Abstract
Surveillance is a key component of the French plan for prevention of healthcare-associated infection (HAI) and has progressively evolved in the past decades. We describe the development and current organisation of surveillance of HAI in France and summarise key achievements and results. Surveillance of HAI is under the auspice of the national institute for public health surveillance through a central coordinating structure, the Reseau d alerte, d investigation et de surveillance des infections nosocomiales (RAISIN), which consists of five regional coordinating structures, two national advisory committees of the Ministry of Health and public health agencies. Surveillance includes the performance of national prevalence surveys every five years (latest in 2006), specific surveillance networks to follow trends and characterise HAI that are national priority, and mandatory reporting of HAI that meet specific criteria for alert purposes. RAISIN prioritises activities, defines technical specifications of surveillance systems, coordinates their implementation, and supports response to alerts, emergences or outbreaks of HAI. We demonstrate that the French surveillance program of HAI has become comprehensive and contributes to evaluating the impact of control and prevention of HAI. Data from RAISIN indicate a general decrease in the risk of HAI in acute care in France. They show a decrease in HAI during recent years, particularly of those related to methicillin-resistant Staphylococcus aureus (MRSA) for which a drop of 38% was documented between 2001 and 2006. RAISIN is also integrated into European surveillance of HAI coordinated by the European Centre for Disease Control.
Highlights
Healthcare-associated infections (HAI) are leading causes of morbidity and mortality among hospitalised patients [1]
Five to 10 % of patients admitted to acute care hospitals acquire during their stay one or more infections according to recent European prevalence surveys [2,3,4].This proportion is greater in immunocompromised patients and patients with underlying diseases, undergoing invasive procedures, admitted to an intensive care unit (ICU) and the elderly
In 173 HCF that participated over all years, compliance to glove use increased from 60.6% in 2004 to 66.1% in 2006 and sharps disposal containers accessibility increased from 65.2% to 68.6%, while blood and body fluids exposure (BBFE) incidence decreased slightly (Table 3) [45]
Summary
Healthcare-associated infections (HAI) are leading causes of morbidity and mortality among hospitalised patients [1]. Among the 228 HCF that participated from 2003 to 2006 incidence of ESBL increased from 0.17 to 0.19 (+12%, Table 3) in line with a growing proportion of Escherichia coli among Enterobacteriaceae species (2003:25%; 2006: 43%) These results suggest a positive impact of the HAI national program on hospital-acquired MRSA [50]. Following C. difficile 027 introduction in 2006 in France, a network of five regional laboratories (one in each CClin area) coordinated by a specific NRC was created to enhance the national capacity of typing of C. difficile strains isolated from patients suffering severe disease or outbreaks identified through the mandatory notification system This close institutional interaction between routine surveillance activities, detection of new emerging infectious threats and the planning of reference laboratory resources greatly facilitated the response to 027 C. difficile spread in French hospitals [59]. A prospective surveillance of C. difficile infections has been implemented in 2009
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