Surveillance of surgical site infections and prevention indicators in

TECHNICAL DOCUMENT

www.ecdc.europa.eu

Surveillance of

surgical site infections and

prevention indicators in

European hospitals

HAI-Net SSI protocol, version 2.2

ECDC TECHNICAL DOCUMENT

Surveillance of surgical site infections and

prevention indicators in European

hospitals

HAI-Net SSI protocol, version 2.2

This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Tommi Kärki.

Contributing authors

Tommi Kärki, Carl Suetens.

Acknowledgements

ECDC would like to thank the HAI-Net SSI operational contact points and Member States experts for providing

input during meetings (October 2013, February 2014 and June 2016), and the Member States that participated in

the pilot survey on the proposed protocol changes in October-December 2016.

The current HAI-Net SSI protocol v2.2 is the final version of the new HAI-Net SSI protocol, slightly adapted after

the pilot version 2.0 in the autumn of 2016.

Suggested citation: European Centre for Disease Prevention and Control. Surveillance of surgical site infections and

prevention indicators in European hospitals - HAI-Net SSI protocol, version 2.2. Stockholm: ECDC; 2017.

Stockholm, May 2017

PDF

ISBN 978-92-9498-060-1

doi: 10.2900/260119

Catalogue number TQ-04-17-433-EN-N

Reproduction is authorised, provided the source is acknowledged

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

iii

Contents

Surveillance of surgical site infections and prevention indicators in European hospitals .......................................... i

Abbreviations ............................................................................................................................................... iv

1. From HAI-Net SSI 1.02 to 2.2: summary of major changes ............................................................................ 3

2. Unit-based (light) versus patient-based (standard) surveillance of SSIs ........................................................... 4

3. Definitions ................................................................................................................................................. 5

3.1 Case definitions of SSIs ....................................................................................................................... 5

3.2 Other key definitions ........................................................................................................................... 6

3.3 Structure and process indicators for SSI prevention ................................................................................ 8

4. Indicators to be produced at the European level on the occurrence and characteristics of SSIs ....................... 11

4.1 Percentage of SSIs by category .......................................................................................................... 11

4.2 Percentage of SSIs excluding post-discharge diagnosed SSIs ................................................................ 11

4.3 Incidence density of in-hospital SSIs ................................................................................................... 11

5. Data collection ......................................................................................................................................... 12

5.1 Population under surveillance ............................................................................................................. 12

5.2 Type of surgery under surveillance ..................................................................................................... 12

5.3 Levels of data requirement ................................................................................................................. 13

5.4 Hierarchy of datasets ......................................................................................................................... 13

5.5 Technical variables ............................................................................................................................ 13

6. Hospital/unit data (patient-based and unit-based protocol) .......................................................................... 15

6.1 Hospital and unit characteristics – Form A1 ......................................................................................... 15

6.2 Structure and process indicators – Form A2 ......................................................................................... 17

6.3 Unit-based protocol denominator data – Form AL3 ............................................................................... 18

7. Patient/operation data (patient-based and unit-based protocol) .................................................................... 20

7.1 Patient-based protocol patient/operation data – Form A3 ...................................................................... 20

7.2 Unit-based protocol patient/operation data – Form AL4 ........................................................................ 22

8. SSI data and microorganism/resistance data (patient-based and unit-based protocol) .................................... 24

8.1 SSI data – Form A3/AL4 .................................................................................................................... 24

8.2 Microorganism and antimicrobial resistance data – Form A3/AL4 ........................................................... 24

9. HAISSICOVERAGE dataset ........................................................................................................................ 26

10. Confidentiality ........................................................................................................................................ 27

10.1 Patient confidentiality ...................................................................................................................... 27

10.2 Hospital and unit confidentiality ........................................................................................................ 27

10.3 Publication policy ............................................................................................................................. 27

References .................................................................................................................................................. 28

Annex 1. ICD-9-CM code list of surgical procedures......................................................................................... 29

Annex 2. Microorganisms code list ................................................................................................................. 33

Annex 3. Antimicrobial resistance markers and codes ...................................................................................... 36

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Abbreviations

ASA American Society of Anesthesiologists

CARD Cardiac surgery

CABG Coronary artery bypass grafting

CBGB Coronary artery bypass grafting with both chest and donor site incisions

CBGC Coronary artery bypass grafting with chest incision only

CHOL Cholecystectomy

COLO Colon surgery

CSEC Caesarean section

EC European Commission

EU European Union

GP General practitioner

HAI Healthcare-associated infection

HAI-Net Healthcare-Associated Infection surveillance Network

HELICS Hospitals in Europe Link for Infection Control through Surveillance project

HPRO Hip prosthesis

IPC Infection prevention and control

ICU Intensive care unit

IPSE Improving Patient Safety in Europe project

KPRO Knee prosthesis

LAM Laminectomy

LOS Length of stay

NHSN The US National Healthcare Safety Network (formerly NNIS System)

OR Operating room

PAP Perioperative antibiotic prophylaxis

REC Rectum surgery

SPI Structure and process indicator

SSI Surgical site infection

TESSy The European Surveillance System

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Introduction and objectives

The European Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of

healthcare-associated infections (HAIs) (2009/C 151/01), recommends ‘performing the surveillance of the incidence

of targeted infection types’, ‘using surveillance methods and indicators as recommended by ECDC and case definitions

as agreed upon at Community level in accordance with the provisions of Decision No 2119/98/EC’ [1,2].

In 2000–2002, harmonised methods for the surveillance of two targeted infection types, surgical site infections (SSIs)

and healthcare-associated infections in intensive care units (ICUs), were developed by the network HELICS (Hospitals

in Europe Link for Infection Control through Surveillance), funded by the European Commission’s Directorate-General

for Health and Consumers (DG SANCO), and progressively implemented in Member States by HELICS and later as

part of the Improving Patient Safety in Europe (IPSE) project. In July 2008, the coordination of the European

surveillance of healthcare-associated infections was transferred from the IPSE network to the European Centre for

Disease Prevention and Control (ECDC) in accordance with ECDC’s mandate. ECDC continued HAI surveillance with

protocols that were first updated during the annual meetings of the HAI surveillance network in 2009–2010.

In 2013, the European Commission requested ECDC to collect additional data on structure and process indicators for

HAIs as well as data on mortality from HAIs, based on the ECDC PPS results and in accordance with the Council

recommendation 2009/C 151/01 [2]. The latest changes to the HAI-Net SSI surveillance protocol, including the

addition of structure and process indicators, were discussed in HAI-Net surveillance network meetings first in 2013

and 2014, and in a protocol meeting in June 2016. A pilot survey on the suggested protocol changes was carried out

in the second half of 2016, and final decisions for the current protocol version 2.2 were done after a teleconference

with the pilot survey countries in January 2017.

SSIs remain an important target for the surveillance of HAIs and an official priority for surveillance in several

European countries. SSIs are among the most common HAIs [3]. They are associated with longer postoperative

hospital stay, additional surgical procedures or stay at intensive care unit, and higher mortality. All patients

undergoing surgery are at risk for complications, including SSIs.

The main objective of the European protocol for the surveillance of SSIs is to ensure standardisation of definitions,

data collection and reporting procedures for hospitals participating in the national/regional surveillance of surgical

site infections across Europe, in order to contribute to the EU surveillance of healthcare-associated infections and to

improve the quality of care in a multicenter setting.

The specific objectives of the surveillance activities are:

At the level of the hospital:

 to lower the incidence of SSIs by encouraging the owners of the problem (primarily the surgical staff) to:

 comply with existing guidelines and ‘good surgical practice’

 correct or improve specific practices

 develop, implement and evaluate new preventive practices through follow-up and inter-hospital

comparisons of adjusted SSI rates and of compliance with key preventive measures.

 participation in the European network will also produce gains at local level from international comparisons

that may provide insights that would not be revealed by surveillance limited at the regional or national level.

At the level of regional or national network coordination:

 to prevent SSIs through surveillance;

 to provide the units with the necessary reference data to make comparisons of risk-adjusted rates between

units/hospitals:



 to follow-up epidemiological trends in time

 to identify and follow-up risk factors of SSIs

 to improve the quality of data collection

 to compare and follow-up the implementation of key preventive measures of SSIs between hospitals and

between EU/EEA countries.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

At the European level:

 to prevent SSIs through surveillance by providing European reference data for adjusted SSI rates and

compliance with key preventive measures

 to monitor the burden of SSIs in European hospitals, in terms of incidence and attributable mortality

 to monitor and describe the epidemiology of SSIs in selected surgical procedures in European hospitals

 to identify regions or countries at higher need of EU support with regard to surveillance and control of SSIs



 tofacilitate the communication and the exchange of experience between national/regional networks for the

surveillance of SSIs

 to stimulate the creation of national/regional coordination centres for the surveillance of SSIs where these

centres/networks do not exist

 to provide methodological and technical support to the national/regional coordination centres

 to improve surveillance methodology, data validation and utilisation

 to validate risk factors of SSIs at the EU level

 to explore the correlation between structure and process indicators and the incidence of SSIs throughout

Europe in order to generate hypotheses and new insights in healthcare-associated infection prevention and

control.

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

1. From HAI-Net SSI 1.02 to 2.2: summary of

major changes

The first version of this document was produced in October 2003 as the protocol

Surveillance of Surgical Site

Infections

(HELICS/IPSE protocol 9.1, 2004). Changes to the protocol were applied, either based on agreements

made during the annual meetings of the European network for the surveillance of healthcare-associated infections

(HAI-Net) in June 2009 and June 2010, or because they were necessary for the integration of the HAI surveillance

data into The European Surveillance System (TESSy) of ECDC. The latest version was the protocol version 1.02

released in 2012. Further changes on the protocol were discussed in HAI-Net network meetings in 2012–2014 and

in June 2016, and with the HAI-Net SSI pilot survey participants in January 2017; following which the protocol

version 2.2 has been drafted.

