Control Of Healthcare-associated Infections Research Articles

Healthcare workers\u2019 perspectives on healthcare-associated infections and infection control practices: a video-reflexive ethnography study in the Asir region of Saudi Arabia

BackgroundHealthcare-associated infections (HAIs) are a global public health problem. For the fulfillment of Saudi Arabia’s Vision 2030, the promotion of preventive care medicine through HAI management is a crucial issue. This study explores the perspectives of Saudi tertiary healthcare workers (HCWs) on HAIs and infection control measures.MethodsQuantitative data were assessed to determine HCWs’ knowledge of HAI and their attitudes towards and practice of infection control measures. Semi-structured interviews were used to collect qualitative data from 40 doctors and nurses. The interviews were audio-recorded and transcribed verbatim. Further, routine sterile procedures in the wards and intensive care units were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was videographed and transcribed. Both interview data and reflective discussion of the video were analysed using thematic analysis. The quantitative data were analysed using the Kruskal–Wallis test and logistic regression analysis.ResultsKruskal–Wallis test revealed no difference in mean knowledge, attitude, or practice scores between nurses/ doctors or the genders. There was a significant difference in knowledge score and practice scores between the Intensive care unit & the Paediatric ward /infection control department with the maximum scores in knowledge and practice among participants from the intensive care unit. Logistic regression analysis for dependent variables (knowledge and attitude) and independent variables like age, gender, designation, and departments was not significant. The qualitative data yielded four themes: knowledge of HAI and infection control, infection control measures in practice, a shortfall in infection control measures and HAI, and required implementation. Video-reflexive ethnography (VRE) revealed lapses in handwashing practice and proper usage of personal protective equipment (PPE), especially surgical masks.ConclusionEarly introduction of training programmes in medical and nursing schools and video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to HCWs. A possible reason for the outbreak of Middle East Respiratory Syndrome coronavirus in this part of Saudi Arabia could be a lapse in PPE usage. Intensive training programs for all the HCWs, strict vigilant protocols, and a willingness to change behaviour and practice, will significantly benefit the spread of outbreaks.

Healthcare-associated infection prevention and control management in a tertiary hospital and an overall evaluation.

Healthcare-associated infection (HAI) is a crucial factor influencing medical quality. Studies about HAI management situations are rare, especially for the Inner Mongolia region of China. Therefore, this study aimed to investigate management procedures and the overall evaluation of HAI in order to inform HAI management improvement more scientifically. A questionnaire was used to investigate HAI-related prevention and control indicators in tertiary hospitals in the Inner Mongolia region from July 2018 to June 2019. The survey showed that the mean incidence rate of HAI was 3.79%. The mean rate of hand hygiene compliance of healthcare workers (HCWs), inpatient's antibiotics-use rate, and the detection of the antibiotic ratio before therapy was 54.34%, 34.33%, and 25.40%, respectively. The mean of the surgical site infection (SSI) rate of the level I incision and the preventive antibiotics-use ratio of the level I incision was 1.31% and 28.89%, respectively. The mean of the multi-drug resistant organism (MDRO) infection rate was 0.40% and the mean of the MDRO detection rate was 18.55%. The mean of the central line-associated bloodstream infection rate was 2.24%, the ventilator-associated pneumonia (VAP) rate was 11.17%, and the catheter-associated urinary tract infection (CAUTI) rate was 1.95‰. As for the overall evaluation, 19 (35.85%) hospitals had a bad grade, 18 (33.96%) hospitals had a medium grade, and 16 (30.19%) hospitals had a good grade. The incidence rate of HAI in tertiary hospitals in the Inner Mongolia region is higher than the national level. Also, the overall evaluation of bad-grade hospitals and their deficiencies should be used as an example to improve the HAI management level.

Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections.

Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies. Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.

Incidencia de infección de localización quirúrgica en cirugía de colon según metodología RENAVE: estudio prospectivo 2017-2019

BackgroundNavarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. Methods416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. ResultsThe cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories2 and3. ConclusionsThe incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.

