical site infection (SSI), but individual studies of care bundles report conflicting outcomes. This study assesses the effectiveness of care bundles to reduce SSI among patients undergoing colorectal surgery. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials, quasi-experimental studies, and cohort studies of care bundles to reduce SSI. The search strategy included database and clinical trials register searches from 2012 until June 2014, searching reference lists of retrieved studies and contacting study authors to obtain missing data. The Downs and Black checklist was used to assess the quality of all studies. Raw data were used to calculate pooled relative risk (RR) estimates using Cochrane Review Manager. The I(2) statistic and funnel plots were performed to identify publication bias. Sensitivity analysis was carried out to examine the influence of individual data sets on pooled RRs. RESULTS: Sixteen studies were included in the analysis, with 13 providing sufficient data for a meta-analysis. Most study bundles included core interventions such as antibiotic administration, appropriate hair removal, glycemic control, and normothermia. The SSI rate in the bundle group was 7.0% (328/4,649) compared with 15.1% (585/3,866) in a standard care group. The pooled effect of 13 studies with a total sample of 8,515 patients shows that surgical care bundles have a clinically important impact on reducing the risk of SSI compared to standard care with a CI of 0.55 (0.39-0.77; P = .0005). CONCLUSION: The systematic review and meta-analysis documents that use of an evidence-based, surgical care bundle in patients undergoing colorectal surgery significantly reduced the risk of SSI.
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    English hospitals under report SSIs
    (BMJ, 2013) Tanner, Judith; Padley, Wendy; Kiernan, Martin; Leaper, David; Baggott, Rob; Norrie, Peter
    We thank Lamagini and colleagues for their interest in our paper. These authors from the HPA claim that we are misinformed and lacking in understanding. Yet, our criticisms are the same as those expressed by the Public Accounts Committee and the DH Advisory Committee on HCAIs. Even the European Centers for Disease Control says the English SSI surveillance system ‘lags’ behind the rest of Europe. The SSI surveillance data published by the HPA does not include post discharge surveillance (save for readmission data in the mandatory scheme) which account up to 80% of SSIs. This results in the ‘true’ scale of SSIs being hugely under reported. As length of stay after surgery continues to fall this becomes ever more important. An SSI surveillance system which does not include post discharge surveillance is akin to describing the size of iceberg by measuring only the part seen above the water.
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    Reliable surgical site infection surveillance with robust validation is required
    (2013) Tanner, Judith; Kiernan, Martin; Leaper, David; Baggott, Rob
    We would like to thank Lamagni and her colleagues from the Health Protection Agency for their interest in our paper. While they state in their letter that post discharge surveillance (PDS) is not used for benchmarking, and therefore Trusts which conduct PDS are not penalised, we should like to point out that inconsistencies were also found among in-patient and readmission data which are used for benchmarking .Therefore Trusts could be penalised. They also claim that the national surveillance programme, which collects in-patient and readmission data, produces reliable data. However, one of the authors of the Lamagni letter appears to contradict this in the January 2013 edition of the Journal of Infection Prevention (JIP)1. In the JIP article, Wilson discusses various data collection methods, such as prospective, active, passive, staff reporting, telephone follow up of laboratory reports only, liaison with ward staff and case note review, and states how each of these methods has a ‘major effect’ on reported SSI rates. All of these data collection methods are permissible in the current national surveillance programme, yet Wilson goes on to argue that a national surveillance system must prescribe data collection methods which minimise the risk of selection and measurement bias, thereby enabling comparisons between hospitals. Indeed, in effect supporting the claims of our paper, Wilson further states that reliable surveillance methods are desirable if data are to be trusted by surgical teams and also calls for robust validation systems.
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    Surgical site infection: Poor compliance with guidelines and care bundles
    (Wiley, 2014) Leaper, David; Tanner, Judith; Kiernan, Martin; Assadian, O.; Edmiston, C. E.