The main changes include:

 adding the structure and process indicators (SPIs) to the hospital/unit-level data collection as discussed in

the earlier meetings in 2012–2014 and in 2016; the use of the new variables is recommended for all

participating countries and hospitals

 the follow-up period for deep and organ/space SSIs if an implant is in place was shortened from one year to

90 days

 a new variable for implant has been added, linking to the length of the follow-up period to be used

 to better assess the excess mortality associated with SSIs, a variable has been added at the infection level

to assess the relationship between the SSI and death (if applicable), in addition to the old in-hospital

outcome variable

 The American Society of Anaesthesiologists (ASA) physical status classification system has been updated

following the 2014 version

 a new variable for multiple surgical procedures performed through the same incision within the same

session in the operating room has been added

 a variable for endoscopic/laparoscopic surgical procedures has been added to the unit-based reporting

protocol

 reporting cardiac surgery (CARD) and rectum surgery (REC) is now allowed

 reporting of other coding for surgical procedures than ICD-9-CM is now possible, in case ICD-9-CM cannot

be reported.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

2. Unit-based (light) versus patient-based

(standard) surveillance of SSIs

As for the protocol for the surveillance of ICU-acquired infections, a unit-based version has been included in the

surveillance of surgical site infections since the protocol version 1.02. While the ‘standard’ patient-based protocol

allows risk adjustment of SSI rates through the use of the basic NNIS (now NHSN, The US National Healthcare

Safety Network) risk index for inter-hospital comparisons [3,4,5], the unit-based or ‘light’ protocol, provides a less-

labour intensive solution, producing partially the same indicators as the patient-based version for follow-up of

trends and the same possibilities for adjustment of differences in post-discharge surveillance. It also allows for

descriptive results about infections and antimicrobial resistance, but with no possibility for risk-adjusted

comparisons.

Case definitions and included patients are the same for both versions, but while in the patient-based protocol risk

factors are collected for each patient (infected or not), in the unit-based protocol denominator data are aggregated

at the hospital (and optionally surgical unit) level.

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

3. Definitions

3.1 Case definitions of SSIs

The same case definitions are used as in previous protocol versions, e.g. HELICS

Surveillance of Surgical Site

Infections –

Version 9.1, September 2004 and HAISSI protocol – version 1.02 with the exception of the 90-day

follow-up period for deep or organ/space infections if implant is in place.

3.1.1 Superficial incisional

Infection occurs within 30 days after the operation and involves only skin and subcutaneous tissue of the incision

and at least one of the following:

 purulent drainage with or without laboratory confirmation, from the superficial incision

 organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision

 at least one of the following signs or symptoms of infection: pain or tenderness, localised swelling, redness,

or heat and superficial incision is deliberately opened by surgeon, unless incision is culture-negative

 diagnosis of superficial incisional SSI made by a surgeon or attending physician.

3.1.2 Deep incisional

Infection occurs within 30 days after the operation if no implant

is left in place or within 90 days if implant is in

place and the infection appears to be related to the operation and infection involves deep soft tissue (e.g. fascia,

muscle) of the incision and at least one of the following:

 purulent drainage from the deep incision but not from the organ/space component of the surgical site

 a deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least

one of the following signs or symptoms: fever (> 38°C), localised pain or tenderness, unless incision is

culture-negative

 an abscess or other evidence of infection involving the deep incision is found on direct examination, during

reoperation, or by histopathologic or radiologic examination

 diagnosis of deep incisional SSI made by a surgeon or attending physician.

3.1.3 Organ/space

Infection occurs within 30 days after the operation if no implant

is left in place or within 90 days if implant is in

place and the infection appears to be related to the operation and infection involves any part of the anatomy (e.g.

organs and spaces) other than the incision that was opened or manipulated during an operation and at least one of

the following:

 purulent drainage from a drain that is placed through a stab wound into the organ/space

 organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space

 an abscess or other evidence of infection involving the organ/space that is found on direct examination,

during reoperation, or by histopathologic or radiologic examination

 diagnosis of organ/space SSI made by a surgeon or attending physician.

The US National Nosocomial Infection Surveillance definition: a nonhuman-derived implantable foreign body (e.g., prosthetic

heart valve, nonhuman vascular graft, mechanical heart, or hip prosthesis) that is permanently placed in a patient during surgery

[6].

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

3.2 Other key definitions

3.2.1 Basic SSI risk index

The basic SSI risk index is the index used in the US National Healthcare Safety Network (NHSN) and assigns

surgical patients into categories based on the presence of three major risk factors [4,5,6,7,8,9,10]:

 operation lasting more than the duration cut point hours, where the duration cut point is the approximate

75th percentile of the duration of surgery in minutes for the operative procedure, rounded to the nearest

whole number of hours

 contaminated (class 3) or dirty/infected (class 4) wound class

 ASA classification of 3, 4, or 5.

The patient’s SSI risk category is the number of these factors present at the time of the operation.

Table 1. Calculation of basic SSI risk index

Calculation

Score =0, if:

Score=1, if:

Wound contamination class

W1, W2

W3, W4

ASA classification

A1, A2

A3, A4, A5

Duration of operation under 75th

percentile cut-off value in hours (see table

in chapter 3.2.4)

≤ 75th percentile cut-off value in hours

> 75th percentile cut-off value in hours

Basic SSI risk index =

Sum of scores

3.2.2 Wound contamination class

Wound contamination class as described by Altemeier

et al.

[9].

Table 2. Wound contamination classification

Wound

contamination

class

Description

A clean wound is an uninfected operative wound in which no inflammation is encountered and the

respiratory, alimentary, genital or uninfected urinary tracts are not entered. In addition, clean wounds are

primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow non-

penetrating trauma should be included in this category.

Clean-contaminated wounds are operative wounds in which the respiratory, alimentary, genital or

uninfected urinary tracts are entered under controlled condition and without unusual contamination.

Specifically operations involving the biliary tract, appendix, vagina and oropharynx are included in this

category provided no evidence of infection or major break in technique is encountered

Contaminated wounds include open, fresh, accidental wounds. In addition operations with major breaks in

sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent

inflammation is encountered are included in this category.

Dirty or infected wounds include old traumatic wounds with retained devitalised tissue and those that

involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing

postoperative infection were present in the operative field before the operation.

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

3.2.3 The ASA physical status classification (ASA score)

Physical status classification developed by the American Society of Anesthesiologists (ASA) [10].

Table 3. ASA physical status classification

ASA score

Definition

Examples

A normal healthy patient

Healthy, non-smoking, no or minimal alcohol

use

A patient with mild systemic disease or condition

Mild diseases or conditions only without

substantive functional limitations. Examples

include (but not limited to): current smoker,

social alcohol drinker, pregnancy, obesity

(30<body mass index<40), well-controlled

diabetes mellitus or hypertension, mild lung

disease

A patient with severe systemic disease

Substantive functional limitations;

One or more moderate to severe diseases.

Examples include (but not limited to): poorly

controlled diabetes mellitus or hypertension,

chronic obstructive pulmonary disease,

morbid obesity (body mass index ≥40),

active hepatitis, alcohol dependence or

abuse, implanted pacemaker, moderate

reduction of ejection fraction, end stage

renal disease undergoing regularly scheduled

dialysis, premature infant postconceptional

age < 60 weeks

A patient with an incapacitating systemic disease that is a

constant threat to life

Examples include (but not limited to):

ongoing cardiac ischemia or severe valve

dysfunction, severe reduction of ejection

fraction, sepsis, disseminated intravascular

coagulation or end stage renal disease not

undergoing regularly scheduled dialysis

A moribund patient who is not expected to survive without the

operation

Examples include (but not limited to):

ruptured abdominal/thoracic aneurysm,

massive trauma, intracranial bleed with mass

effect, ischaemic bowel in the face of

significant cardiac pathology or multiple

organ/system dysfunction

3.2.4 Duration of operation

The table below shows the 75th percentile cut-off values for the selected NHSN procedures. In case of a

reintervention within 72 hours after the primary procedure, the duration of the re-intervention needs to be added

to the duration of the primary procedure.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Table 4. Cut-off values for duration of operative procedure categories

category

COLO

Colon surgery

Incision, resection or anastomosis of the large bowel; includes

large-to-small and small-to-large bowel anastomosis

Laparoscopic excision of large intestine

Enterotomy

Intestinal anastomosis

17.3–17.39, 45.00–45.03,45.15, 45.26,

45.31–45.34, 45.4, 45.41, 45.49,

45.50–45.52, 45.4, 45.41, 45.49,

45.50–45.52, 45.61–45.63, 45.7–

45.95, 46.0, 46.03, 46.04, 46.1–

46.14,46.20–46.24, 46.31, 46.39,

46.4, 46.41, 46.43, 45.5, 46.51, 46.52,

46.7–46.76, 46.9–46.94

REC

Rectum surgery

48.25, 48.35, 48.40, 48.42, 48.43,

48.49, 48.5–48.59, 48.6–48.69, 48.74

CHOL

Cholecystectomy

51.0,51.03, 51.04,51.13, 51.2–51.24

Removal of gallbladder, includes procedures performed using the

laparascope

HPRO

Arthroplasty of hip

00.70–00.73, 00.85-00.87, 81.51–

81.53

KPRO

Arthroplasty of knee

00.80–00.84, 81.54–81.55

LAM

Laminectomy

Exploration or decompression of spinal cord through excision or

incision into vertebral structures

03.0–03.09, 80.50, 80.51, 80.53,

80.54, 80.59, 84.60–84.69, 84.80–

84.85

CSEC

Caesarean section

74.0–74.2, 74.4, 74.9–74.99

CARD

Cardiac surgery

35.00-35.04, 35.06, 35.08, 35.10-

35.14, 35.20-35.28, 35.31-35.35,

35.39, 35.42, 35.50, 35.51, 35.53,

35.54, 35.60-35.63, 35.70-35.73,

35.81-35.84, 35.91-35.95, 35.98-

35.99, 37.10-37.12, 37.31-37.33,

37.35-37.37, 37.41, 37.49, 37.60

CABG

Coronary artery bypass, unspecified

36.1–36.2

CBGB

Coronary artery bypass grafting with both chest and donor site incisions

Chest procedure to perform direct revascularisation of the heart; includes

obtaining suitable vein from donor site for grafting

36.10–36.14, 36.19

CBGC

Coronary artery bypass grafting with chest incision only

Chest procedure to perform direct vascularisation of the heart using, for

example, the internal mammary artery

36.15–36.17, 36.2

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

5.3 Levels of data requirement

In ECDC’s TESSy system, variables are classified according to three levels of requirement:

 required true (error): data will be rejected if this variable is missing (also called ‘mandatory’)

 required true (warning): variables strongly recommended to be collected for routine analysis and/or for

the correct interpretation of the results. A warning will be produced if these variables are missing, but the

users can still approve their data in TESSy.



 required false: no error or warning if data is missing, data used for additional analysis (also called

‘optional’)

5.4 Hierarchy of datasets

The set of variables for HAI-Net SSI reporting consists of nine technical variables and a set of epidemiological

variables. Technical variables are only relevant at the surveillance network coordination.

