Abstract
BackgroundSurveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI.MethodsAn international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ).ResultsDifferences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were considered.ConclusionsOur study showed an excellent concordance between US and European definitions of PN and primary BSI. PN and primary BSI rates of countries using either US or European definitions can be compared if the points highlighted in this study are taken into account.
Highlights
Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates
Based on a kappa value of 0.75 and on an expected HAI incidence of 1%, we estimated a sample size of 98 cases per infection type. Differences in definitions Both sets of definitions of HAI were reviewed by the working group
bloodstream infection (BSI) definitions varied since Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) does not accept a positive blood culture with a microorganism related to an infection at another site
Summary
Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. In the 1970s, the US Centers for Disease Control and Prevention (CDC) created the National Nosocomial Infection Surveillance System (NNIS) and published uniform surveillance definitions for nosocomial infections [7,8,9] These definitions have been updated gradually for surgical site infection (SSI) [10], for ventilator-associated pneumonia (VAP) [11], primary bloodstream infection (BSI) [12] and in 2010 for urinary tract infection (UTI) [13]. Key terms such as “device-associated infection” or “intensive care unit (ICU)-associated infection” were defined [14]. This system is integrated as part of the National Healthcare Safety Network (NHSN) [12]
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