Hospital Acquired Infection Surveillance System Research Articles

National Automated Surveillance of Hospital-Acquired Bacteremia in Denmark Using a Computer Algorithm

BACKGROUND In 2015, Denmark launched an automated surveillance system for hospital-acquired infections, the Hospital-Acquired Infections Database (HAIBA). OBJECTIVE To describe the algorithm used in HAIBA, to determine its concordance with point prevalence surveys (PPSs), and to present trends for hospital-acquired bacteremia SETTING Private and public hospitals in Denmark METHODS A hospital-acquired bacteremia case was defined as at least 1 positive blood culture with at least 1 pathogen (bacterium or fungus) taken between 48 hours after admission and 48 hours after discharge, using the Danish Microbiology Database and the Danish National Patient Registry. PPSs performed in 2012 and 2013 were used for comparison. RESULTS National trends showed an increase in HA bacteremia cases between 2010 and 2014. Incidence was higher for men than women (9.6 vs 5.4 per 10,000 risk days) and was highest for those aged 61-80 years (9.5 per 10,000 risk days). The median daily prevalence was 3.1% (range, 2.1%-4.7%). Regional incidence varied from 6.1 to 8.1 per 10,000 risk days. The microorganisms identified were typical for HA bacteremia. Comparison of HAIBA with PPS showed a sensitivity of 36% and a specificity of 99%. HAIBA was less sensitive for patients in hematology departments and intensive care units. Excluding these departments improved the sensitivity of HAIBA to 44%. CONCLUSIONS Although the estimated sensitivity of HAIBA compared with PPS is low, a PPS is not a gold standard. Given the many advantages of automated surveillance, HAIBA allows monitoring of HA bacteremia across the healthcare system, supports prioritizing preventive measures, and holds promise for evaluating interventions. Infect Control Hosp Epidemiol 2017;38:559-566.

A quality improvement project to improve the accuracy in reporting hospital acquired infections in post cesarean section patients in a district hospital in Rwanda

Purpose Hospitals are responsible for protecting the well-being of their patients and staff. To do so, accurate information is needed for the hospital to make appropriate decisions and allocate resources efficiently. This study aims to describe the implementation process of a surveillance system to reduce hospital-acquired infection (HAI) reporting errors in the maternity unit of a district hospital in Rwanda. Design/methodology/approach The team adapted an evidence-based tool to identify and report HAI, provided training to staff and distributed reporting responsibilities equally between the maternity staff to improve accuracy in HAI reporting. Findings The intervention successfully reduced the reporting discrepancy of HAI from 6.5 to 1.9 per cent: p < 0.05. Practical implications This case study described the implementation process of a surveillance system using strategic problem solving to reduce HAI reporting errors. The results can inform hospitals in similar settings of the steps to follow to implement a cost-neutral HAI surveillance system to reduce reporting errors. The accurate data will enable the hospital to take corrective measures to address HAI in the future. Originality/value The results will inform hospitals in similar settings of steps to follow to implement a cost-neutral HAI surveillance system using the SPS approach to reduce reporting errors.

Establishment of a hospital-acquired infection surveillance system in a teaching hospital in Rwanda

Hospital-based infection surveillance and control programs can reduce hospital acquired infection (HAI) prevalence. In resource-limited countries, HAI surveillance is challenging to implement due to inadequate or lacking laboratory infrastructure and trained personnel. A HAI surveillance system was implemented in a teaching hospital in Rwanda. A multi-disciplinary team developed a point-prevalence HAI surveillance tool based on World Health Organization (WHO’s) criteria and conducted surveillance on all inpatient units from September 2013 to March 2014. The baseline HAI rate was 15.1%. Highest HAI rates were found in intensive care unit (ICU) (50.0%), Neonatal ICU (23.1%) and Orthopedics/burn unit (37.3%). Factors significantly associated with increased risk of developing HAIs included surgery within the past month (odds ratio [OR] 2.75, 95%CI: 1.40, 5.40), use of a urinary catheter (OR 2.10, 95%CI: 1.05, 4.25), use of mechanical ventilator (OR 3.14, 95%CI: 1.01, 9.74), and use of chest drain, naso-gastric tube, external fixator (OR=3.93). Longer hospital length of stay was also significantly associated with a risk of HAI (OR 1.02). It is feasible in a low-resource setting to establish HAI surveillance and obtain an accurate HAI rate. The surveillance information can inform prioritization of infection prevention efforts.