Osasun-asistentziarekin erlazionatutako infekzioen epidemiologia eta kontrola

Osasun-asistentziarekin erlazionatutako infekzioak (OAEI) hainbat osasun-eremutan osasun-arreta jasotzeagatik gaixoek paira ditzaketen infekzioak dira. Infekzio hauek ez dira gaixoetan bakarrik azaltzen; osasun-langileei, bestelako langileriari eta gaixoen bisitariei ere kalte egin diezaiekete. Infekzio hauen ondorioz, gaixoen morbilitatea eta heriotza-tasa areagotu egiten da eta, aldi berean, antimikrobianoen aurkako erresistentziak eta kostu ekonomikoak handitu egiten dira. Europa mailan % 5,7k (3,2 milioi pertsona) pairatzen du honelako infekzioa urtero eta Espainia mailan infekzio hauen prebalentzia % 4,8koa da. Espainian, OAEI usuenak dira gernubidekoa, arnasbidekoak, kokapen kirurgikoko infekzioak eta bakteriemiak. Mikroorganismo ezberdinak daude inplikatuak infekzio mota horietan, baina bakterioak dira ugarienak. Infekzioak murrizteko, funtsezkoa da osasun-eremua ahalik garbiena mantentzea, eta bertan biltzen den pertsona orok mikroorganismoen trans- misioa gutxitzeko neurriak hartzea. Hori dela eta, OAEIen zaintza eta prebentziorako neurriak aurrera eramatea funtsezkoa da ahalik paziente gutxiena kaltetzeko. Neurri horiek infekzioaren kate epidemiologikoaren elementuak moldatzera bideratuta daude eta lau taldetan sailka daitezke: neurri estandarrak, transmisio-bidearen araberako neurriak, osasun-eremuaren ingurumen neurriak eta infekzioen kontrol eta zaintzarako prozedura espezifikoak. Horien artean daude eskularruak, maskarak edo mantala jartzea; airearen edo ur laginen kontrol mikrobiologikoa; elikagaien kudeaketaren gainekoak; gaixoen eta osasun-langileen txertoen bidezko immunizazioa edo antibiotikoen bidezko profilaxia. Baina neurri horietatik garrantzitsuena eta mundu-mailan hedatuta dagoena osasun-profesionalek, bisitariek eta baita pazienteek ere burutu behar duten eskuen higienea da, hori baita infekzio hauek murrizteko ekintzarik eraginkorrena, Munduko osasun Erakundeak aipatzen duen moduan »Arreta garbia, arreta seguruagoa» kanpainan. OAEIak eragin ditzaketen mikroorganismo ohikoenak zeintzuk diren jakinik, horien transmisioa ekiditeko eta, horrela, infekzioen tratamendu egokiena aukeratzeko neurriak hobeto har daitezke.

Early diagnosis and rapid isolation: response to COVID-19 outbreak in Korea

Early diagnosis and rapid isolation: response to COVID-19 outbreak in Korea

Infection preventionists role in antimicrobial stewardship: Survey of APIC members

The primary job responsibility of infection preventionists (IPs) is to lead organizational initiatives that prevent and control health care-associated infections. Increasingly, IPs are participating in activities that support antimicrobial stewardship programs (ASPs). We conducted a survey of Association of Professionals in Infection Control and Epidemiology members practicing in acute care facilities to determine the degree of their involvement in ASP activities.

Surveillance of surgical-site infections and antimicrobial resistance patterns in a tertiary hospital in Alexandria, Egypt.

Surveillance and antimicrobial resistance (AMR) monitoring are fundamental to Health care associated infections control. Limited data are available from developing countries for both. This study aimed to evaluate incidence and risk factors of surgical site infections (SSIs), etiological pathogens and AMR patterns identification. A prospective active surveillance study was implemented over a 24- month period at a 110-bed multispecialty non-teaching tertiary hospital. Follow up data were collected for 30-90 days. SSI was diagnosed according to Centers for Disease Control and Prevention and National Healthcare Safety Network (CDC/NHSN) criteria. The SSI isolates were identified by Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF/MS). Antibiotics susceptibility test was performed according to Clinical Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Out of a total of 3,642 patients, 70% had complete follow-up. SSI was detected in 57 cases (2.3%), 61.4% of which were detected post discharge. Factors significantly associated with increased SSI risk included smoking, diabetes, ASA score 5/E, ICU admission, previous admission and increased hospital stay. Sixty-five isolates were obtained; 70.8% were GNB while 24.6% were GPC and 4.6% were Candida albicans. Regarding AMR, 58.7% of isolates were extended spectrum β lactamase (ESBL) producers while 45.7% were Carbapenem resistant. Multi drug resistant (MDR) was detected in 13% of isolates, 54.3% were extended drug resistant (XDR) and 10.9% were pan drug resistant (PDR). Eighty-six percent of Staphylococci isolates were methicillin-resistant. Despite low SSI rates detected, the high incidence of AMR identified is alarming.

