Surgical site infections: incidence and trends at a community teaching hospital

There has been increased national attention on methicillin-resistant Staphylococcus aureus (MRSA) and surgical site infections (SSIs) highlighted by the media, the public, and federal agencies. It was therefore considered important to analyze the trends and incidence of inpatient detected SSIs and associated resistant organisms at our own institution.

The analysis reflects the cultures and sensitivities of SSI on the surgical services at Monmouth Medical Center, a 527-bed community teaching hospital, from January 2003 through December 2007. The SSIs included in the study were those detected in hospitalized patients.

There were 312 surgical patients who developed SSIs. Contrary to observed national trends, our study demonstrated a statistically significant decrease in the incidence of MRSA among all the surgical services. We also noted a statistically significant decrease trend of SSIs in orthopedic surgery. The 312 patients' cultures yielded 399 bacterial strains. The most common strains varied with the service. Overall, the most common isolate identified was Staphylococcus species, numbering 143% or 35.8% of all isolates. MRSA was identified in 46 SSIs and 8 SSIs were positive for vancomycin-resistant enterococci (VRE).

Only a hospital-specific SSI analysis can help focus improvement with clinical impact. The scrutiny of SSI analysis has highlighted SSI problems in the pediatric and orthopedic surgery services that have been addressed.