Establishment of a hospital-acquired infection surveillance system in a teaching hospital in Rwanda

Hospital-based infection surveillance and control programs can reduce hospital acquired infection (HAI) prevalence. In resource-limited countries, HAI surveillance is challenging to implement due to inadequate or lacking laboratory infrastructure and trained personnel. A HAI surveillance system was implemented in a teaching hospital in Rwanda. A multi-disciplinary team developed a point-prevalence HAI surveillance tool based on World Health Organization (WHO’s) criteria and conducted surveillance on all inpatient units from September 2013 to March 2014. The baseline HAI rate was 15.1%. Highest HAI rates were found in intensive care unit (ICU) (50.0%), Neonatal ICU (23.1%) and Orthopedics/burn unit (37.3%). Factors significantly associated with increased risk of developing HAIs included surgery within the past month (odds ratio [OR] 2.75, 95%CI: 1.40, 5.40), use of a urinary catheter (OR 2.10, 95%CI: 1.05, 4.25), use of mechanical ventilator (OR 3.14, 95%CI: 1.01, 9.74), and use of chest drain, naso-gastric tube, external fixator (OR=3.93). Longer hospital length of stay was also significantly associated with a risk of HAI (OR 1.02). It is feasible in a low-resource setting to establish HAI surveillance and obtain an accurate HAI rate. The surveillance information can inform prioritization of infection prevention efforts.

Internal and External Validation of a Computer-Assisted Surveillance System for Hospital-Acquired Infections in a 754-Bed General Hospital in the Netherlands.

OBJECTIVE To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs). DESIGN Validation cohort. SETTING A 754-bed teaching hospital in the Netherlands. METHODS For the internal validation of a CAPPS for HAIs, 2,526 patients were included. All patient records were retrospectively reviewed in depth by 2 infection control practitioners (ICPs) to determine which patients had suffered an HAI. Preventie van Ziekenhuisinfecties door Surveillance (PREZIES) criteria were used. Following this internal validation, 13 consecutive CAPPS were performed in a prospective study from January to March 2013 to determine weekly, monthly, and quarterly HAI point prevalence. Finally, a CAPPS was externally validated by PREZIES (Rijksinstituut voor Volksgezondheid en Milieu [RIVM], Bilthoven, Netherlands). In all evaluations, discrepancies were resolved by consensus. RESULTS In our series of CAPPS, 83% of the patients were automatically excluded from detailed review by the ICP. The sensitivity of the method was 91%. The time spent per hospital-wide CAPPS was ~3 hours. External validation showed a negative predictive value of 99.1% for CAPPS. CONCLUSIONS CAPPS proved to be a sensitive, accurate, and efficient method to determine serial weekly point-prevalence HAI rates in our hospital. Infect Control Hosp Epidemiol 2016;1-6.

Active surveillance of hospital-acquired infections in South Africa: Implementation, impact and challenges.

Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem. To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections, based on international standards, in a private academic hospital. Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done. Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance. Active surveillance requires a significant investment in resources and is a sustained operational challenge, although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals.

Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units.

BackgroundVietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam.MethodsMonthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included.ResultsAmong 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively).ConclusionA high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

A Reliable User Authentication and Key Agreement Scheme for Web-Based Hospital-Acquired Infection Surveillance Information System

With the rapid development of the Internet, both digitization and electronic orientation are required on various applications in the daily life. For hospital-acquired infection control, a Web-based Hospital-acquired Infection Surveillance System was implemented. Clinical data from different hospitals and systems were collected and analyzed. The hospital-acquired infection screening rules in this system utilized this information to detect different patterns of defined hospital-acquired infection. Moreover, these data were integrated into the user interface of a signal entry point to assist physicians and healthcare providers in making decisions. Based on Service-Oriented Architecture, web-service techniques which were suitable for integrating heterogeneous platforms, protocols, and applications, were used. In summary, this system simplifies the workflow of hospital infection control and improves the healthcare quality. However, it is probable for attackers to intercept the process of data transmission or access to the user interface. To tackle the illegal access and to prevent the information from being stolen during transmission over the insecure Internet, a password-based user authentication scheme is proposed for information integrity.

