Portrait
Marie-Christine Eisenring, you have been working for Swissnoso for 13 years. How have your tasks changed during this time?
The Swissnoso programme for the surveillance of surgical site infections (SSI surveillance) is developing all the time – as are my tasks as project head. At first, it was our job to extend the multicentre programme, which was developed in the canton of Valais for institutions in western Switzerland and Ticino, to the rest of Switzerland, standardise the surveillance procedure and design the tools to be used. Over time, we widened the SSI surveillance process to include additional surgical procedures, refined it and put in place the validation audit system. The method of reporting also changed. In the first stage, we developed an individual reporting system for hospitals and clinics. This was followed, at the request of and in collaboration with ANQ, by the transparent publication of the results as a second stage. For several years, we have also been responsible for preparing the national report on behalf of the ANQ. The last major change came when I took early retirement in the summer. Since then, I’ve been working in a 20% capacity to support my successor, Christelle Perdrieu, through her early days and provide her with all the information she needs to deal with this complex assignment.
What do you most enjoy about your work?
Depending on the severity Surgical site infections (SSIs) can be very stressful for patients. They have a significant impact on the health services, also when it comes to the financial aspects. Some of these infections can be avoided through targeted prophylactic measures. More than half of the infections result in patients having to undergo a follow-up operation and a third a rehospitalisation. It means a lot to me that I can assist with prevention and help ensure the quality of care. I really appreciate being involved in the theoretical side of things at Swissnoso, contributing to publications, analysing the figures and communicating the results. I’m also motivated by the collaboration with partners such as SwissRDL, hospitals and clinics and experts from different fields. Personal contacts with the people responsible for SSI surveillance in the institutions are particularly important to me and, over the years, these have developed into both professional relationships and friendships.
What are Swissnoso’s tasks in the context of ANQ reviews of surgical site infections?
Swissnoso is the scientific guarantee responsible for the surveillance procedure and data analysis and reports the results to the hospitals and clinics. Swissnoso draws up the national comparison and institution-specific reports, takes care of the validation process in hospitals and clinics and conducts training courses. The project management team is in charge of implementing the SSI surveillance programme from the operational perspective. We liaise with around 500 individuals who are accountable for the surveillance of surgical site infections in over 160 institutions. We collaborate very closely with ANQ and also SwissRDL, our partner for data hosting and data evaluation in accordance with the Swissnoso guidelines. We are still working with ANQ to continue to improve how we assess surgical site infections. SSI surveillance is now part of the ANQ review plan and compulsory in all hospitals and clinics that perform the relevant surgical procedures.
You are also responsible for running the Module SSI surveillance courses. Why are these so important?
I have a great deal of respect for the work undertaken by the experts responsible for SSI surveillance in hospitals and clinics. Without them, we would have no data or evaluations, which we could analyse and compare, as a basis for improvements. The aim of the compulsory courses is to raise awareness of the problem and to train these individuals and ensure that a standardised surveillance procedure is employed. A standardised procedure and proper implementation are key requirements for obtaining reliable data, which is why every new person who is appointed to deal with SSI surveillance must undergo the training. We have set up a hotline to provide support to the relevant personnel in the institutions. They can contact us to ask any questions about the procedure and also involve us in the evaluation of more complex cases. We are always there to answer any questions and endeavour to respond within a reasonable period of time.
Swissnoso also conducts comprehensive validation audits in the hospitals and clinics. What is evaluated during these audits?
The validation visits to institutions are an important part of our programme and aid the transparent publication of results on the ANQ web portal. Simply implementing a surveillance programme is not enough without there also being a special focus on data quality. Otherwise, one or other of the institutions might vary the extent of their efforts to detect infections, which would result in systematic distortions, an effect that would be reflected in the infection rates recorded. The validation visits enable us to verify that the standardised surveillance procedure is being consistently implemented and to evaluate the quality and reliability of the collected data. We audit the entire surveillance process, the outcome of each surveillance and the internal structures. The quality of a surveillance process is determined with the help of questionnaires, multiple observational processes, discussions and randomly selected case reviews and recorded on a scale of 0 to 50 (validation score). Marylaure Dubouloz and Katja Di Salvo are in charge of the validation audit, for which the project manager is responsible. They are in close communication with the individuals responsible for SSI and are also able to offer coaching where needed.
What are the benefits of the audits?