HAI-Net SSI patient-based protocol data

(RecordType

‘

HAISSI’)

contains five datasets in four hierarchical levels:

 first level ‘HAISSI’ includes data referring to the hospital/unit that are repeated in all records reporting the

operation data, infection data and microorganisms and resistance data.

The level is required.

 second level ‘HAISSI$IND’ includes variables about structure and process indicators for SSI prevention.

The level is optional.

 second level ‘HAISSI$OP’ includes variables about patient, operation and risk factors.

The level is required.

 third level ‘HAISSI$OP$INF’ includes variables about SSIs.

The level is required.

 fourth level ‘HAISSI$OP$INF$RES’ includes variables about pathogens and their resistance.

The level is optional.

HAI-Net SSI unit-based protocol data

(RecordType

‘

HAISSILIGHT’)

contains five datasets in four hierarchical levels:

 first level ‘HAISSILIGHT’ includes data referring to the hospital/unit that are repeated in all records

reporting the operation data, infection data and microorganisms and resistance data.

The level is required.

 second level ‘HAISSILIGHT$IND’ includes variables about structure and process indicators for SSI

prevention.

The level is optional.

 second level ‘HAISSILIGHT$OPCAT’ includes variables about operations.

The level is required.

 third level ‘HAISSILIGHT$OPCAT$INF’ includes variables about SSIs and operations.

The level is required.

 fourth level ‘HAISSILIGHT$OPCAT$INF$RES’ includes variables about pathogens and their resistance.

The level is optional.

Furthermore, ‘HAISSICOVERAGE’ dataset contains variables about different types of operation and their national

denominators. The dataset is optional.

5.5 Technical variables

Reporting country: ISO codes (International Organization for Standardization ISO 3166-1 -alpha-2-code

elements): AT = Austria, BE = Belgium, BG = Bulgaria, CY = Cyprus, CZ = Czech Republic, DE = Germany, DK =

Denmark, EE = Estonia, ES = Spain, FI = Finland, FR = France, GB = Great Britain, GR = Greece, HR = Croatia,

HU = Hungary, IE = Ireland, IT = Italy, IS = Iceland, LI = Liechtenstein, LV = Latvia, LT = Lithuania, LU =

Luxembourg, MT = Malta, NL = Netherlands, NO = Norway, PL = Poland, PT = Portugal, RO = Romania, SK =

Slovakia, SI = Slovenia, SE = Sweden.

Network id: Unique identifier for each network – Member State selected and generated. Code can be omitted, if

the hospital identifiers are unique within the reporting country, but should be combined with HospitalId if same

codes are used across different subnetworks that are reported through by single DataSource (e.g. data from five

regional CCLIN networks reported as one database by France).

Subject: HAISSI

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Table 6. Technical variables

Variable name (transport label)

Description

Value list

Required

Record ID (RecordId)

Unique identifier for the hospital (and,

optionally, the surgical unit) within each

Network. Recommended format: [Network

ID]- [HospitalId]-[UnitId]-

[DateUsedForStatistics]

True (Error)

Record type (RecordType)

Structure and format of the data (case based

reporting and aggregate reporting).

True (Error)

Record type version (RecordTypeVersion)

There may be more than one version of a

record type. This element indicates which

version the sender uses when generating the

message. Required when no metadata set is

provided at upload

False

Subject (Subject)

Disease to report

True (Error)

Data source (DataSource)

The data source (surveillance system) that the

record originates from

[List of data sources]

True (Error)

Reporting country (ReportingCountry)

The country reporting the record

[List of countries]

True (Error)

Date used for statistics

(DateUsedForStatistics)

Year covered or the start date of the

surveillance period

Yyyy, yyyy-mm-dd

True (Error)

Status (Status)

Status of reporting NEW/UPDATE or DELETE

(deactivate). Default if left out: NEW/UPDATE.

If set to DELETE, the record with the given

recordId will be deleted from the TESSy

database (or better stated, invalidated). If set

to NEW/UPDATE or left empty, the record is

newly entered into the database

NEW/UPDATE

DELETE

False

Network ID (NetworkId)

Unique identifier for each network – Member

State selected and generated. Can be omitted

if the hospital identifiers are unique within the

reporting country

False

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

6. Hospital/unit data (patient-based and

unit-based protocol)

Hospital/unit data are the same for patient- and unit-based protocol and use the same forms (forms A1 and A2) to

collect hospital/unit and the structure and process indicator data. The only difference is that the aggregated unit-

based operation data are only collected and required for unit-based protocol. The first level (RecordType ‘HAISSI’

or ‘HAISSILIGHT’) is required for patient- and unit-based protocol.

In the TESSy database, hospital/unit, structure and process indicator data and the unit-based protocol denominator

data are divided into separate levels (RecordTypes ‘HAISSI’/’HAISSILIGHT’, ‘HAISSI$IND’/’HAISSILIGHT$IND’ and

‘HAISSILIGHT$OPCAT’).

6.1 Hospital and unit characteristics – Form A1

Hospital code (required): Unique identifier for each hospital – Member State selected and generated, should

remain identical in different surveillance periods/years. Required.

Hospital surveillance period start (required): The start date of the surveillance period or the surveillance

year.

Hospital type: PRIM = Primary level, SEC = Secondary level, TERT = Tertiary level, SPEC = Specialised/Other,

UNK = Unknown

 Primary:

 often referred to as ‘district hospital’ or ‘first-level referral’

 often corresponds to a general hospital without teaching function

 few specialities (mainly internal medicine, obstetrics-gynaecology, paediatrics, general surgery or

only general practice)

 limited laboratory services are available for general, but not for specialised pathological analysis.

 Secondary:

 often referred to as ‘provincial hospital’

 often corresponds to general hospital with teaching function

 highly differentiated hospital by function with five to 10 clinical specialities, such as haematology,

oncology, nephrology, ICU

 takes some referrals from other (primary) hospitals.

 Tertiary:

 often referred to as ‘central’, ‘regional’ or ‘tertiary-level’ hospital

 often corresponds to University hospital

 highly specialised staff and technical equipment (ICU, haematology, transplantation, cardio-thoracic

surgery, neurosurgery)

 clinical services are highly differentiated by function

 specialised imaging units

 provides regional services and regularly takes referrals from other (primary and secondary) hospitals.

 Specialised hospital:

 single clinical specialty, possibly with sub-specialties

 highly specialised staff and technical equipment

 e.g. paediatric hospital, infectious diseases hospital.

Hospital size: total number of beds in the hospital or rounded to the closest 100 beds.

Hospital location: region as NUTS-1 code where hospital is located. See:

http://ec.europa.eu/eurostat/web/nuts/overview

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Method used for post-discharge surveillance: Method used for post-discharge surveillance of surgical site

infections:

 READM = Detection at readmission (=passive post-discharge surveillance): patient is readmitted with SSI,

often because of the SSI;

 REPSURG = Reporting on surgeon’s initiative: surgeon actively reports post-discharge infections detected at

outpatient clinic or private clinic follow-up to the hospital surveillance staff, e.g. using standardised forms,

web-based system, e-mail or telephone

 REPGP = Reporting on GP’s initiative: general practitioner (GP) reports post-discharge infections detected at

follow-up consultation to the hospital surveillance staff, e.g. using standardised forms, web-based system,

e-mail or telephone

 REPPAT = Reporting on patient’s initiative: e.g. form send to hospital surveillance staff

 ICSURG = Obtained by IC staff from surgeon: the hospital surveillance staff – usually infection control (IC)

staff – obtains information from surgeon using telephone, additional questionnaire, visit to surgeon or

patient chart review

 ICGP = Obtained by IC staff from GP: hospital surveillance staff obtains information from general

practitioner using telephone, additional questionnaire or visit

 CPAT = Obtained by IC staff from patient: hospital surveillance staff obtains information from patient using

telephone or additional questionnaire

 NONE = No post-discharge surveillance done

 UNK = Unknown, no data about post-discharge surveillance method available.

Alcohol handrub (AHR) consumption per year in surgical wards/units: AHR consumption per year in all

surgical wards/units participating in SSI surveillance in the hospital.

Patient-days per year in surgical wards/units: Patient-days per year in all surgical wards/units participating

in SSI surveillance in the hospital. Note: should be the denominator data for the AHR consumption, thus from the

same wards as the AHR consumption in litres.

Do you have a system for root cause analysis/review in place: Does the hospital have a system for root

cause analysis/review in place. Y = Yes; N = No; Unk = Unknown.

Root cause analysis specification: If there is a system for root cause analysis in place, specify in which cases.

Unit ID: Unique identifier for each surgical unit – Member State selected and generated.

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

6.2 Structure and process indicators – Form A2

The second level (RecordType ‘HAISSI$IND’ and ‘HAISSILIGHT$IND’) includes variables about structure and

process indicators for SSI prevention. The collection of structure and process indicator data is strongly

recommended, but the data level is optional for both patient- and unit-based reporting surveillance. In case data

for structure and process indicators are reported, several variables on the level are required.