Organisation of hospital infection control in Mongolia

As with other areas of the public sector in Mongolia, the healthcare system has undergone significant structural and policy reforms since the early 1990s. The previous infection control system, characterised as a sanitary-epidemiological network, was dismantled with no replacement. A new infection control management system was established in 1997 with the adoption of infection control policies and guidelines, establishment of hospital infection control programmes in all major hospitals, training of health professionals and the commencement of passive surveillance of hospital-acquired infections (HAIs). Recent health statistics claim that HAIs occur in 0.01-0.02% of all hospital admissions with the highest percentage (0.05%) in tertiary hospitals in the capital city Ulaanbaatar, but this is very likely to be an underestimate. In 2002 the Government approved a national programme to establish a sentinel surveillance system for HAIs with improved laboratory-based monitoring. However, implementation has been delayed due to insufficient support from stakeholders and a shortage of resources and trained infection control professionals. Non-governmental infection control initiatives are limited by time and coverage.

Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia

To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI). Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line-associated BSI. Six Victorian public hospitals with more than 100 beds. Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line-associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line-associated BSI were also assessed to see whether they met the definition of central line-associated BSI. Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (k = 0.31). Of the 46 reported central line-associated BSIs, 27 were confirmed to be central line-associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%-73%). Of the 62 cases of bacteremia reviewed that were not reported as central line-associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%-83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72. The agreement between the reporting of central line-associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line-associated BSIs may be missed in Victorian public hospitals.

Impact of revising the National Nosocomial Infection Surveillance System definition for catheter-related bloodstream infection in ICU: Reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals

Effective and comparable surveillance for central venous catheter-related bloodstream infections (CLABSIs) in the intensive care unit requires a reproducible case definition that can be readily applied by infection control professionals. Using a questionnaire containing clinical cases, reproducibility of the National Nosocomial Infection Surveillance System (NNIS) surveillance definition for CLABSI was assessed in an Australian cohort of infection control professionals participating in the Victorian Hospital Acquired Infection Surveillance System (VICNISS). The same questionnaire was then used to evaluate the reproducibility of the National Healthcare Safety Network (NHSN) surveillance definition for CLABSI. Target hospitals were defined as large metropolitan (1A) or other large hospitals (non-1A), according to the Victorian Department of Human Services. Questionnaire responses of Centers for Disease Control and Prevention NHSN surveillance experts were used as gold standard comparator. Eighteen of 21 eligible VICNISS centers participated in the survey. Overall concordance with the gold standard was 57.1%, and agreement was highest for 1A hospitals (60.6%). The proportion of congruently classified cases varied according to NNIS criteria: criterion 1 (recognized pathogen), 52.8%; criterion 2a (skin contaminant in 2 or more blood cultures), 83.3%; criterion 2b (skin contaminant in 1 blood culture and appropriate antimicrobial therapy instituted), 58.3%; non-CLABSI cases, 51.4%. When survey questions regarding identification of cases of CLABSI criterion 2b were removed (consistent with the current NHSN definition), overall percentage concordance increased to 62.5% (72.2% for 1A centers). Further educational interventions are required to improve the discrimination of primary and secondary causes of bloodstream infection in Victorian intensive care units. Although reproducibility of the CLABSI case definition is relatively poor, adoption of the revised NHSN definition for CLABSI is likely to improve the concordance of Victorian data with international centers.