The fourth round of validations is currently in progress and the median value of the scores awarded to evaluations has improved significantly since the first round. That is a positive change. The fact that the validation score is shown in the transparent results published by ANQ should serve as an added incentive for institutions to make improvements. Yet the overall situation is still diverse - the quality of surveillance processes at some institutions is outstanding while there are missing data and deficiencies at others. The validation reports, which we send to the facilities visited, provide practical recommendations for rectifying these issues. Apart from the outliers, we are on the whole satisfied with the quality of the surveillance processes.
You mentioned the ongoing developments. Which new developments were seen in 2021?
We adapted the surveillance method with effect from 1 October 2021. Surgical procedures that include an implant are now only followed up after 90 days, whereas they were previously reviewed in two stages – after 30 days and after one year. Follow-up after discharge from hospital is now also automatic and involves the use of a digital tool that was recently developed by Swissnoso and SwissRDL. This has considerably simplified the surveillance process after discharge. The aim is to reduce the burden on the institutions - without this having too much of an impact on the ability of the programme to detect infections.
In 2021, you worked on a study investigating the connection between surveillance quality and infection rates. What did the results of this study show?
The study showed that there is a correlation between surveillance quality of certain surgical procedures and reported infection rates. Institutions with low infection rates often also have a low validation score, indicating the presence of deficiencies in their surveillance processes. Conversely, a high infection rate correlates with a high validation score and thus with a good quality of surveillance. In other words, the more we look for surgical site infections using a standardised method, the more infections we will find. That is why we are now considering whether, in future, the validation score should be included when calculating the required risk adjustment of the results. From a methodical perspective, we are faced with the problem that the validation scores are not necessarily consistent with the surveillance periods that have been analysed and reported on.
How are surgical site infection rates developing? And, in your opinion, what do we need to do to reduce the rates further?
Thirteen years after introducing the programme there has been a statistically significant decline in infection rates in the case of seven surgical procedures. That is very pleasing. Yet the results from the individual institutions sometimes vary greatly, which shows that we still need to take action. I am convinced that systematic surveillance will enable us to make further improvements. For example, I see a lot of potential in ensuring that prophylactic antibiotics are appropriately administered. Too many patients are still not receiving the preventive treatments at the right time. Whether it’s the administration of antibiotics, removal of hair or disinfecting the skin prior to surgery, the new SSI intervention module prepared by Swissnoso places a special focus on these simple procedures. The first results of the monitoring of preventive measures have shown that there is still room for improvement in terms how they are implemented on site.
When you look back on your career – what are you most grateful for?
I have always greatly valued the many contacts and close collaboration with individuals from a range of specialist areas. It is therefore very important to me to end this interview by thanking everyone I had the privilege to work with during these fascinating years. I would like to thank in particular:
- Prof. Nicolas Troillet, Medical Head of the SSI Surveillance Programme
- Prof. Andreas Widmer, President of Swissnoso
- The members of Swissnoso
- Marylaure Dubouloz and Katja Di Salvo, research assistants, Validation
- Christelle Perdrieu, new Project Head of SSI Surveillance and Validation
- The General Secretariat of Swissnoso
- Petra Busch, Regula Heller, Daniela Zahnd and Andrea Henneke as the responsible contact partners at ANQ
- The team at SwissRDL, in particular Kurt Schmidlin
- My employer, the Central Institute of Hospitals (ZIS), Valais Hospital
- Everyone working in Swiss hospitals and clinics who is responsible for the surveillance of surgical site infections
Marie-Christine Eisenring is a specialist in hospital hygiene and a federally certified expert in infection prevention. She trained as a Clinical Nurse Specialist and later completed a postgraduate degree in epidemiology at London University. She was a medical delegate of the International Committee of the Red Cross (ICRC) before working in the area of infection prevention for various cantons and organisations from 1994 onwards. Among other things, she coordinated the Infection Prevention Programme in the canton of Valais and the multicentre SSI Surveillance Programme before it was implemented nationally. Marie-Christine Eisenring has been President of the Joint Commission for Infection Prevention Training in Western Switzerland and the SIPI professional association (Spécialistes Infirmiers en Prévention de l’Infection). She was also involved in the national working group responsible for the implementation of the national training programme and spent 13 years working as project head of the module SSI Surveillance and Validation at Swissnoso.
Photos: © Geri Krischker / ANQ