Healthcare-associated infections in Finnish acute care hospitals: a national prevalence survey, 2005

doi:10.1016/j.jhin.2008.03.005

Journal of Hospital Infection

Volume 69, Issue 3, July 2008, Pages 288-294

https://doi.org/10.1016/j.jhin.2008.03.005 Get rights and content

Summary

The objectives of the first national prevalence survey on healthcare-associated infections (HAIs) in Finland were to assess the extent of HAI, distribution of HAI types, causative organisms, prevalence of predisposing factors and use of antimicrobial agents. The voluntary survey was performed during February–March 2005 in 30 hospitals, including tertiary and secondary care hospitals and 10 (25%) other acute care hospitals in the country. The overall prevalence of HAI was 8.5% (703/8234). Surgical site infection was the most common HAI (29%), followed by urinary tract infection (19%) and primary bloodstream infection or clinical sepsis (17%). HAI prevalence was higher in males, among intensive care and surgical patients, and increased with age and severity of underlying illness. The most common causative organisms, identified in 56% (398/703) of patients with HAIs, were Escherichia coli (13%), Staphylococcus aureus (10%) and Enterococcus faecalis (9%). HAIs caused by multi-resistant microbes were rare (N = 6). A total of 122 patients were treated in contact isolation due to the carriage of multi-resistant microbes. At the time of the survey, 19% of patients had a urinary catheter, 6% central venous line and 1% were ventilated. Antimicrobial treatment was given to 39% of patients. These results can be used for prioritising infection control measures and planning more detailed incidence surveillance of HAI. The survey was a useful tool to increase the awareness of HAI in participating hospitals and to train infection control staff in diagnosing HAIs.

Introduction

The Study of the Efficacy of Nosocomial Infection Control (SENIC) in US hospitals demonstrated that surveillance should be included in infection control activities to be effective.¹ Subsequently, prevalence surveys of healthcare-associated infections (HAIs) have been performed in several European countries to define HAI control priorities.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 In Finland, according to the Communicable Disease Law revised in 2004, all healthcare settings should have HAI prevention and control programmes. The infection control teams on healthcare district level have a consulting role in these activities. To support these regional and local infection control activities, the Finnish Hospital Infection Program (SIRO) has conducted prospective incidence surveillance on healthcare-associated bloodstream infections (BSIs) and surgical site infections (SSIs) since 1999. In the absence of nationwide prevalence surveys on HAIs in Finland, there have been no data to define the overall burden of HAIs at the national level.

The aim of this study was to assess the magnitude of HAI in Finnish acute care hospitals, distribution of HAI types, causative organisms, prevalence of predisposing factors and use of antimicrobial agents. We also aimed to improve the quality of the prevalence surveys in individual hospitals by providing a common protocol with standardised HAI definitions and training to support consistent implementation.

Section snippets

Methods

All acute care hospitals were invited to a voluntary survey by a letter to the chief executive officers and physicians responsible for communicable disease control in all 20 healthcare districts. All inpatients present on the study day on adult acute care wards were included, with the exception of those who were only on day visits. The survey was completed in each hospital between 2 February and 11 March 2005. Each ward was surveyed on a single day, preferring Tuesdays, Wednesdays and Thursdays

Results

The survey was performed in 30 acute care hospitals. All tertiary (N = 5) and secondary (N = 15) care hospitals took part in the survey, as well as 10 (25%) of the 40 other acute care hospitals (Table I). A total of 8234 patients were examined: 2759 (34%) had signs and/or symptoms of an infection or ongoing treatment for an infection on study day; 1824 (22%) had community-acquired infections; and there was a suspicion of HAI for 829 (10%).

A total of 753 HAIs were confirmed in 703 patients. The

Discussion

Our national prevalence survey, covering all specialties except paediatrics and psychiatry, provided a comprehensive picture of the HAI burden in Finnish acute care hospitals. The overall participation of hospitals was high (50%) and all tertiary and secondary care hospitals participated. On study day, 9% of patients had at least one HAI, of which nearly 30% were SSIs. The prevalence (2–20%) and types of HAIs varied widely between different specialties. A microbiological diagnosis was made in

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^☆: Abstract presented at the 10th European Programme for Intervention Epidemiology Training (EPIET) Scientific Seminar, Maó, Spain, 13–15 October 2005 and at the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA), Chicago, USA, 18–21 March 2006, as a poster; and the results of antimicrobial use in the Journal of Antimicrobial Chemotherapy 2007;60(2):440–444.

^c: See Appendix.

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Healthcare-associated infections in Finnish acute care hospitals: a national prevalence survey, 2005☆

Summary

Introduction

Section snippets

Methods

Results

Discussion

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