Infeksjoner etter keisersnitt

All hospitals in Norway are required to participate in the Norwegian Surveillance System for Hospital-Acquired Infections (NOIS). Hospitals can choose to have from one to five given surgical procedures under surveillance, caesarean section being one of them. This article describes the incidence of surgical site infections after caesarean sections and identifies causes for such infections. A national protocol, was developed in accordance with the European protocol (HELICS). Patients undergoing a caesarean section (1 September - 30 November in 2005, 2006 or 2007) in the participating hospitals were included and followed-up for 30 days. Cases were identified in accordance to standardised case definitions. Potential risk factors as well as demographic and clinical data were recorded. 3900 women were included. 290 infections were diagnosed (incidence 8.3 %) among the 3491 women who were followed up after discharge. Only 14 % of the infections were diagnosed during the hospital stay. Age higher than 29 years and contaminated wound class 3 were significantly associated with infection. Among the 54 women with an organ/space or deep infection, 20 were readmitted to the hospital and 11 were reoperated. One of 12 women who undergo a caesarean section develops a surgical site infection. The incidence of infections in Norway is lower than in many other European countries. We recommend hospitals to evaluate the preventive measures implemented at their institution.

Caesarean section surgical site surveillance in a private healthcare setting: a collaboration with the Victorian Hospital Acquired Infection Surveillance System (VICNISS) Coordinating Centre

The aim of this study was to test the application of the Victorian Hospital Acquired Infection Surveillance System (VICNISS) surveillance methods in a large private sector provider of maternity services, and compare the infection rates and compliance with national guidelines for surgical antibiotic prophylaxis with the VICNISS aggregate results. VICNISS methods were adopted for a 3-month period for surveillance of surgical site infections following caesarean sections, with the involvement of many sectors within the hospital including surgeons, anaesthetists, maternity services and operating theatre staff. During the study period there were 96 emergency and 205 elective caesareans. There was one superficial infection. The rate of compliance for choice of surgical antibiotic prophylaxis was 95.3%. The collaboration demonstrated the willingness and ability of private healthcare providers to contribute to State infection control surveillance data and highlights the opportunity for State programs to benefit from the inclusion of private sector surveillance data.

MRSA infections in smaller hospitals, Victoria, Australia

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) cause significant morbidity, mortality, and associated costs. Trained infection control (IC) nurses in 84 smaller (<100 acute beds) hospitals during a 20-month period collected data on MRSA infections. The aggregate rate for all MRSA infections confirmed by the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre IC nurse was 1.5 per 10,000 acute care occupied bed days (OBDs) (95% CI: 1.2-1.8). MRSA infections of 0.5 per 10,000 OBDs were detected >48 hours after admission (95% CI: 0.3-0.7). The aggregate rate for MRSA infections in sterile sites was 0.2 per 10,000 OBDs (95% CI: 0.0-0.4) and in nonsterile sites was 1.3 per 10,000 OBDs (95% CI: 1.0-1.6). The results suggested that serious MRSA infections in Victoria's smaller hospitals are an infrequent event. Most are "inherited" either from the community or other health care facilities.

An Alternative Scoring System to Predict Risk for Surgical Site Infection Complicating Coronary Artery Bypass Graft Surgery

To analyze the risk factors for surgical site infection (SSI) complicating coronary artery bypass graft (CABG) surgery and to create an alternative SSI risk score based on the results of multivariate analysis. A prospective cohort study involving inpatient and laboratory-based surveillance of patients who underwent CABG surgery over a 27-month period from January 1, 2003 through March 31, 2005. Data were obtained from 6 acute care hospitals in Victoria, Australia, that contributed surveillance data for SSI complicating CABG surgery to the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre and the Australasian Society of Cardiac and Thoracic Surgeons, also in Victoria. A total of 4,633 (93%) of the 4,987 patients who underwent CABG surgery during this period were matched in the 2 systems databases. There were 286 SSIs and 62 deep or organ space sternal SSIs (deep or organ space sternal SSI rate, 1.33%). Univariate analysis revealed that diabetes mellitus, body mass index (BMI) greater than 35, and receipt of blood transfusion were risk factors for all types of SSI complicating CABG surgery. Six multivariate analysis models were created to examine either preoperative factors alone or preoperative factors combined with operative factors. All models revealed diabetes and BMI of 30 or greater as risk factors for SSI complicating CABG surgery. A new preoperative scoring system was devised to predict sternal SSI, which assigned 1 point for diabetes, 1 point for BMI of 30 or greater but less than 35, and 2 points for BMI of 35 or greater. Each point in the scoring system represented approximately a doubling of risk of SSI. The new scoring system performed better than the National Nosocomial Infections Surveillance System (NNIS) risk index at predicting SSI. A new weighted scoring system based on preoperative risk factors was created to predict sternal SSI risk following CABG surgery. The new scoring system outperformed the NNIS risk index. Future studies are needed to validate this scoring system.