Direct medical burden of antimicrobial-resistant healthcare-associated infections: empirical evidence from China

Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the biggest global public health challenges, and overlap widely. These infections cause significant morbidity and mortality, put pressure on health systems, and incur rising direct and indirect costs. This study analysed the direct medical burden attributable to AMR-HAIs in Chinese public tertiary hospitals, and aimed to inform both the medical regulators and hospital managers for better control of HAIs and containment of AMR. The propensity score matching method (γ= 0.25σ, nearest neighbor 1:1 matching) was applied to conduct a retrospective cohort study in five public tertiary hospitals in the Hubei province of China during 2013-2015. Descriptive analysis, Pearson's chi-squared test, Mann-Whitney U-test, Wilcoxon signed-rank test and paired/independent Z/T test were conducted. The statistically significant level was set at P<0.05. From 2013 to 2015 overall, the additional total medical expenditure per HAI-AMR inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-AMR inpatient was 41 days compared with that of the non-HAIs (P<0.001). In combination with AMR, HAIs caused significant additional medical expenses and affected the turnover rate of hospital beds. Most of the increased medical costs fell to patients and their families. These findings call for more effective control of HAIs and containment of AMR. A national study is needed to estimate the medical, social and economic burden of HAIs in combination with AMR.

Effective cooperation

The article presents the effective experience of cooperation of two non-governmental organizations in the Nizhny Novgorod region: Professional Association of Specialists with Higher and Secondary Medical and Pharmaceutical Education and National Association of Specialists for the Control of Healthcare-Associated Infections.

Prevention and Control of Healthcare-Associated with Infections in Birth Rooms of Referral Hospitals in Ouagadougou: Availability of Equipment, Knowledge and Practices of Health Workers

Objective: The neonatal mortality rate remains a serious problem in most countries in sub-Saharan Africa such as Burkina Faso, where, in 2010 this mortality rate was 28 per 1000 live births [1] [2]. Its reduction is possible and passes first by the strict prevention of infections in birth rooms. The objective of this study was to describe the practices of infection prevention in the birth rooms of seven referral hospitals in Ouagadougou from April 1 to July 31, 2016. Materials and Methods: This was a cross-sectional study on the knowledge, attitudes and practices of the rules of prevention and control of healthcare associated infections (PCHAI) among 123 consenting health workers who provided birth room care in 7 hospitals in Ouagadougou. Data were collected through individual interviews and direct observations. The study was authorized by the Institutional Ethics Committee in 2015 under the number 32. The data analysis was done with the Epi Info software version 2000. Results: The “five clean in the birth room” were known by 26.83%. Regarding the equipment used for PCHAI, sterile gloves were mentioned by 75.61% of the agents, the source of clean water by 62.60% and soap by 57.11%; in practice, 17.07% of the respondents had not washed their hands and 42 providers (34%) had not performed with complete mastery the wearing of sterile gloves before giving birth, and 55.28% had not cleaned the perineum. Conclusion: Deficiencies in the prevention and control of healthcare-associated infections have been identified. Training on infection prevention in the neonatal period is needed for the benefit of hospital providers.

Introduction of NGS in Environmental Surveillance for Healthcare-Associated Infection Control.

The hospital environment significantly contributes to the onset of healthcare associated infections (HAIs), representing the most frequent and severe complications related to health care. The monitoring of hospital surfaces is generally addressed by microbial cultural isolation, with some performance limitations. Hence there is need to implement environmental surveillance systems using more effective methods. This study aimed to evaluate next-generation sequencing (NGS) technologies for hospital environment microbiome characterization, in comparison with conventional and molecular methods, in an Italian pediatric hospital. Environmental samples included critical surfaces of randomized rooms, surgical rooms, intensive care units and delivery rooms. The resistome of the contaminating population was also evaluated. NGS, compared to other methods, detected with higher sensitivity the environmental bacteria, and was the only method able to detect even unsearched bacteria. By contrast, however, it did not detect mycetes, nor it could distinguish viable from dead bacteria. Microbiological and PCR methods could identify and quantify mycetes, in addition to bacteria, and PCR could define the population resistome. These data suggest that NGS could be an effective method for hospital environment monitoring, especially if flanked by PCR for species identification and resistome characterization, providing a potential tool for the control of HAI transmission.

A Path to Ending Hepatitis C in Ethiopia: A Phased Public Health Approach to Achieve Micro-Elimination.

