Evaluation of the SENIC risk index in a Spanish university hospital

OBJECTIVE: To assess the performance of the Study of the Efficacy of Nosoco mial Infection Control (SENIC) risk index for the evaluation of the risk of surgical-site infection (SSI) in a country other than the United States, h aving a different health system. SETTING: 350-bed university hospital in Spain belonging to the National Hea lth System (Insalud). DESIGN: Observational cohort study of 1,019 patients who underwent consecut ive surgery from January to December 1992. Surgical-infection risk factors assessed by the traditional wound-classification system (clean, clean-conta minated, contaminated, and dirty-infected wound) and by the SENIC risk inde x (length of intervention more than 2 hours, more than three discharge diag noses, abdominal surgery, and contaminated or dirty-infected wound) were co mpared by forward logistic regression. RESULTS: The SENIC risk index showed a greater ability to predict SSI than the traditional wound-classification system. The study carried out in our i nstitution reproduced the estimators provided by the SENIC study in the Uni ted States. The SENIC risk index provided a stepwise increase in SSI rates, according to the number of factors present, for every traditional wound-cl assification group. In the case of clean wounds, the incidence of surgical infection (per 100 interventions) increased (1.5, 2.4, 5.5, and 50; P < .00 1) for patients having from zero to three risk factors of the SENIC risk in dex. CONCLUSIONS: This study shows that the SENIC risk index results are reprodu cible, and the index can be used to compare rates of wound infection across countries with different health systems than the United States.