Operation code (required): NHSN code of the primary operative procedure under surveillance according to SSI

surveillance protocol for which the structure and process indicator data is collected: CARD = cardiac surgery; CBGB

= coronary artery bypass grafting with both chest and donor site incisions; CBGC = coronary artery bypass grafting

with chest incision only; CABG = coronary artery bypass grafting, not specified; COLO = colon surgery; CHOL =

cholecystectomy; CSEC = caesarean section; HPRO = hip prosthesis; KPRO = knee prosthesis; LAM =

laminectomy; REC = rectum surgery.

Indicator period start (required): start date of the structure and process indicator data collection.

Indicator period end: end date of the structure and process indicator data collection.

Indicator code (required): code of the structure and prevention indicator:

 ASTPAP60MIN = administration of PAP within 60 minutes before incision (except when administering

vancomycin and fluoroquinolones);

 ASTPAP24HRS = discontinuation of PAP within 24 hours after initiation of surgery;

 NOHAIRREM = no hair removal, or if hair removal was necessary, only clipping;

 ALCSKINANT = use of alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in

the OR;

 NORMTHERM = ensuring the patient's normothermia within one hour of the end of operation (36-38°C

(rectal measurement) or 35,5-37,5 °C (non-rectal measurement));

 GLUCMONIT = protocol for intensive perioperative blood glucose control used and blood glucose levels

monitored.

Number of observations (required): number of observations for each indicator code.

Hospital data

Hospital code:

Hospital surveillance period start: ___/___/___

Hospital type : O primary O secondary O tertiary O specialised

Hospital size:

Hospital location (NUTS-1):

Post-discharge surveillance

method: O READM O REPSURG O REPGP O REPPAT O ICSURG O ICGP O ICPAT O NONE O UNK

litres

patient-days

Ward/unit identifier (optional)

Surgical ward/unit ID:

Do you have a system for root cause analysis/review in place: O Yes O No O Unknown

If Yes, please specify in which cases:_____________________________________________________

_____________________________________________________________________________________

___

_____________________________________________________________________________________

___

European Surveillance of Surgical Site Infections

Form A1. Standard/light surveillance option: Hospital and ward/unit data

Alcohol handrub (AHR) consumption per year

in surgical wards/units:

Patient-days per year in surgical wards/ units

(same wards/units as for the AHR):

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Number of compliant observations (required): number of compliant observations for each indicator code.

Comments: comments on the SPI data. Free text.

6.3 Unit-based protocol denominator data – Form AL3

The second level in the unit-based protocol (RecordType ‘HAISSILIGHT$OPCAT’) includes denominator data and

variables about each operation category. The level is required in unit-based surveillance protocol.

Operation code (required): NHSN (National Healthcare Safety Network) code of the primary operative

procedure under surveillance according to SSI surveillance protocol for which the aggregated denominator data is

collected: CARD = cardiac surgery; CBGB = coronary artery bypass grafting with both chest and donor site

incisions; CBGC = coronary artery bypass grafting with chest incision only; CABG = coronary artery bypass

grafting, not specified;COLO = colon surgery; CHOL = cholecystectomy; CSEC = caesarean section; HPRO = hip

prosthesis; KPRO = knee prosthesis; LAM = laminectomy; REC = rectum surgery

Endoscopic procedure: denominator data entry is for endoscopic/laparoscopic operations or open operations.

Note that endoscopic/laparoscopic requires that the entire operation was performed using endoscopic/laparoscopic

approach.

Hospital/ward, surveillance year and operation type for which the indicators are observed

Hospital code:

as in form A1

Operation code:

O CARD O CBGB O CBGC O CABG O CHOL O COLO O CSEC O HPRO O KPRO O LAM O REC

Indicator period start: ___/___/___

Indicator period end: ___/___/___

Indicator data

European Surveillance of Surgical Site Infections

Form A2. Standard/light surveillance option: Indicator data

N of observations

N of compliant

observations

Preoperative skin preparation

Administration of PAP within 60 minutes before incision (except when

administering vancomycin and fluoroquinolones):

Period in which the indicators have

been assessed

Discontinuation of PAP within 24 hours after initiation of surgery:

Comments:_______________________________________________________________________________

Ensuring the patient's normothermia within one hour of the end of

operation (36-38°C (rectal measurement) or 35,5-37,5 °C (non-rectal

measurement)):

Protocol for intensive perioperative blood glucose control used and blood

glucose levels monitored:

Preoperative Antibiotic Prophylaxis (PAP)

Other indicators

No hair removal, or if hair removal was necessary, only clipping:

Use of alcohol-based antiseptic solutions based on CHG for surgical site

skin preparation in the OR:

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

ICD-9-CM code: ICD-9-CM code of the primary operative procedure under surveillance according to SSI

surveillance protocol for which the denominator data was collected. Use 4-digit code or 3-digit code if 4-digit code

not available. Recommended coding system.

Non ICD-9-CM code: any other code of the primary operative procedure under surveillance according to SSI

surveillance protocol for which the denominator data was collected, e.g. ICD-10-CM or NCSP codes. Alternative

coding system to be used if ICD-9-CM code cannot be reported.

Non ICD-9-CM code name: name of the other code used for the primary operative procedure under

surveillance, e.g. ICD-10-CM or NCSP. Alternative coding system to be used if ICD-9-CM code cannot be reported.

Surveillance period started (required): start date of the time period covered by this denominator entry.

Surveillance period ended (required): end date of the time period covered by this denominator entry.

Number of operations: number of surgical procedures in the category of operations according to operation code,

endoscopic/laparoscopic (if given) and ICD-9 (if given) during the survey period.

Number of operations with known discharge date: number of surgical procedures in the category of

operations with known discharge date according to operation code, endoscopic/laparoscopic (if given) and ICD-9 (if

given) during the survey period.

Number of postoperative patient days: number of post-operation hospital patient days. Definition: the sum of

patient days in the hospital following the operation (discharge date − operation date + 1) according to operation

code, endoscopic/laparoscopic and ICD-9 (if given).

Aggregated operation category denominator data

Operation code:

O CARD O CBGB O CBGC O CABG O CHOL O COLO O CSEC O HPRO O KPRO O LAM O REC

Endoscopic operation: O Yes O No O Unknown

ICD-9-CM code:

Other operation code:

If other code than ICD-9, please specify: ______

Start date of the denominator entry ___/___/___

End date of the denominator entry ___/___/ ____

Number of operations:

Number of operations with known

discharge date

Number of post-operation hospital

patient-days

European Surveillance of Surgical Site Infections

Form AL3. Light surveillance option: Operation category denominator form

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

7. Patient/operation data (patient-based and

unit-based protocol)

7.1 Patient-based protocol patient/operation data – Form

The second level of the patient-based protocol (RecordType ‘HAISSI$OP’) includes variables about patient,

operation and risk factors and are collected for each patient/operation. The level is required in patient-based

surveillance protocol.

Patient/operation variables:

Patient counter: numeric code for each patient, unique within hospital. Anonymous code assigned by hospital to

specify patient.

Age: age of the patient at date of operation.

Gender: the gender of the patient who undergoes the operation. F = Female; M=Male; O = Other; Unk =

Unknown.

Date of hospital admission: date patient was admitted to hospital in order to undergo the operation under

surveillance.

Date of hospital discharge: date the patient was discharged from hospital where they underwent the operation

under surveillance or date of in-hospital death or date of last follow-up in hospital if discharge date is unknown.

This date is used to calculate the number of post-operative in-hospital patient days.

Date of last follow-up post-discharge: date last information on the patient was obtained after discharge from

hospital, for example from surgeon (out-patient department or private practice) or general practitioner. This date is

used to calculate the total amount of follow-up days (in-hospital and post-discharge). (DateOfLastFollowup)

Date of last follow-up in hospital: date last information on the patient was obtained during the hospitalisation,

for example from surgeon. Can be used when different from date of hospital discharge, e.g. if hospital stay is

longer than 30 days, or follow-up of surveillance was discontinued for other reasons while patient was still in

hospital to calculate the total amount of follow-up days (in-hospital).

Outcome from hospital: patient status at the last reported hospital discharge or at end of follow-up in hospital.

Operation ID (required): unique identifier for each operation – hospital selected and generated.

Date of operation (required): date operation under surveillance was carried out.

Operation code (required): NHSN (National Healthcare Safety Network) code of the primary operative

procedure under surveillance according to SSI surveillance protocol.

ICD-9-CM code: ICD-9-CM code of the primary operative procedure under surveillance according to SSI

surveillance protocol. See Annex 1. Use 4-digit code or 3-digit code if 4-digit code not available. Recommended

coding system.

Other operation code: other code of the primary operative procedure under surveillance according to

SSI surveillance protocol, for example ICD-10. Please also specify the other coding system in a separate field (see

below). Alternative coding system to be used if ICD-9-CM code cannot be reported.

Name of the non ICD-9-CM code: name of the other code used for the primary operative procedure under

surveillance: ICD-10-PCS = International classification of diseases-10 Procedure Coding System; ICD-10-AM =

International classification of diseases-10-AM; ICD-11 = International classification of diseases 11 (2017/2018

onwards); CCAM = Classification des Actes Médicaux; CVV = Classificatie van verrichtingen; GOA =

Gebührenordnung für Ärzte; ICPM = International Classification of Procedures in Medicine; NCSP = Nomesco

Classification of Surgical Procedures; NPS = Nomenclature des prestations de santé; OPS-301 = Operationen- und

Prozedurenschlüssel; OPCS-4 = OPCS Classification of Interventions and Procedures version 4. Alternative coding

system to be used if ICD-9-CM code cannot be reported.

Endoscopic procedure: enter ‘Yes’ only if the entire operation was performed using an endoscopic/laparoscopic

approach.

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Multiple operations: enter ‘Yes’ if multiple procedures were performed through the same incision within the

same session in the operating room. Duration of operation should be calculated for the combined duration of all

procedures. If more than one NHSN operative procedure category was performed through the same incision,

attribute the SSI to the procedure that is thought to be associated with the infection [4].