Ethiopia's hepatitis C virus (HCV) prevalence is predicted to rise by 2030. To halt this increasing trend, a suitable approach to the elimination of HCV is needed. This review explores the current status, challenges, and opportunities and outlines a strategy for the micro-elimination approach in Ethiopia. I searched PubMed and EMBASE using combined Medical Subject Heading databases for the literature on HCV micro-elimination. A phased public health approach to HCV micro-elimination, including preparation/capacity building (phase I), implementation (phase II), and rollout and scale-up (phase III), targeting people living with HIV, prisoners, chronic hepatitis and cancer patients, blood donors, and pregnant women is a pragmatic strategy to Ethiopia. This can be implemented at general and tertiary care referral hospitals with a future scale-up to district hospitals through task-shifting by training general practitioners, nurses, laboratory technologists, and pharmacists. Availability of the highly effective direct-acting antivirals (DAAs) can be ensured by expanding the existing program that provides highly subsidized DAAs through an agreement with Gilead Sciences, Inc. and eventually aiming at domestic generic manufacturing. The significant enablers to HCV micro-elimination in Ethiopia include the control of healthcare-associated HCV infection, blood safety, access to affordable testing and pan-genotypic DAAs, task-shifting, multisectoral partnership, and regulatory support. General population-based HCV screening and treatment are not cost-effective for Ethiopia because of high cost, program complexity, and disease epidemiology.

Evolution of Healthcare-associated infections over five years: results of prevalence surveys

Abstract Background Tunisia is not spared from the scourge of healthcare associated infections (HAIs). National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. We aimed to describe bacteriological profile as well as treatment modalities of HAIs in Sahloul Hospital for the last five years. Methods We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Results Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2015, 17 germs were identified, and in 88.2% of cases (n = 5), isolated pathogens were also gram-negative bacilli, the most frequent were Pseudomonas aeroginosa (n = 4) and Acinetoobacter baumanii (n = 3). Besides, cephalosporin 3rd generation was the most frequent antibiotic used for the treatment. However, in 2016, Klebsiella Pneumoniae was the most frequent germ isolated. Among those infected patients, 26 were treated (92.8%). In 2017, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%), mostly Escherichia coli and Pseudomonas aerginosa, followed by Acinetobacter baumanii. in 2018, 16 germs were identified, the most frequent were Gram Negative Bacilli (55.5%), mostly Klebsiella Pneumoniae. Conclusions The challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms. Key messages Our study helped us to have an insight into the most common isolates identified throughout the last five years. An incidence survey was carried out to better highlight the impact of healthcare associated infections in our hospital.

Artificial Intelligence-based tools to control healthcare associated infections: where do we stand

Abstract Background Control of Healthcare associated infections (HAI) is a key public health concern in Europe. Current HAI surveillance systems are based on manual medical records review, vulnerable to misclassification &amp; expensive. Artificial intelligence (AI), as a digital tool, offers great potential to HAI control. Still, scant evidence is available on both its practice and impact. Methods As part of a broader multidisciplinary project, we conducted a systematic review to retrieve, pool and critically apprize all the available evidence on practice, performance and impact of AI-based HAI control programmes. We followed PRISMA and searched the Medline and Embase databases for relevant studies. Included studies were stratified by HAI type and outcomes of interest, including all possible performance measures, clinical, organizational and economic outcomes. Results We screened 2873 records, resulting in 27 papers included in the review. Studies were carried out in 9 countries, the majority in the US (56%), 18.5% in EU countries, 25.9% published in 2018. Two thirds of studies focused on selected types of infections. Study designs were very diverse and performance observed for HAI detection were very heterogeneous, precluding pooled calculation of summary diagnostic accuracy estimates in most instances, but generally higher than non AI-based models. Overall performance measures of AI algorithms were: sensitivity range 19%-92%, accuracy 70.2%-96.1%. Conclusions Use of AI for HAI surveillance of HAI has increased reliability compared to traditional surveillance or to automated surveillance models. With ongoing improvements in information technology, implementation of AI models will improve the quality and capacity of surveillance will support hospital HAI surveillance. Main messages AI offer great potential to healthcare associated infections control. Preliminary evidence show AI-based models have perform better than manual or automated models for HAIs detection.

