Nosocomial infection surveillance and control: current situation in Spanish hospitals

doi:10.1016/j.jhin.2009.01.013

Journal of Hospital Infection

Volume 72, Issue 1, May 2009, Pages 50-56

https://doi.org/10.1016/j.jhin.2009.01.013 Get rights and content

Summary

We studied healthcare-associated infection (HCAI) surveillance and control programmes in Spanish hospitals in 2006 and the human resources and materials used. A questionnaire on the structure, organisation and resources for HCAI surveillance and control was sent to all hospitals registered in the 2005 National Catalogue of Hospitals. A total of 237 hospitals (29.8%) responded, representing 55.9% of the beds included in the catalogue. Some 92% of hospitals had a surveillance and control programme, although 29.9% had had it for less than five years. Only 17.4% of hospitals had one infection control nurse per 250 beds, and only 36.2% had one infection control doctor per 500 beds. Surveillance is the main activity of those responsible for surveillance and control, and the most widely used systems are reviews of microbiology laboratory test results and studies of outbreaks, prevalence surveys, the incidence of certain procedures and of infection in critical care areas. Collaboration in multicentre studies is variable. EPINE, the prevalence survey of nosocomial infections in Spain, is performed annually in 80.5% of centres; ENVIN-UCI, a study of the incidence of infection in critically ill patients, is carried out in 24.8%, and the European study of the incidence of surgical infection, HELICS, in 22.7%. Priority should be given to improving specialised human resources and establishing common surveillance and control systems.

Introduction

Nosocomial or healthcare-associated infection (HCAI) is the most frequent and widely studied adverse effect of hospitalisation, and a major public health problem in developed countries due to morbidity and mortality.1, 2 Surveillance and control programmes have been known to reduce the incidence of infection since the 1980s.³ Both the SENIC (Study on the Efficacy of Nosocomial Infection Control) and subsequent analyses recommend that hospitals employ specialised medical and nursing personnel for this purpose, and that they develop programmes to achieve effective control of nosocomial infection.4, 5 The SENIC study established standards for infection control personnel as a function of the number of beds, such as one nurse per 250 beds.

Infection control programmes (ICPs) commenced in Spain in the 1980s. The infection control model designed for hospitals then still operates today.6, 7, 8 Preventive medicine services were created for infection surveillance and control. They are composed of physician specialists in preventive medicine and public health, and infection control nurses. Most hospitals have an infection control committee as an advisory body to hospital management.⁹ In the 1990s, hospital outbreaks caused by meticillin-resistant Staphylococcus aureus (MRSA) and the impact in the media of aspergillus outbreaks were key factors in the creation of new preventive medicine services in some public hospitals.10, 11, 12, 13, 14 The Prevalence Survey of Nosocomial Infections in Spain (EPINE) using a common methodology has been published annually since 1990. In 1990, the prevalence was 9.87%, and in 2006 it was 7.90%. This downward trend was significant and has been credited to improved infection prevention and control.15, 16

This study aimed to identify the epidemiological surveillance systems and nosocomial infection prevention and control programmes in Spanish hospitals, together with the available resources and their level of development.

Section snippets

Study population

The National Catalogue of Hospitals was used; in 2005 it listed 795 hospitals: acute care (N = 541), long term (N = 116), psychiatric (N = 90) and single specialty (oncological, ophthalmic, maternity, etc.) (N = 48).

Study design

This was a cross-sectional observational study using a self-administered questionnaire aimed at key informants who were responsible for the nosocomial infection surveillance and control or, occasionally, delegated by the hospital administrator.

Questionnaire

Questions were grouped as follows:

–
General:

Results

Replies were received from 237 (29.8%) of the 795 hospitals contacted. The response rate was 17.4% for hospitals with <200 beds, 52% for those with 200–500 beds, and 80% for hospitals with >500 beds; it represented 55.9% of all hospital beds (160 490).

Discussion

This is the largest and most complete survey of hospital surveillance and control systems published in Europe. Even though ICP activities in Spain began in the 1980s, previous surveys involved only some aspects of the topic.¹⁷ Although most hospitals with >500 beds replied, our study could have a non-response bias since only a small percentage of small hospitals responded. Nevertheless, the survey covered >50% of the hospital beds in Spain in 2006.

The number of large (including university)

Acknowledgements

We thank all the staff (management, preventive medicine services, infection control teams, infection commission, etc.) of the hospitals that helped make this study possible.

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Intravascular catheters (IC) are widely used for diagnostic and therapeutic purposes. Based on EPINE data, almost 70% of patients admitted in Spanish hospitals have at least one catheter inserted.1 Local and systemic infections are one of the main complications associated with the use of IC, which are related to high morbidity and mortality rates.
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In general, those studies looked mainly at infection control personnel, prevention activities, and surveillance.10,12,14-17 The use of a mailed or electronic questionnaire was more frequent than in locus visiting.10-12,15-18 A Korean study also included the evaluation of resources for hand hygiene,11,14 but they only evaluated hospitals with >300 beds.
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Nosocomial infection surveillance and control: current situation in Spanish hospitals

Summary

Introduction

Section snippets

Study population

Study design

Questionnaire

Results

Discussion

Acknowledgements

Am J Infect Control

J Hosp Infect

J Hosp Infect

Med Clin (Barc)

J Hosp Infect

Enferm Infecc Microbiol Clin

Clin Microbiol Infect

Am J Infect Control

Med Intensiva

Am J Infect Control

Infection control – a problem for patient safety

N Engl J Med

The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II

N Engl J Med