Hospital-related determinants for surgical-site infection following hip arthroplasty

OBJECTIVE: To determine hospital-related risk factors for surgical-site infection (SSI) following hip arthroplasty. DESIGN: Prospective, multicenter cohort study based on surveillance data and data collected through a structured telephone interview. With the use of multilevel logistic regression, the independent effect of hospital-related characteristics on SSI was assessed. SETTING: Thirty-six acute care hospitals in the Dutch surveillance network for nosocomial infections (PREZIES), from 1996 to 2000. PATIENTS: Thirteen thousand six hundred eighty patients who underwent total or partial hip arthroplasty. RESULTS: A high annual volume of operations was associated with a reduced risk of SSI (risk-adjusted risk ratio [RR] per 50 extra operations, 0.85; 95% confidence interval [CI95], 0.74-0.97). With each extra full-time-equivalent infection control staff member per 250 beds available for prevention of SSI, the risk for SSI was decreased (RR, 0.48; CI95, 0.16-1.44), although the decrease was not statistically significant. Hospital size, teaching status, university affiliation, and number of surgeons and their years of experience showed no important association with the risk of SSI. CONCLUSION: Undergoing surgery in a hospital with a low volume of operations increases a patient's risk of SSI.