Review of methods of national prevalence surveys of healthcare-associated infections in 17European countries

Abstract number: P624

Suetens C., Ammon A., Weist K., Sodano L., Monnet D.L.

Objectives: In order to prepare a common protocol for a EU-wide point prevalence survey (PPS) of healthcare-associated infections (NI) in 2010–2011, a methodological analysis of current national protocols in 17 European countries was carried out.

Methods: Methodological data were extracted from papers, full reports or protocols published in international or national scientific journals, on the internet or from copies obtained from national PPS coordinating centres when not available elsewhere. Keywords used for MEDLINE and Google searches were: prevalence combined with nosocomial, hospital, hospital-acquired and healthcare-associated infections.

Results: The percentage prevalence of HCAI varied from 3.5% to 9.9%. The main differences are summarised in table 1. The first difference concerns the use of different case definitions. Secondly, all criteria of the case definition had to be present on the day of the survey in some studies while in others criteria were looked at for the entire infection episode. The strict application of the criteria was either controlled, e.g. during analysis, or left to the investigators' judgment. Third, included infection types were sometimes limited to the major types only (urinary tract, bloodstream, lower respiratory tract, surgical site infections). Fourth, specific infection types included different subtypes (e.g. exclusion of asymptomatic bacteriuria). Fifth, infections acquired in other hospitals were sometimes included. Finally, large differences existed regarding the workload (patient-based data for all patients, for infected patients only, or aggregated infection and denominator data), type of risk factors, exclusion or not of specific types of departments (e.g. paediatrics), types of hospitals (e.g. long-term care), types of patients (e.g. minimum length of stay), type of investigators (internal vs external) and their training, case finding methods, the use of data sources such as a pharmacy or microbiology database and the type of microbiological data collected during the PPS.

Conclusions: The European Centre for Disease Prevention and Control (ECDC) plans an EU-wide PPS of NI in order to obtain nationwide data on all types of NI from all EU Member States. The current review however shows that most MS may have to adapt their current national protocol in order to comply with an EU-agreed method including at least common case definitions, comparable case ascertainment and a minimal common dataset for stratified comparisons.

Methodological difference%Countriesa
Case definitions  
  Diagnostic related groups11.8%LV, SE
  CDC, modified11.8%FR, NL
  CDC, unmodified76.5%Other
Imported HCAI includedb47.1%DK, ES, FI, FR, IE, NL, SE, UK
Included infections  
  All infections52.9%BE, GR, IT, LT, LV, NL, PT, SE, SI
  Only main infection types11.8%NO, DK
  Exclusion of secondary bloodstream infections23.5%UK, IE, FI, DE
  Exclusion of asymptomatic bacteriuria11.8%ES, FR
Data collection type/workload  
  Aggregated numerator and denominator11.8%NO, DK
  Patient-based numerator and aggregated denominator11.8%SE, LV
  Patient-based numerator and denominator76.5%Other
Exclusion of specific patients or specialties17.6%FR, NL, FI
aBE: Belgium, DE: Germany, DK: Denmark, ES: Spain, FI: Finland, FR: France, GR: Greece, IE: Ireland, IT: Italy, LT: Lithuania, LV: Latvia, NL: Netherlands, NO: Norway, PT: Portugal, SE: Sweden. SI: Slovenia, UK: United Kingdom; references: see review in ECDC Annual Epidemiological Report on Communicable Diseases 2008 available from http//, except Belgian PPS available from
bNot always included in main HCAI prevalence result; UK, IL: only if re-admission from same hospital.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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