Impact of hospital-wide surveillance on hospital-acquired infections in anacute-care hospital in The Netherlands

The goal of surveillance is to identify hospital-acquired infections (HAI) and risk factors, to apply targeted interventions and to evaluate their eff ect in an ongoing sg-stem. Continuing active surveillance in a 270-bed acut e-care hospital is being performed on clinical patients, excluding day-care . The period 1984-1997 is described here. Specific surveillance-based inter ventions included the introduction of antimicrobial prophylasis in gynaecol ogy patients with postoperative urinary tract catheters and in patients sch eduled for appenditectomy and hysterectomy: General measures included educa tion, implementation of protocols, feedback of surgeon-specific infection r ates. In total, 3545 HAI were found in 13 years of surveillance. The incide nce was 4.7/100 admissions and 4.5/1000 patient days. Age-specific incidenc es ranged from 1.3 in the age-category 1-14 years, to 10.2 in patients aged 75 years and above. If age-specific incidences had remained at their 1984 level, over 3000 additional infections would have occurred, affecting all a ge groups escept those up to 14 years. The distribution of types of infecti ons differed between services. Following the targeted interventions, the ra te of infections in gynaecology decreased from 19.4 per 1000 patient days i n 1984 to 2.4 per 1000 patient dass in 1996. The rates of wound infection f ollowing appendicectomy and hysterectomy decreased by 69% and 82%, respecti vely; in the period following the institution of antimicrobial prophylaxis. Over 4000 micro-organisms were isolated front the HAI; multi-resistant str ains were isolated sporadically We conclude that hospital-wide surveillance of hospital-acquired infections provides appropriate targets for intervent ions tailored to the specific needs of the hospital. The impact of such int erventions can readily be documented from the surveillance data. (C) 2000 T he Hospital Infection Society.