Implant in place: enter ‘Yes’ if there is an implant in place. The follow-up period if an implant in place should be

extended to 90 days after the operation for deep or organ/space infections. Implant is defined according to the US

National Nosocomial Infection Surveillance definition: a nonhuman-derived implantable foreign body (e.g.,

prosthetic heart valve, nonhuman vascular graft, mechanical heart, or hip prosthesis) that is permanently placed in

a patient during surgery [6].

Wound contamination class: ehe wound contamination class as described in the section 3.2.2: W1 = Clean; W2

= Clean-contaminated; W3 = Contaminated; W4 = Dirty or infected; UNK = Unknown.

Duration of operation: duration of operation (in minutes) from skin incision to skin closure. In case of re-

intervention within 72 hours after the primary procedure, the duration of the re-intervention needs to be added to

the duration of the primary procedure.

Urgent operation: planning time of the operation. ‘Yes’ means urgent operation that was not planned at least 24

hours in advance. ‘No’ means elective operation that was planned at least 24 hours in advance.

ASA classification: physical status classification developed by the American Society of Anesthesiology. Status at

the time of the operation: A1 = Normally healthy patient; A2 = Patient with mild systemic disease or condition;

A3 = Patient with severe systemic disease that is not incapacitating; A4 = Patient with an incapacitating systemic

disease that is a constant threat to life; A5 = Moribund patient who is not expected to survive for 24 hours with or

without operation; UNK = Unknown.

Patient received surgical prophylaxis: Perioperative systemic administration of antimicrobial agent(s) at or

within two hours prior to primary skin incision with the aim of preventing sepsis in the operative site. In case of

caesarean section, after clamping of umbilical cord.

Surgical site infection (required): Presence of a SSI for this operation. For CBGB, only chest wound infections

are to be reported.

Number of OR door openings: number of operating room (OR) door openings during the operation, measured

from opening of the sterile equipment until the closure of the surgical wound. Recommended to be collected only if

an automated system for OR door openings is in place.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

7.2 Unit-based protocol patient/operation data – Form AL4

The third level of the unit-based protocol (RecordType ‘HAISSILIGHT$OPCAT$INF’) includes variables about

patients and operations that are only collected for patients and operations with a SSI. The level is required in unit-

based surveillance protocol.

Demographic/operation variables (unit-based reporting surveillance):

Patient counter: numeric code for each patient, unique within hospital. Anonymous code assigned by hospital to

specify patient.

Age: age of the patient at date of operation.

Gender: the gender of the patient who undergoes the operation. F = Female; M=Male; O = Other; Unk =

Unknown.

Date of hospital discharge: date the patient was discharged from hospital where they underwent the operation

under surveillance or date of in-hospital death or date of last follow-up in hospital if discharge date is unknown.

This date is used to calculate the number of post-operative in-hospital patient days.

Outcome from hospital: patient status at the last reported hospital discharge or at end of follow-up in hospital.

Operation ID (required): unique identifier for each operation – hospital selected and generated.

Date of operation (required): date of operation under surveillance.

Operation code (required): NHSN (National Healthcare Safety Network) code of the primary operative

procedure under surveillance according to SSI surveillance protocol.

ICD-9-CM code: ICD-9-CM code of the primary operative procedure under surveillance according to SSI

surveillance protocol. Use 4-digit code or 3-digit code if 4-digit code not available. Recommended coding system.

Operation/patient data

Hospital code: Patient counter:

Ward ID (optional):

Age:

Gender: O Male O Female O Other O UNK

Date of hospital admission: ___/___/___ Date of discharge:

___/___/___

Date of last follow-up post-

___/___/___ Date of last follow-up in hospital: ___/___/___

discharge:

Operation ID: Date of operation: ___/___/___

Operation code: O CARD O CBGB O CBGC O CABG O CHOL O COLO O CSEC O HPRO O KPRO O LAM O REC

ICD-9-CM:

Other operation code: If other code than ICD-9, please specify: ____________

Endoscopic procedure: O Yes O No O UNK

Duration of operation: min. ASA classification: O A1 O A2 O A3 O A4 O A5 O UNK

Antibiotic prophylaxis: O Yes O No O UNK

Multiple operations: O Yes O No O UNK

European Surveillance of Surgical Site Infections

Form A3. Standard surveillance option: Operation/patient and infection data

Outcome from hospital: O Alive O Dead in hospital O UNK

Implant in place: O Yes O No O UNK

Wound contamination class: O Clean O Clean-contaminated O Contaminated O Dirty or infected O UNK

Urgent operation: O Yes O No O UNK

Surgical site infection: O Yes O No O UNK

Number of OR door openings during operation: __________

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Other operation code: any other code of the primary operative procedure under surveillance according to

SSI surveillance protocol, for example ICD-10. Alternative coding system to be used if ICD-9-CM code cannot be

reported.

Name of the non ICD-9-CM code: name of the other code used for the primary operative procedure under

surveillance. (NonICD9CodeName): ICD-10-PCS = International classification of diseases-10 Procedure Coding

System; ICD-10-AM = International classification of diseases-10-AM; ICD-11 = International classification of

diseases 11 (2017/2018 onwards); CCAM = Classification des Actes Médicaux; CVV = Classificatie van

verrichtingen; GOA = Gebührenordnung für Ärzte; ICPM = International Classification of Procedures in Medicine;

NCSP = Nomesco Classification of Surgical Procedures; NPS = Nomenclature des prestations de santé; OPS-301 =

Operationen- und Prozedurenschlüssel; OPCS-4 = OPCS Classification of Interventions and Procedures version 4.

Alternative coding system to be used if ICD-9-CM code cannot be reported.

Endoscopic procedure: enter ‘Yes’ only if the entire operation was performed using an endoscopic/laparoscopic

approach.

Implant in place: enter ‘Yes’ if there is an implant in place. The follow-up period if an implant in place should be

extended to 90 days after the operation for deep or organ/space infections.

Operation/patient data

Hospital code: Patient counter:

Ward ID (optional):

Operation ID:

Age:

Gender: O Male O Female O Other O Unknown

Date of hospital discharge: ___/___/___

If readmission, record the first discharge

Outcome from hospital: O Alive O Dead in hospital O UNK

Operation ID:

Date of operation: ___/___/___

O CARD O CBGB O CBGC O CABG O CHOL O COLO O CSEC O HPRO O KPRO O LAM O REC

ICD-9-CM code:

Other operation code:

If other code than ICD-9, please specify: ________

Endoscopic procedure: O Yes O No O Unknown

Implant in place: O Yes O No O Unknown

If implant in place -> 90-day follow-up for D/O SSI

European Surveillance of Surgical Site Infections

Form AL4. Light surveillance option: Operation/patient and infection data

Operation code:

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

8. SSI data and microorganism/resistance

data (patient-based and unit-based protocol)

8.1 SSI data – Form A3/AL4

The SSI data (RecordTypes HAISSI$OP$INF and HAISSILIGHT$OP_CAT$INF) collected on the third level are the

same for patient- and unit-based protocol surveillance. These data are collected for each infection episode, by type

of infection. In the unit-based protocol the level contains also patient/operation data (see also section 7.2). The

level is required for both patient- and unit-based surveillance protocol.

Date of infection onset (required): date when the first clinical evidence of SSI appeared or the date the

specimen used to make or confirm the diagnosis was collected, whichever comes first.

Type of infection (required): type of infection (see section 3.1): S=Superficial incisional; D = Deep incisional; O

= Organ/space; UNK = Unknown

SSI diagnosis: SSI diagnosis in-hospital or post-discharge.

SSI Post-discharge surveillance method: method used for post-discharge surveillance of SSIs (see also

section 6.1): READM = Detection at readmission; REPSURG = Reporting on surgeon’s initiative; REPGP = Reporting

on GP’s initiative; REPPAT = Reporting on patient’s initiative; ICSURG = Obtained by IC staff from surgeon; ICGP =

Obtained by IC staff from GP; ICPAT = Obtained by IC staff from patient; UNK = Unknown.

Infection outcome (at hospital discharge): outcome of the patient with infection on discharge from the

hospital. In case of death, appreciation of the relationship of death to the infection by clinician and/or surveillance

staff: A = Discharged alive; DDEFREL = Death, infection definitely contributed to death; DNOTREL = Death, not

related to infection; DPOSREL = Death, infection possibly contributed to death; DUNKREL = Death, unknown

relationship to infection; UNK = Unknown.

8.2 Microorganism and antimicrobial resistance data – Form

A3/AL4

The fourth level (RecordTypes ‘HAISSI$OP$INF$RES’ and HAISSILIGHT$OP_CAT$INF$RES) is the same for patient-

and unit-based protocol surveillance and includes variables about isolated microorganisms and antimicrobial

resistance. The level is optional for in both patient- and unit-based protocol surveillance.

Isolate result (required): microorganism or reason why not available. See Annex 2.

Antibiotic code: antibiotic code tested for susceptibility. See Annex 3.

SIR: final interpretation result of all different susceptibility tests performed. See Annex 3. Report S (susceptible), I

(intermediate), R (resistant) or UNK (unknown) for the antimicrobial group (preferred) or for tested antimicrobials

within the group. Reporting group susceptibility requires that at least one antimicrobial belonging to the group is

tested. If several antibiotics within the group were tested (e.g. carbapenems (CAR)), report the least susceptible

result for the group (e.g. meropenem R + imipenem I = CAR R).

Infection data

Date of onset: ___/___/___ Type of infection: O Superficial O Deep O Organ/Space O UNK

SSI diagnosis:

O HOSP O PD O UNK

SSI postdischarge surveillance method:

O READM O REPSURG O REPGP O REPPAT O ICSURG O ICGP O ICPAT O OTHER O UNK

Infection outcome (at hospital discharge): O alive O death, HAI definitely contributed to death

O death, HAI possibly contributed to death O death, no relation to HAI O death, relationship to HAI unknown O UNK

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Pandrug-resistant (PDR): microorganism is pandrug resistant. Not PDR = N (susceptible to at least one

antimicrobial), possible PDR = P (I/R to all antimicrobials tested in hospital), confirmed PDR = C (I/R to all

antimicrobials confirmed by reference laboratory), UNK=Unknown [17].

