Many hospital patients undergo surgeries or receive medical devices, such as catheters , but these also increase the risk of healthcare-associated infections (HAI). Most frequent HAI are surgical site, lower respiratory tract, bloodstream and urinary tract infections. Dutch hospitals can monitor HAI within the collaboration PREZIES (www.prezies.nl) and compare themselves with national figures. Surveillance contributes to timely detection, enabling interventions, if needed, and allowing these to be evaluated.
This thesis of Tjallie van der Kooi describes how in the past 20 years HAI surveillance in combination with patient safety programmes contributed to the reduction of many types of HAI, with the focus on central venous catheter-related bloodstream infection (CRBSI). Dutch hospitals implemented a “bundle” of best practices, and reduced CRBSI rates from 4.0 to 1.6 per 1000 catheter days. The European PROHIBIT study demonstrated the effectiveness of a CRBSI bundle, and of better hand hygiene (HH). Healthcare workers (HCWs) need to wash/disinfect their hands frequently to prevent transmission of micro-organisms. At the start of this study HH was 49%, i.e. in only half of the situations that required HH, this was performed. After the HH campaign the proportion of HCWs that improved HH at least 20% ranged from 33 to 95% between hospitals.
Because patient data are nowadays primarily recorded electronically, some HAI can now be monitored through automated surveillance, which reduces workload and results in more reliable figures. Despite the successful reduction of many HAI, surveillance remains important as both changes in the population, e.g. aging, as changes in healthcare may affect HAI incidence.