Artificial Intelligence-based tools to control healthcare associated infections: where do we stand

Abstract Background Control of Healthcare associated infections (HAI) is a key public health concern in Europe. Current HAI surveillance systems are based on manual medical records review, vulnerable to misclassification and expensive. Artificial intelligence (AI) offers great potential to public health action and, specifically, to HAI control. Still, scant evidence is available on both its practice and impact. Methods As part of a broader multidisciplinary project, we conducted a systematic review to retrieve, pool and critically apprize all the available evidence on practice, performance and impact of AI-based HAI control programmes. We followed PRISMA guidelines and searched the Medline and Embase databases for relevant studies. Included studies were stratified by HAI type and outcomes of interest, including all possible performance measures, clinical, organizational and economic outcomes. Results We screened 2873 records, resulting in 27 papers included in the review. Studies were carried out in 9 countries, the majority in the US (56%), 18.5% in EU countries, 25.9% published in 2018. Two thirds of studies focused on selected types of infections. Study designs were very diverse and performance observed for HAI detection were very heterogeneous, precluding pooled calculation of summary diagnostic accuracy estimates in most instances, but generally higher than non AI-based models. The highest performance outcomes were Specificity and Negative Predictive Value. Overall performance measures of AI algorithms were: sensitivity range 19%-92%, specificity range 64%-96%, accuracy 70.2%-96.1%. Conclusions Use of AI algorithms for HAI surveillance of HAI has increased reliability compared to traditional surveillance or to automated surveillance models. With ongoing improvements in information technology, implementation of AI models will improve the quality and capacity of surveillance will support hospital HAI surveillance. Key messages Artificial Intelligence (AI) offer great potential to healthcare associated infections (HAI) control. Preliminary evidence show AI-based models have perform better than manual or automated models for HAIs detection.

A Convergence Study on the Factor Influencing to Healthcare-Associated Infection Control Guidelines of Nursing Students

In this preliminary study exploring the development of an convergent educational program, we identified the factors that affect adherence to healthcare-associated infection (HAI) control guidelines. The data were collected using a self-reported questionnaire of 183 nursing students. The collected data were analyzed using AMOS 21.0 and SPSS 21.0 program. The model fit was χ2=52.06 (df=9, p <.01), GFI=.93, RMSEA=.16, NFI=.85, and CFI=.90, and the explanatory power was 26.2%. As a result in this study, it was found that the theory of planned behavior(TPB) was appropriate for explaining the intention about healthcare-associated infection control guidelines. It is necessary to develop an education program that can reinforce the concepts of TPB, and iterate research to verify its effectiveness.

Factors Affecting the Performance of Healthcare-Associated Infections (HAIs) control- Focus on Empowerment and Awareness of General Hospital Nurses

The aims of the study to investigate the relationship between awareness, empowerment and performance of healthcare associated infections (HAIs) control and to identify factors influencing performance of HAIs among general hospital nurses. Data were collected from 230 nurses in two general hospitals in B city, with the questionnaire of an empowerment, awareness and performance of infection control tool. The data were analyzed by t-test, one-way ANOVA, Pearson's correlation coefficient and multiple regressions. The performance of infection control was significantly correlated with empowerment and awareness of infection control. The empowerment had a positive correlation with an awareness of infection control (r= .233, p <.001) respectively. The infection control performance was influenced by infection control awareness, empowerment and number of annual job training, which explained 42.2% of the performance of infection control. Infection management performance of general hospitals nurses is affected not only by infection awareness but also by empowerment and job education. Therefore, it suggests that HAIs management program could develop for the nurses and provide empowerment with job training to improve the management and performance of HAIs, also to reinforce via constant support by the hospital.

The Significance of Multidirectional Studies in Control of Health Care-Associated Infections

The Significance of Multidirectional Studies in Control of Health Care-Associated Infections

An Overview of Surgical Site Infection in Low- and Middle-Income Countries: the Role of Recent Guidelines, Limitations, and Possible Solutions

The purpose of this manuscript is to review preventive strategies for surgical site infection (SSI) in low- and middle-income countries (LMIC) and how the recent World Health Organization (WHO) guidelines, along with the Centers for Disease Control (CDC) recommendations on SSI prevention, may be implemented on these settings, considering frequent limitations and possible solutions. Surgical site infection (SSI) is the most common postoperative complication and in LMIC is the first cause among healthcare-associated infections (HAI). SSIs are largely preventable if there is a standardized process of care throughout the operative and perioperative period. SSIs, especially clean procedures, are considered a marker of quality in healthcare. Education and cultural aspects have an enormous influence on the correct performance of SSI preventive measures. Getting patients and healthcare professionals engaged with prevention is the first step to make policies work properly in LMIC, no matter how this might take a lot of time and effort to be accomplished. Infection control professionals are not a luxury in any setting and efforts to support HAI control should be a priority. Surveillance is one of the most important and difficult tasks in SSI prevention.