Microorganism and antimicrobial resistance data (repeatable per infection/microorganisms)

Microorganism code AM S/I/R PDR Microorganism code 2 AM S/I/R PDR

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

9. HAISSICOVERAGE dataset

The HAISSICOVERAGE dataset/file was introduced to collect the total numbers of operations carried out at the

national level per year (for the reported surveillance year). These data should only be reported for surgical

procedures included in the national/regional surveillance and will be used for the calculation of the surveillance

coverage of the operative categories included in the surveillance.

Table 7. Variables in the HAISSICOVERAGE dataset

Variable name (transport label)

Description

Value list

Required

Number of operations for coronary artery

bypass grafting (NoOfOperationsCABG)

Total number of operations for coronary artery

bypass grafting for the complete network or the

Member State if only one network for the year

True (Warning)

Number of operations for colon surgery

(NoOfOperationsCOLO)

Total number of operations for colon surgery for

the complete network or the Member State if only

one network for the year

True (Warning)

Number of operations for cholecystectomy

(NoOfOperationsCHOL)

Total number of operations for cholecystectomy

for the complete network or the Member State if

only one network for the year

True (Warning)

Number of operations for caesarean

section (NoOfOperationsCSEC)

Total number of operations for caesarean section

for the complete network or the Member State if

only one network for the year

True (Warning)

Number of operations for hip prosthesis

(NoOfOperationsHPRO)

Total number of operations for hip prosthesis for

the complete network or the Member State if only

one network for the year

True (Warning)

Number of operations for knee prosthesis

(NoOfOperationsKPRO)

Total number of operations for knee prosthesis for

the complete network or the Member State if only

one network for the year

True (Warning)

Number of operations for laminectomy

(NoOfOperationsLAM)

Total number of operations for laminectomy for

the complete network or the Member State if only

one network for the year

True (Warning)

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

10. Confidentiality

10.1 Patient confidentiality

It will not be possible to identify individual patients in the European database on SSI by coding patient information,

only at the hospital level or at the level of the official networks in the countries. However, for validation purposes,

the hospitals should be able to trace back patients based on the anonymous unique operative procedure ID.

10.2 Hospital and unit confidentiality

Individual hospitals will not be identifiable in the European database on SSI by coding hospital information at the

hospital level or at the level of the official networks in the countries. When presenting the results of the European

SSI surveillance, it has to be secured that no individual hospital can be recognised.

10.3 Publication policy

Data will be published in ECDC’s Annual Epidemiological Reports and in disease-specific reports on HAI

surveillance, in online reports and scientific publications. Data can only be published if the official surveillance

networks in the countries give written consent for publication. If requested by a network, publications have to

acknowledge the data source (i.e. the networks) and provide contact information.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

References

1. Official Journal of the European Union. Council recommendation of 9 June 2009 on patient safety, including the

prevention and control of healthcare-associated infections (HAI) (2009/C 151/01). Available from:

http://ec.europa.eu/health//sites/health/files/patient_safety/docs/council_2009_en.pdf

2. Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a

network for the epidemiological surveillance and control of communicable diseases in the Community. Official

Journal of the European Communities 1998:L268/1-6. Available from: http://eur-

lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31998D2119:EN:HTML

3. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated

infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.

4. Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Event. 2017. Available from:

https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

5. Gaynes RP. Surgical Site Infections and the NNIS SSI Risk Index: room for improvement. Infect Control Hosp Epidemiol

2000;21(3):184-5.

6. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Am

J Infect Control 1999;27:97-134. Available from: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf

7. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004,

issued October 2004. Available from: http://www.cdc.gov/ncidod/dhqp/pdf/nnis/2004NNISreport.pdf

8. Culver DH, Horan TC, Gaynes RP et al. Surgical wound infection rates by wound class, operative procedure and patient

risk index. Am J Med 1991;91(suppl 3B):152S-7S.

9. Altemeier WA, Burke JF, Pruitt BA, Sandusky WR. Manual on control of infection in surgical patients (2nd ed.)

Philadelphia, PA: JB Lippincott, 1984.

10. American Society of Anesthesiologists. ASA physical status classification system. 2014. Available from:

http://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/asa-physical-status-

classification-system.pdf

11. World Health Organization. Patient safety workshop: learning from error. Geneva: WHO; 2010. Available from:

http://apps.who.int/iris/bitstream/10665/44267/1/9789241599023_eng.pdf

12. European Centre for Disease Prevention and Control. Systematic review and evidence-based guidance on perioperative

antibiotic prophylaxis. Stockholm: ECDC; 2013.

13. World Health Organization. Global guidelines for the prevention of surgical site infection. Geneva: WHO; 2016.

Available from: http://www.who.int/gpsc/ssi-prevention-guidelines/en/

14. World Health Organization. Implementation manual. Surgical safety checklist. Geneva: WHO; 2008. Available from:

http://www.who.int/patientsafety/safesurgery/ss_checklist/en/

15. Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD et al. Society for Healthcare

Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care

hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014;35(8):967-77.

16. Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L et al. Strategies to prevent surgical

site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S66-88.

17. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-

resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired

resistance. Clin Microbiol Infect 2012;18(3):268-81. Available from:

http://www.sciencedirect.com/science/article/pii/S1198743X14616323

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Annex 1. ICD-9-CM code list of surgical

procedures

ICD-9-CM code list of surgical procedures for EU

surveillance

Other allowed operation codes included in NHSN

COLO

45.0 = Enterotomy

45.00 = Incision of intestine, not otherwise specified

45.03 = Incision of large intestine

45.4 = Local excision or destruction of lesion or tissue of

large intestine

45.41 = Excision of lesion or tissue of large intestine

45.49 = Other destruction of lesion of large intestine

45.5 = Isolation of intestinal segment

45.50 = Isolation of intestinal segment, not otherwise

specified

45.52 = Isolation of segment of large intestine

45.7 = Partial excision of large intestine

45.71 = Multiple segmental resection of large intestine

45.72 = Cecectomy

45.73 = Right hemicolectomy

45.74 = Resection of transverse colon

45.75 = Left hemicolectomy

45.76 = Sigmoidectomy

45.79 = Other partial excision of large intestine

45.8 = Total intra-abdominal colectomy

45.9 = Intestinal anastomosis

45.90 = Intestinal anastomosis, not otherwise specified

45.92 = Anastomosis of small intestine to rectal stump

45.93 = Other small-to-large intestinal anastomosis

45.94 = Large-to-large intestinal anastomosis

45.95 = Anastomosis to anus

46.0 = Exteriorisation of intestine

46.03 = Exteriorisation of large intestine

46.04 = Resection of exteriorised segment of large

intestine

COLO

17.3 = Laparoscopic partial excision of large intestine:

17.31 = Laparoscopic multiple segmental resection of large

intestine

17.32 = Laparoscopic cecectomy

17.33 = Laparoscopic right hemicolectomy

17.34 = Laparoscopic resection transverse colon

17.35 = Laparoscopic left hemicolectomy

17.36 = Laparoscopic sigmoidectomy

17.39 = Laparoscopic partial excision of large intestine

45.26 = Open biopsy of large intestine

45.81 = Laparoscopic total intra-abdominal colectomy

45.82 = Open total intra-abdominal colectomy

45.83 = Other and unspecified total intra-abdominal

colectomy SB

45.01 = Incision of duodenum

45.02 = Other incision of small intestine

45.15 = Open biopsy of small intestine

45.31 = Other local excision of lesion of duodenum

45.32 = Other destruction of lesion of duodenum

45.33 = Local excision of lesion or tissue of small intestine,

except duodenum

45.34 = Other destruction of lesion of small intestine, except

duodenum

45.51 = Isolation of segment of small intestine

45.61 = Multiple segmental resection of small intestine

45.62 = Other partial resection of small intestine

45.63 = Total removal of small intestine

45.91 = Small-to-small intestinal anastomosis

46.01 = Exteriorisation of small intestine

46.02 = Resection of exteriorised segment of small intestine

46.20 = Ileostomy, not otherwise specified

46.21 = temporary ileostomy

46.22 = Continent ileostomy

46.23 = Other permanent ileostomy

46.24 = Delayed opening of ileostomy

46.31 = Delayed opening of other ileostomy

46.39 = Other enterostomy

46.41 = Revision of stoma of small intestine

46.51 = Closure of stoma of small intestine

46.71 = Suture of laceration of duodenum

46.72 = Closure of fistula of duodenum

46.73 = Suture of laceration of small intestine, except

duodenum

46.74 = Closure of fistula of small intestine, except duodenum

46.93 = Revision of anastomosis of small intestine

REC

48.5 = Abdominoperineal resection of rectum (till 2008-10-

10)

48.6 = Other resection of rectum

48.61 = Transsacral rectosigmoidectomy

48.62 = Anterior resection of rectum with synchronous

colostomy

48.63 = Other anterior resection of rectum

48.64 = Posterior resection of rectum

48.65 = Duhamel resection of rectum

48.69 = Other resection of rectum

REC

48.25 = Open biopsy of rectum

48.35 = Local excision of rectal lesion or tissue

48.40 = Pull-through resection of rectum, not otherwise spec

48.42 = Laparoscopic pull-through resection of rectum

48.43 = Open pull-through resection of rectum

48.49 = Other pull-through resection of rectum

48.50 = Abdominoperineal resection of rectum, not specified

48.51 = Laparoscopic abdominoperineal resection of the

rectum

48.52 = Open abdominoperineal resection of the rectum

48.59 = Other abdominoperineal resection of the rectum

48.74 = Rectorectostomy

HPRO

81.5 = Joint replacement of lower extremity

HPRO

00.70 = Revision of hip replacement, both acetabular and

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

ICD-9-CM code list of surgical procedures for EU

surveillance

Other allowed operation codes included in NHSN

81.51 = Total hip replacement

81.52 = Partial hip replacement

81.53 = Revision of hip replacement

femoral components

00.71 = Revision of hip replacement, acetabular component

00.72 = Revision of hip replacement, femoral components

00.73 = Revision of hip replacement, acetabularliner and/or

femoral head only

00.85 = Resurfacing hip, total acetabulum, and femoral head

00.86 = Resurfacing hip, partial, femoral head

00.87 = Resurfacing hip, partial, acetabulum

KPRO

00.80 = Revision of knee replacement, total (all

components)

