surgical site infection surveillance quality 1175 table 2. Domains, Scores, Weights, and Mean Scores per Domain in 147 Surveillance Teams No. Domain 1 Inclusion of cases 2 Medical documentation


3 Follow-up during hospitalization


Score and Evaluation 0 points Apparent selection bias


1 point Selection bias probable 2 points Selection bias possible 3 points Complete, no selection bias


0 points Documentation mostly incomplete


1 point Documentation partially incomplete 2 points Documentation complete


0 points No review of medical documentation


1 point Incomplete review or only in case of suspicion of infection during phone interview


2 points Complete review 3 points Complete review with documentation of reasoning


4 Postdischarge surveillance, including phone interview


5 Data quality of eCRF compared to original data


6 Documentation of cases with infection


7 Supervision of suspected cases by medical supervisor


8 Medical supervisor’s background


9 Training 0 points Not performed


1 point Incomplete 2 points Complete, locally adapted form 3 points Complete, standardized form 0 points ≥6 mistakes


1 points 3–5 mistakes 2 points 2 mistakes 3 points ≤1 mistake 0 points None


1 point Incomplete 2 points Complete 3 points Complete and reviewed by medical supervisor 0 points Never


1 point Occasionally 2 points Regularly 3 points Always 0 points None


1 points Surgeon or dedicated nurse alone 2 points Surgeon together with internist 3 points Infectious diseases specialist and/or internist 0 points No participation in a training session


1 points Incomplete, not all staffmembers participating in surveillance have attended a training session


2 points Complete, all staff members participating in surveillance have attended a training session


All domains Maximum unweighted score: 25 points NOTE. SD, standard deviation; eCRF, electronic case report form.


follow-up were reviewed between October 1, 2012, and June 26, 2016. The overall infection rate , as determined by the validators, was 4.4% (95% confidence interval [CI], 3.3%–5.8%). The characteristics of these cases are shown in Table 4. Overall, 15 cases (1.4%) were incorrectly classified as no infection, and 1 case (0.09%) wasmisclassified as an infection, accounting for a specificity of the surveillance of 99.9% (95% CI, 99.5%–100%), a sensitivity of 69.4% (95% CI, 54.6%–81.7%), a positive predictive value of 97.1% (95% CI, 85.1%–99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%–99.2%). Of the 15 false negatives, 9 occurred in colon surgery cases, 3 in hip prosthesis cases, 2 in caesarean section cases, and 1 in an


appendectomy case. 8 of these 15 cases (53.3%) were superficial incisional infections and 7 (46.7%) were organ-space infections. The 15 cases with missed infections were from 15 different hospitals; 4 (26.7%) were missed in private hospitals and 10 (66.7%) were missed in in non–university-affiliated public hospitals. Furthermore, 1 (6.7%) occurred in a university- affiliated hospital, corresponding to the distribution of reviewed cases among these hospital categories. In univariate GEE, misclassification of infection status was associated with lower quality of supervision of suspected cases by a medical supervisor (P=.009), and unweighted mean (standard deviation) scores in cases with false-negative


17.02 (3.51) 15.15 (6.95) 1.5 1.77 (0.97) 1.85 (1.46) 3 1.68 (0.77) 3.97 (2.30) 3 1.72 (0.46) 0.83 (1.37) Weight


Unweighted Mean Score (SD)


2 2.42 (0.78) Weighted


Mean Difference From Maximum Score (SD)


1.17 (1.56)


1.5 0.85 (1.09)


3.22 (1.64)


1.5 1.76 (0.97) 2 2.60 (0.72) 1.5 2.50 (0.71)


1.86 (1.46) 0.81 (1.45) 0.75 (1.06)


2.5 1.72 (0.51)


0.69 (1.29)


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