SENTINEL SYSTEM FOR NOSOCOMIAL INFECTIONS IN THE NETHERLANDS - A PILOT-STUDY

OBJECTIVE: To determine the feasibility of standardized surveillance o f nosocomial infections (NI) in The Netherlands, using local data on p atients with NI collected by infection control practitioners (ICPs) an d denominator data on all patients under surveillance obtained from th e Dutch National Medical Registry (LMR). DESIGN: A prospective, multic enter study. SETTING: Eight hospitals in the Utrecht region, and the N ational Institute of Public Health and the Environment. PATIENTS: ICPs traced NI in gynecological and orthopedic patients for 9 to 16 months . Denominator data on all patients under surveillance were obtained fr om the LMR. RESULTS: Data from 8,922 patients mere collected; the ICPs registered 470 patients with 526 NI. Overall, the NI incidence was 5. 9 per 100 patients, or 6.3 per 1,000 patient days. Urinary tract infec tions (UTI) were most frequent (3.3%), followed by surgical-wound infe ctions (SWI; 2.0%) and bloodborne infections (0.12%). The incidence of both SWI and UTI differed markedly between hospitals, only partially on account of differences in patient mix (age, type of operations), an tibiotic prophylaxis, and intensity of tracing methods for NI. Delay i n the availability of denominator data hampered the timely feedback of incidence figures. CONCLUSIONS: Surveillance of NI in a network of se ntinel hospitals offered valuable information on the occurrence of NI and on factors influencing the incidence of NI. It revealed situations in which both NI surveillance and infection control methods in indivi dual hospitals should be improved. Obtaining denominator data on all p atients from electronically registered patient discharge data greatly reduces the workload of ICPs and enables surveillance on all types of NI (all body sites and all pathogens). For timely feedback, numerator and denominator data within hospitals must be linked (Infect Control H osp Epidemiol 1997;18:818-824).