00.81 = Revision of knee replacement, tibial component

00.82 = Revision of knee replacement, femoral component

00.83 = Revision of knee replacement, patellar component

00.84 = Revision of knee replacement, tibial insert (liner)

81.54 = Total knee replacement

81.55 = Revision of knee replacement

KPRO

<same>

LAM

03.0 = Exploration and decompression of spinal canal

structures

03.01 = Removal of foreign body from spinal canal

03.02 = Reopening of laminectomy site

03.09 = Other exploration and decompression of spinal

canal

80.5 = Excision or destruction of intervertebral disc

80.50 = Excision or destruction of intervertebral disc,

unspecified

80.51 = Excision of intervertebral disc

fibrosus

80.59 = Other destruction of intervertebral disc

LAM

80.53 = Repair of the anulus fibrosus with graft or prosthesis

80.54 = Other and unspecified repair of the anulus fibrosus

84.60 = Insertion of spinal disc prosthesis, not otherwise

specified

84.61 = Insertion of partial spinal disc prosthesis, cervical

84.62 = Insertion of total spinal disc prosthesis, cervical

84.63 = Insertion of spinal disc prosthesis, thoracic

84.64 = Insertion of partial spinal disc prosthesis,

lumbosacral

84.65 = Insertion of total spinal disc prosthesis, lumbosacral

84.66 = Revision or replacement of artificial spinal disc

prosthesis, cervical

84.67 = Revision or replacement of artificial spinal disc

prosthesis, thoracic

84.68 = Revision or replacement of artificial spinal disc

prosthesis, lumbosacral

84.69 = Revision or replacement of artificial spinal disc

prosthesis, not otherwise

84.80 = Insertion or replacement of interspinosus process

device(s)

84.81 = Revision of interspinosus process device(s)

84.82 = Insertion or replacement of pedicle-based dynamic

stabilisation device(s)

84.83 = Revision of pedicle-based dynamic stabilisation

device(s)

84.84 = Insertion of replacement of facet replacement

device(s)

84.85 = Revision of facet replacement device(s)

CBGB

36.1 = Bypass anastomosis for heart revascularisation

36.10 = Aortocoronary bypass for heart revascularisation

36.11 = Aortocoronary bypass of one coronary artery

36.12 = Aortocoronary bypass of two coronary arteries

36.13 = Aortocoronary bypass of three coronary arteries

36.14 = Aortocoronary bypass of four or more coronary

arteries

36.19 = Other bypass anastomosis for heart revascularisation

CBGB

<same>

CABG

<same>

CBGC

36.15 = Single internal mammary-coronary artery bypass

36.16 = Double internal mammary-coronary artery bypass

36.17 = Abdominal – coronary artery bypass

36.2 = Heart revascularisation by arterial implant

CBGC

<same>

CHOL

51.0 = Cholecystotomy and cholecystostomy

51.03 = Other cholecystostomy

51.04 = Other cholecystotomy

51.2 = Cholecystectomy

51.21 = Other partial cholecystectomy

CHOL

51.13 = Open biopsy of gallbladder or bile ducts

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

ICD-9-CM code list of surgical procedures for EU

surveillance

Other allowed operation codes included in NHSN

51.22 = Cholecystectomy

51.23 = Laparoscopic cholecystectomy

51.24 = Laparoscopic partial cholecystectomy

CSEC

74.0 = Classical caesarean section

74.1 = Low cervical caesarean section

74.2 = Extraperitoneal caesarean section

74.4 = Caesarean section of other specified type

74.9 = Caesarean section of unspecified type

74.91 = Hysterotomy to terminate pregnancy

74.99 = Other caesarean section of unspecified type

CSEC

<same>

CARD

35.00 = Closed heart valvotomy, unspecified valve

35.01 = Closed heart valvotomy, aortic valve

35.02 = Closed heart valvotomy, mitral valve

35.03 = Closed heart valvotomy, pulmonary valve

35.04 = Closed heart valvotomy, tricuspid valve

35.06 = Transapical replacement of aortic valve

35.08 = Transapical replacement of pulmonary valve

35.10 = Open heart valvuloplasty without replacement,

unspecified valve

35.11 = Open heart valvuloplasty of aortic valve

without replacement

35.12 = Open heart valvuloplasty of mitral valve

without replacement

35.13 = Open heart valvuloplasty of pulmonary valve

without replacement

35.14 = Open heart valvuloplasty of tricuspid valve

without replacement

35.20 = Replacement of unspecified heart valve

35.21 = Open and other replacement of aortic valve

with tissue graft

35.22 = Open and other replacement of aortic valve

35.23 = Open and other replacement of mitral valve

with tissue graft

35.24 = Open and other replacement of mitral valve

35.25 = Open and other replacement of pulmonary

valve with tissue graft

35.26 = Open and other replacement of pulmonary valve

35.27 = Open and other replacement of tricuspid valve

with tissue graft

35.28= Open and other replacement of tricuspid valve

35.31 = Operations on papillary muscle

35.32 = Operations on chordae tendineae

35.33 = Annuloplasty

35.34 = Infundibulectomy

35.35 = Operations on trabeculae carneae cordis

35.39 = Operations on other structures adjacent

to valves of heart

35.42 = Creation of septal defect in heart

35.50 = Repair of unspecified septal defect of heart

with prosthesis

35.51 = Repair of atrial septal defect with prosthesis,

open technique

35.53 = Repair of ventricular septal defect with prosthesis, open

technique

35.54 = Repair of endocardial cushion defect with prosthesis

35.60 = Repair of unspecified septal defect of heart with

tissue graft

35.61 = Repair of atrial septal defect with tissue graft

35.62 = Repair of ventricular septal defect with tissue graft

36.63 = Repair of endocardial cushion defect with tissue

graft

35.70 = Other and unspecified repair of unspecified septal

defect of heart

35.71 = Other and unspecified repair of atrial septal defect

CARD

<same>

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

ICD-9-CM code list of surgical procedures for EU

surveillance

Other allowed operation codes included in NHSN

35.72 = Other and unspecified repair of ventricular septal

defect

35.73 = Other and unspecified repair of endocardial

cushion defect

35.81 = Total repair of tetralogy of Fallot

35.82 = Total repair of total anomalous pulmonary

venous connection

35.83 = Total repair of truncus arteriosus

35.84 = Total correction of transposition of great

vessels, not elsewhere classified

35.91 = Interatrial transposition of venous return

35.92 = Creation of conduit between right ventricle

and pulmonary artery

35.93 = Creation of conduit between left ventricle

and aorta

35.94 = Creation of conduit between atrium and

pulmonary artery

35.95 = Revision of corrective procedure on heart

35.98 = Other operations on septa of heart

35.99 = Other operations on valves of heart

37.10 = Incision of heart, not otherwise specified

37.11 = Cardiotomy

37.12 = Pericardiotomy

37.31 = Pericardiectomy

37.32 = Excision of aneurysm of heart

37.33 = Excision or destruction of other lesion or

tissue of heart, open approach

37.35 = Partial ventriculectomy

37.37 = Excision or destruction of other lesion or

tissue of heart,thorac.approach

37.41 = Implantation of prosthetic cardiac support

device around the heart

37.49 = Other repair of heart and pericardium

37.60 = Implantation or insertion of biventricular

external heart assist system

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Annex 2. Microorganisms code list

The code list is adapted from the original WHOCARE coding system. The current list is a selection of

microorganisms based on their frequency of occurrence in healthcare-associated infections in different EU networks

and infection types and/or on their public health importance. The minimal list represents the minimal level of detail

that should be provided by every network.

Microorganism selection and minimal list

Microorganism

Code

Minimal list

Gram-positive cocci

Staphylococcus aureus

STAAUR

Staphylococcus epidermidis

STAEPI

STACNS

Staphylococcus haemolyticus

STAHAE

Coag-neg. staphylococci, not specified

STACNS

Other coagulase-negative staphylococci (CNS)

STAOTH

Staphylococcus

spp.

not specified

STANSP

GPCTOT

Streptococcus pneumoniae

STRPNE

STRSPP

Streptococcus agalactiae

(B)

STRAGA

Streptococcus pyogenes

(A)

STRPYO

Other haemol. Streptococcae (C, G)

STRHCG

Streptococcus

spp., other

STROTH

Streptococcus

spp., not specified

STRNSP

Enterococcus faecalis

ENCFAE

ENCSPP

Enterococcus faecium

ENCFAI

Enterococcus

spp., other

ENCOTH

Enterococcus

spp., not specified

ENCNSP

Gram-positive cocci, not specified

GPCNSP

GPCTOT

Other Gram-positive cocci

GPCOTH

Gram-negative cocci

Moraxella catharralis

MORCAT

GNCTOT

Moraxella

spp.

, other

MOROTH

Moraxella

spp.

, not specified

MORNSP

Neisseria meningitidis

NEIMEN

Neisseria

spp., other

NEIOTH

Neisseria

spp., not specified

NEINSP

Gram-negative cocci, not specified

GNCNSP

Other Gram-negative cocci

GNCOTH

Gram-positive bacilli

Corynebacterium

spp.

CORSPP

GPBTOT

Bacillus

spp.

BACSPP

Lactobacillus

spp.

