• Project Surveillance Ziekenhuisinfecties regio Utrecht ; een studie naar de haalbaarheid van surveillance van ziekenhuisinfecties in een netwerk van registrerende ziekenhuizen

      Severijnen AJ; Verbrugh HA; Mintjes-de Groot AJ; Vandenbroucke-Grauls CMJE; Klokman-Houweling R; Gruteke P; Schellekens JFP; van Pelt W; CIE; LBA; St Antonius Ziekenhuis; Nieuwegein; Diakonessenhuis; Utrecht; Ziekenhuis Eemland; Amersfoort; Hofpoort Ziekenhuis; Woerden; Lorentz Ziekenhuis; Zeist; Ziekenhuis Oudenrijn; Utrecht; Academisch Ziekenhuis Utrecht. (Rijksinstituut voor Volksgezondheid en Milieu RIVM(Streeklaboratorium voor de VolksgezondheidNieuwegein), 1995-04-30)
      The Project Surveillance Hospital Acquired Infections Utrecht region (PSZU) has been initiated to study the feasibility of multicenter surveillance of hospital acquired infections (HAI) in sentinel hospitals. Aim of this network of sentinel hospitals is to stimulate tracing and control of HAI in participating hospitals. Comparison of the hospitals' own outcome to the aggregated results points to conditions in the individual hospital to be improved. The pilot study especially focussed on logistic aspects: the standardisation of HAI surveillance in different hospitals and the usefulness of data on hospital admissions from a national data source. In 8 hospitals in the Utrecht region a standardised surveillance of HAI was developed. Infection control practitioners (ICP) traced HAI by active surveillance during 9-16 months in the period of March 1992 - June 1993 on gynaecological and orthopaedical patients. Data on HAI patients were put on diskette and mailed on a monthly base to the Center of Infections Disease Epidemiology of the RIVM. Denominator data on all gynaecological and orthopaedical hospital admissions (with and without HAI) were obtained from the Dutch Information System on Hospital Care and Day Nursing, Utrecht. Both data sets were merged by patient admission number and analysed at the Center of Infections Disease Epidemiology. Results were reported back to the participating hospitals. Standardised surveillance of HAI in a group of sentinel hospitals worked out well: HAI patient were properly identified by the ICP, the HAI data were collected sufficiently accurate to be linked correctly to the hospital admission data. The ICP traced 526 HAI in 8922 patients. The incidence of alle types of HAI was 5.9 per 100 admissions or 6.3 per 1000 patient days. The incidence of surgical wound infections and urinary tract infections was significantly higher in gynaecological patients as compared to orthopaedical patients. HAI patients were older and had a longer hospital stay than patients without a HAI. The HAI incidence considerably differed between hospitals: e.g. in gynaecological patients, the HAI incidence varied from 1.0 to 23.3 per 100 admissions. Hospitals also appeared to differ in other aspects as patient age, repertoire of surgical procedures and protocols for antibiotic prophylaxis ; these differences influenced the incidence of HAI. Difference in the distribution of age between hospitals and departments were accounted for. Some bottlenecks came up: In all hospitals the same HAI inclusion criteria were used. However, as hospitals differed in the set of information collected on a possible HAI patient, the change to be identified as a HAI patient was not the same for all hospitals. The denominator data base from the national hospital admission registration did not fully match the patients under surveillance by the ICP: 8% of the admissed patients were not seen by the ICP. This may give rise to underestimation of the HAI incidence. On the other hand, 5% of the patients seen by the ICP was absent in the denominator data. This was partly due to the fact that some patients were still hospitalised when the registration was finished. The denominator data became available only 3-12 months after the patient left the hospital. The reporting delay in incidence figures will hamper the timely adaptation of policy for tracing and control of HAI in individual hospitals. It is concluded that it is feasible to perform standardised surveillance of HAI in a group of collaborating hospitals and to aggregate and analyse the surveillance data in on hospital admissions from the national data source were useful. These results indicate that a national network of sentinel hospitals for the surveillance of HAI is workable and productive.<br>