Infection prevention practices in the Netherlands: results from a National Survey

Anita Huis,M. Todd Greene,Sarah Krein,Jeroen Schouten,Sanjay Saint,Marlies Hulscher,David Ratz,Dominique Lescure

doi:10.1186/s13756-019-0667-3

Abstract

ObjectiveTo examine the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI).MethodsBetween 18 July 2017 and 31 October 2017, we surveyed the infection prevention teams of all acute care hospitals in the Netherlands. The survey instrument was based on the ‘Translating Healthcare-Associated Infection Prevention Research into Practice’ (TRIP) questionnaire and adapted to the Dutch context. Descriptive statistics were used to examine the reported regular use of CAUTI, CLABSI, VAP, and CDI prevention practices as well as the hospital characteristics.ResultsOut of 72 eligible hospitals, 47 (65.3%) responded. Surveillance systems for monitoring CAUTI, CLABSI, VAP, and CDI were present in 17.8, 95.4, 26.2, and 77.3% of hospitals, respectively. Antimicrobial stewardship programs have been established in 91.5% of participating hospitals. For CAUTI, the majority of hospitals regularly used aseptic technique during catheter insertion (95%) and portable bladder ultrasound scanners (86.1%). Intermittent catheterization and catheter stop-orders were regularly used by 65.8 and 62.2% of hospitals. For CLABSI, all hospitals regularly used maximum sterile barrier precautions and chlorhexidine gluconate for insertion site antisepsis. Avoidance of the femoral site for central line insertions was regularly used by 65.9% of hospitals. Urinary catheters and central-lines impregnated with antibiotics or antiseptics were rarely used (≤ 5%). Selective decontamination strategies for preventing VAP were used in 84% of hospitals. With the exception of disposable thermometers (31.8%), all prevention practices to prevent CDI were regularly used by more than 80% of hospitals.ConclusionsMost Dutch hospitals report regular use of recommended practices for preventing CLABSI and CDI. Several specific practices to prevent CAUTI and VAP were less frequently used, however, providing an opportunity for improvement.

Highlights

Healthcare-associated infection (HAI) is a serious and persistent problem throughout the world
Primary bloodstream infections accounted for 0.8% of the observed HAIs of which 33% were central line-associated, and pneumonia accounted for 20% of the observed HAIs - of which 21% were ventilator-associated [8]
The instrument contained questions about general hospital characteristics, general infection prevention policies, staffing of the infection control program, and use of specific practices related to the prevention and monitoring of catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI)

Summary

Introduction

Healthcare-associated infection (HAI) is a serious and persistent problem throughout the world. HAIs are burdensome to patients, complicate treatment, prolong hospital length-of-stay, induce resistance of microorganisms to antimicrobials, raise healthcare costs, and can be life-threatening [1,2,3,4,5]. Huis et al Antimicrobial Resistance and Infection Control (2020) 9:7 infection types did not seem to explain the differences between the hospitals [8]. Major types of HAIs are device-associated, including catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) [9,10,11]. The Dutch surveillance data of 2017 pointed out that 17% of the observed HAIs were symptomatic urinary tract infections of which 62% were catheter-associated. Primary bloodstream infections accounted for 0.8% of the observed HAIs of which 33% were central line-associated, and pneumonia accounted for 20% of the observed HAIs - of which 21% were ventilator-associated [8]

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Conclusion