Validation of Coronary Artery Bypass Graft Surgical Site Infection Surveillance Data From a Statewide Surveillance System in Australia

To measure the accuracy and determine the positive predictive value (PPV) and negative predictive value (NPV) of data submitted to a statewide surveillance system for identifying surgical site infection (SSI) complicating coronary artery bypass graft (CABG) surgery. Retrospective review of hospital medical records comparing SSI data with surveillance data submitted by infection control consultants (ICCs). Victorian Hospital Acquired Infection Surveillance System (VICNISS) Coordinating Centre in Victoria, Australia. All patients reported to have an SSI following CABG surgery and a random sample of approximately 10% of patients reported not to have an SSI following CABG surgery. The VICNISS ascertainment rate for CABG procedures in Victoria was 95%. One hundred sixty-nine medical records were reviewed, and reviewers agreed with ICCs about 46 (96%) of the patients reported as infected by the ICCs and 31 (91%) of the patients identified with a sternal SSI by the ICCs. In one-third of SSIs, the depth of SSI documented by ICCs was discordant with that documented by the reviewers. Disagreement about patients with donor site SSI was frequent. When the review findings were used as the reference standard, the PPV for ICC-reported SSI was 96% (95% confidence interval [CI], 86%-99%), and the NPV was 97% (95% CI, 92%-99%). For ICC-reported sternal SSI, the PPV was 91% (95% CI, 76%-98%) and the NPV was 98% (95% CI, 94%-100%). There was broad agreement on the number of infected patients and the number of patients with sternal SSI. However, discordance was frequent with respect to the depth of sternal SSI and the identification of donor site SSI. We recommend modifications to the methodology for National Nosocomial Infection Surveillance System-based surveillance for SSI following CABG surgery.

Performance of the National Nosocomial Infections Surveillance Risk Index in Predicting Surgical Site Infection in Australia

The Victorian Hospital Acquired Infection Surveillance System (VICNISS) hospital-acquired infection surveillance system was established in 2002 in Victoria, Australia, and collates surgical site infection (SSI) surveillance data from public hospitals in Australia. To evaluate the association between the US National Nosocomial Infections Surveillance (NNIS) system's risk index and SSI rates for 7 surgical procedures. SSI surveillance was performed with NNIS definitions and methods for surgical procedures performed between November 2002 and September 2004. Correlations were assessed using the Goodman-Kruskal gamma statistic. Data were submitted for the following numbers of procedures: appendectomy, 545; coronary artery bypass graft (CABG), 4,632; cholecystectomy, 1,001; colon surgery, 623; cesarean section, 4,857; hip arthroplasty, 3,825; and knee arthroplasty, 2,416. NNIS risk index and increasing SSI rate were moderately well correlated for appendectomy ( gamma =0.55), colon surgery ( gamma =0.48), and cesarean section ( gamma =0.42). A fairly positive correlation was found for cholecystectomy ( gamma =0.17), hip arthroplasty ( gamma =0.2), and knee arthroplasty ( gamma =0.16). However, for CABG surgery, a poor association was found ( gamma =0.02). The NNIS risk index was positively correlated with an increasing SSI rate for all 7 procedures; the strongest correlation was found for appendectomy, cesarean section, and colon surgery, and the poorest correlation was found for CABG surgery. We believe that risk stratification with the NNIS risk index is appropriate for comparison of data for most procedures and superior to use of no risk adjustment. However, for some procedures, particularly CABG, further studies of alternative risk indexes are needed to better stratify patients.

