BACKGROUND:In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM:To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS:In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS:The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION:Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.

BACKGROUND:Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. AIM:To determine the time-trend of SSI rates in surveillance networks. METHODS:SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. FINDINGS:Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. CONCLUSION:In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.

Purpose: Due to the aging population of Europe there is a growing need for long-term care facilities (LTCF). Elderly are at higher risk of impaired immune system due to multiple underlying, chronic diseases, malnutrition, dehydration, and/or use of immunosuppressant medication. Therefore, healthcare-associated infections (HAI) and antimicrobial use can be significant among residents in these settings. This can contribute to the growing problem of antimicrobial resistance in LTCFs, including multidrug-resistant organisms. Due to the lack of national data, our purpose was to establish baseline rates and to identify priorities for improvement. Methods & Materials: All LTCFs were invited to participate in our questionnaire-based survey between January and December 2015. The assessment covered infection prevention-related topics including: facility demographics, infection prevention practices (e.g. presence of written guidelines, hand hygiene), the most common types of infections and antimicrobial use. Descriptive statistics were used to present the data. Results: A total of 546 LTCFs (43% of all authorized facilities in the country) participated in the survey covering 40,562 beds. The median number of available beds per facility was 74 (range: 10-720). A minority of LTCFs (2%) had assigned an infection control practitioner. Overall, there was a high availability of protocols for hand hygiene, for prevention and management of MRSA infection/colonization and for the prevention of bloodborne pathogen transmission. 70% of LTCFs reported that their residents acquired infections in the preceding year. The most common were respiratory (88%), urinary (76%) and skin/soft tissue (28%) infections. 66% of LTCFs used antimicrobials. Most frequently used antibacterials were beta-lactams, penicillins (ATC J01C) (34%), quinolones (ATC J01 M) (29%), and macrolides, lincosamides and streptogramins (ATC J01F) (13%). Conclusion: Our results indicate that HAIs and antimicrobial use constitute a relevant public health problem in LTCFs in Hungary. We have an urgent need for a national recommendation for good practice in LTCFs in order to prevent HAIs and inappropriate antimicrobial therapy leading to the risk of multidrug resistant pathogen development. In addition, limitation of antibiotic use and continuing education of prescribers on antimicrobial treatment are essential.

Purpose: The second most common health-care associated infection is surgical site infection according to recent national and international prevalence studies, highlighting its public health importance. Although effective preventive measures exist the infection rates have not declined in the last years in Hungary regarding the National Nosocomial Surveillance System. In order to improve the national surveillance system by focusing on most frequent surgical categories with high infection rates we compared rates of surgeries performed in Hungary. Methods & Materials: The analysis was based on the Hungarian National Health Insurance Found dataset of procedures performed in acute care hospitals in Hungary between 2011 and 2015, results interpret the aggregated five year period. The vast majority of procedures are covered by the institution. Surgeries were grouped according to the worldwide used National Healthcare Safety Network (NHSN) operative procedure category mappings by Centers for Disease Control and Prevention (CDC) for surgical site infection surveillance. For the calculation of the numbers of operations per 100,000 inhabitants the Hungarian Central Statistics Office's yearly population data was used. Results: Beside the generally monitored categories, like Caesarean section, cholecystectomy, colon surgery and hip prosthesis (with 322.3, 240.7, 144.4 and 122.9 operations per 100000 per year), other, rarely under surveillance operations, frequency was high (herniorrhaphy, exploratory laparotomy, ovarian and breast surgery with 480.6, 282, 131.1 and 114.3 operations per 100000 per year, respectively). Operations with potentially higher infection rates as limb amputation, appendix surgery and hysterectomy (abdominal and vaginal combined) were also frequently performed (102.8, 100.8 and 99 operations per 100000 per year). As known, number of laminectomy, knee prosthesis, cardiac and bypass operations are also considerable, but patients often undergo thoracic, (para)thyroid, small bowel surgery and craniotomy too. Conclusion: Taking into account the high numbers of certain surgical procedures even with low infection rates they can affect numerous patients. Under surveillance elevated attention could force early detection of infection or even more careful application of preventive measures. Surveillance of frequent operation categories with limited number of procedure types involved has to be considered on national or even on European level, e.g. herniorrhaphy, ovarian surgery.