LACSPP

Listeria monocytogenes

LISMON

Gram-positive bacilli, not specified

GPBNSP

Other Gram-positive bacilli

GPBOTH

Enterobacteriaceae

(continued)

Citrobacter freundii

CITFRE

CITSPP

Citrobacter koseri

(e.g.

diversus

)

CITDIV

Citrobacter

spp.

other

CITOTH

Citrobacter

spp.

not specified

CITNSP

Enterobacter cloacae

ENBCLO

ENBSPP

Enterobacter aerogenes

ENBAER

Enterobacter agglomerans

ENBAGG

Enterobacter sakazakii

ENBSAK

Enterobacter gergoviae

ENBGER

Enterobacter

spp.

other

ENBOTH

Enterobacter

spp.

not specified

ENBNSP

Escherichia coli

ESCCOL

Klebsiella pneumoniae

KLEPNE

KLESPP

Klebsiella oxytoca

KLEOXY

Klebsiella

spp., other

KLEOTH

Klebsiella

spp., not specified

KLENSP

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Microorganism

Code

Minimal list

Proteus mirabilis

PRTMIR

PRTSPP

Proteus vulgaris

PRTVUL

Proteus

spp.

other

PRTOTH

Proteus

spp.

not specified

PRTNSP

Serratia marcescens

SERMAR

SERSPP

Serratia liquefaciens

SERLIQ

Serratia

spp.

other

SEROTH

Serratia

spp.

not specified

SERNSP

Hafnia

spp.

HAFSPP

ETBTOT

Morganella

spp.

MOGSPP

Providencia

spp.

PRVSPP

Salmonella

Enteritidis

SALENT

Salmonella

Typhi or Paratyphi

SALTYP

Salmonella

Typhimurium

SALTYM

Salmonella

spp.

not specified

SALNSP

Salmonella

spp.

other

SALOTH

Shigella

spp.

SHISPP

Yersinia

spp.

YERSPP

Other enterobacteriaceae

ETBOTH

Enterobacteriaceae, not specified

ETBNSP

Gram-negative bacilli

Acinetobacter baumannii

ACIBAU

ACISPP

Acinetobacter calcoaceticus

ACICAL

Acinetobacter haemolyticus

ACIHAE

Acinetobacter lwoffii

ACILWO

Acinetobacter

spp.

other

ACIOTH

Acinetobacter

spp.

not specified

ACINSP

Pseudomonas aeruginosa

PSEAER

Stenotrophomonas maltophilia

STEMAL

Burkholderia cepacia

BURCEP

PSETOT

Pseudomonadaceae

family, other

PSEOTH

Pseudomonadaceae

family, not specified

PSENSP

Haemophilus influenzae

HAEINF

HAESPP

Haemophilus parainfluenzae

HAEPAI

Haemophilus

spp.

other

HAEOTH

Haemophilus

spp.

not specified

HAENSP

Gram-negative bacilli

(continuation)

Legionella

spp.

LEGSPP

Achromobacter

spp.

ACHSPP

GNBTOT

Aeromonas

spp.

AEMSPP

Agrobacterium

spp.

AGRSPP

Alcaligenes

spp.

ALCSPP

Campylobacter

spp.

CAMSPP

Flavobacterium

spp.

FLASPP

Gardnerella

spp.

GARSPP

Helicobacter pylori

HELPYL

Pasteurella

spp.

PASSPP

Gram-negative bacilli, not specified

GNBNSP

Other Gram-negative bacilli, non enterobacteriaceae

GNBOTH

Anaerobes

Bacteroides fragilis

BATFRA

BATSPP

Bacteroides

other

BATOTH

Bacteroides

spp.,

not specified

BATNSP

Clostridium difficile

CLODIF

ANATOT

Clostridium

other

CLOOTH

Propionibacterium

spp.

PROSPP

Prevotella

spp.

PRESPP

Anaerobes, not specified

ANANSP

Other anaerobes

ANAOTH

TECHNICAL DOCUMENT Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2

Microorganism

Code

Minimal list

Other bacteria

Mycobacterium, atypical

MYCATY

BCTTOT

Mycobacterium tuberculosis

complex

MYCTUB

Chlamydia

spp.

CHLSPP

Mycoplasma

spp.

MYPSPP

Actinomyces

spp.

ACTSPP

Nocardia

spp.

NOCSPP

Other bacteria

BCTOTH

Other bacteria, not specified

BCTNSP

Fungi

Candida albicans

CANALB

CANSPP

Candida auris

CANAUR

Candida glabrata

CANGLA

Candida krusei

CANKRU

Candida tropicalis

CANTRO

Candida parapsilosis

CANPAR

Candida

spp., other

CANOTH

Candida

spp., not specified

CANNSP

Aspergillus fumigatus

ASPFUM

ASPSPP

Aspergillus niger

ASPNIG

Aspergillus

spp.

other

ASPOTH

Aspergillus

spp.

not specified

ASPNSP

Other yeasts

YEAOTH

PARTOT

Fungi other

FUNOTH

Fungi, not specified

FUNNSP

Filaments other

FILOTH

Other parasites

PAROTH

Viruses

Adenovirus

VIRADV

VIRTOT

Cytomegalovirus (CMV)

VIRCMV

Enterovirus (polio, coxsackie, echo)

VIRENT

Hepatitis A virus

VIRHAV

Hepatitis B virus

VIRHBV

Hepatitis C virus

VIRHCV

Herpes simplex virus

VIRHSV

Human immunodeficiency virus (HIV)

VIRHIV

Influenza A virus

VIRINA

Influenza B virus

VIRINB

Influenza C virus

VIRINC

Norovirus

VIRNOR

Parainfluenzavirus

VIRPIV

Respiratory syncytial virus (RSV)

VIRRSV

Rhinovirus

VIRRHI

Rotavirus

VIRROT

SARS virus

VIRSAR

Varicella-zoster virus

VIRVZV

Virus, not specified

VIRNSP

Other virus

VIROTH

Microorganism not identified or not found

_NONID

Examination not done

_NOEXA

Sterile examination

_STERI

Result not (yet) available or missing

_NA

_NONID: evidence exists that a microbiological examination has been done, but the microorganism cannot be correctly classified

or the result of the examination cannot be found; _NOEXA: no diagnostic sample taken, no microbiological examination done;

_STERI: a microbiological examination has been done, but the result was negative (e.g. negative culture), _NA Result not (yet)

available or missing.

Surveillance of SSIs and prevention indicators in European hospitals – HAI-Net SSI protocol v.2.2 TECHNICAL DOCUMENT

Annex 3. Antimicrobial resistance markers

and codes

Recommended method to collect AMR markers:

For each AMR marker, indicate whether the microorganism was susceptible (S), intermediate (I), resistant (R) or

susceptibility unknown (U), for the following antimicrobials:

Staphylococcus aureus

 Meticillin-resistant

S. aureus

(MRSA): Susceptibility to oxacillin (OXA) or other marker of MRSA such as

cefoxitin (FOX), cloxacillin (CLO), dicloxacillin (DIC), flucloxacillin (FLC), meticillin (MET)

 Vancomycin-intermediate or vancomycin-resistant

S. aureus

(VISA, VRSA): Susceptibility to glycopeptides

(GLY): vancomycin (VAN) or teicoplanin (TEC)

Enterococcus

spp.:

 • Vancomycin-resistant

Enterococcus

spp. (VRE): Susceptibility to glycopeptides (GLY): vancomycin (VAN)

or teicoplanin (TEC)

Enterobacteriaceae (Escherichia coli, Klebsiella spp., Enterobacter spp., Proteus spp., Citrobacter spp., Serratia spp.,

Morganella spp.)

 Susceptibility to third-generation cephalosporins (C3G): cefotaxime (CTX), ceftriaxone (CRO), ceftazidime

(CAZ)

 Susceptibility to carbapenems (CAR): imipenem (IPM), meropenem (MEM), doripenem (DOR)

Pseudomonas aeruginosa

 Susceptibility to carbapenems (CAR): imipenem (IPM), meropenem (MEM), doripenem (DOR)

Acinetobacter

spp.:

 Susceptibility to carbapenems (CAR): imipenem (IPM), meropenem (MEM), doripenem (DOR)

If AMR markers are collected in accordance with the HAI-Net ECDC PPS I protocol methodology (not

recommended), report S (susceptible), IR (non-susceptible) or U (unknown), except for MRSA, report

nonsusceptibility to oxacillin (or equivalent) as R (resistant).

Previously used AMR markers (0,1,2,9), as indicated in the HAI-SSI protocol v1.02, must not be used.

ECDC is committed to ensuring the transparency and independence of its work

In accordance with the Staff Regulations for Officials and Conditions of Employment of Other Servants of the European Union and the

ECDC Independence Policy, ECDC staff members shall not, in the performance of their duties, deal with a matter in which, directly or

indirectly, they have any personal interest such as to impair their independence. Declarations of interest must be received from any

prospective contractor(s) before any contract can be awarded.

www.ecdc.europa.eu/en/aboutus/transparency

HOW TO OBTAIN EU PUBLICATIONS

Free publications:

• onecopy:

viaEUBookshop(http://bookshop.europa.eu);

• morethanonecopyorposters/maps:

fromtheEuropeanUnion’srepresentations(http://ec.europa.eu/represent_en.htm);

fromthedelegationsinnon-EUcountries(http://eeas.europa.eu/delegations/index_en.htm);

bycontactingtheEuropeDirectservice(http://europa.eu/europedirect/index_en.htm)or

calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) (*).

(*)Theinformationgivenisfree,asaremostcalls(thoughsomeoperators,phoneboxesorhotelsmaychargeyou).

Priced publications:

• viaEUBookshop(http://bookshop.europa.eu).

European Centre for Disease

Prevention and Control (ECDC)

Postaladdress:

Granits väg 8, SE-171 65 Solna, Sweden

Visitingaddress:

Tomtebodavägen 11, SE-171 65 Solna, Sweden

Tel. +46 858601000

Fax+46858601001

www.ecdc.europa.eu

An agency of the European Union

www.europa.eu

Subscribe to our publications

www.ecdc.europa.eu/en/publications

publications@ecdc.europa.eu

@ECDC_EU

Like our Facebook page