The establishment of a statewide surveillance program for hospital-acquired infections in large Victorian public hospitals: A report from the VICNISS Coordinating Centre

A 1998 survey of acute Victorian public hospitals (VPH) revealed that surveillance of hospital-acquired infections (HAI) was underdeveloped, definitions and methodology varied considerably, and results disseminated inconsistently. The survey identified the need for an effective surveillance system for HAI. To develop and support a standardized surveillance program for HAIs in large acute VPH and to provide risk-adjusted, procedure-specific, HAI rates. In 2002, the independent Victorian Nosocomial Infection Surveillance System (VICNISS) Coordinating Centre (VCC) was established to develop and support the standardized surveillance program. A multidisciplinary team was recruited. A communication strategy, surveillance manual, user groups, and Web site were developed. Formal education sessions were provided to participating infection control nurse consultants (ICCs). Surveillance activities were based on the US Centers for Diseases Control and Prevention's National Nosocomial Infection Surveillance System (NNIS) surgical site infection and intensive care unit (ICU) components. NNIS methods were modified to suit local needs. Data collection was paper based or through existing hospital software. An advisory committee of key stakeholders met every second month. The surveillance program was rolled out over 12 months to all 28 large adult VPH. Data on over 20,000 surgical procedures performed at participating sites between November 11, 2002, and December 31, 2004, were submitted. Thirteen hospitals contributed to the ICU surveillance activities. Following aggregation and analysis by the VCC, hospital- and state-level results were posted on the Web page for hospitals to review. A standardized approach for surveillance of HAI was established in a short time frame in over 28 VPH. VICNISS is a tool that will continue to provide participating hospitals with a basis for continuous quality improvement.

SURGICAL ANTIBIOTIC PROPHYLAXIS IN SMALLER HOSPITALS

In 2004, The Victorian Hospital Acquired Infection Surveillance System Coordinating Centre established a smaller hospital (<100 beds) surveillance programme that included an optional 'surgical antibiotic prophylaxis' (SAP) module. Appropriate SAP is believed to be one of the most effective strategies to reduce surgical site infections after certain surgical procedures. Trained infection control nurses in the participating hospitals were asked to collect SAP data for the first 50 consecutive procedures that could be classified into 1 of 12 surgical groups. The choice, timing and duration of antibiotics were compared against the Australian Therapeutic Antibiotic version 12 Guidelines and the US National Surgical Infection Prevention Project Advisory Statement. Fifty-one of the 87 smaller hospitals that participated in the surveillance programme of The Victorian Hospital Acquired Infection Surveillance System Coordinating Centre carried out surgery. Over 20 months, 25 of these hospitals contributed data on 1872 procedures. Antibiotic choice, timing and duration were 52.6, 54.7 and 76.1%, respectively, concordant with published recommendations. For antibiotic choice in five surgical groups (appendectomy, colon surgery, gastric surgery and abdominal and vaginal hysterectomies), less than half of the procedures were concordant with the Australian Therapeutic Antibiotic Guidelines. Substantial opportunities exist in smaller hospitals to improve compliance with published SAP recommendations. Further studies are required to determine the reasons for poor compliance with these recommendations.

Evolution of infection control in Egypt: Achievements and challenges

The high prevalence of hepatitis C virus (HCV) infection in Egypt highlighted the urgent need for implementing infection control (IC) programs in Egypt. The Ministry of Health and Population (MOHP), in collaboration with the US Naval Medical Research Unit No. 3, and the World Health Organization (WHO), developed a national plan to initiate an IC program with the objectives of improving quality of care and reducing transmission of hospital-acquired infections. The strategic plan for this program included setting up an organizational structure, developing IC national guidelines, training health care workers, promoting occupational safety, and establishing a system for monitoring and evaluation. Implementation of the program started in late 2001. The achievements to date include developing a national organizational structure, IC guidelines, and a comprehensive IC training program. To date, a total of 72 hospitals in 13 governorates have been enrolled in the program, and 235 IC professionals have been trained. Many challenges were faced, including administrative, financial, and motivational difficulties. Future plans include expansion of the program to cover all 27 governorates of Egypt and establishment of a surveillance system for hospital-acquired infections. The process of developing the IC program in Egypt may serve as a model for other resource-limited countries that seek to initiate similar programs.