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Point prevalence survey is useful for introducing effective surveillance of healthcare-associated infections
Marjaana Pitkäpaasi1,2, Jaana-Marija Lehtinen1, Mari Kanerva1
1Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland.
Insights
Healthcare-associated infections (HAI) surveillance was implemented in Finnish primary care hospitals using the HALT-2 protocol. The study found an 11% HAI prevalence, highlighting the need for improved antimicrobial use and streamlined data collection.
Area of Science:
- Infectious Diseases
- Public Health Surveillance
- Hospital Epidemiology
Background:
- Mandatory healthcare-associated infections (HAI) surveillance in Finland commenced March 1, 2017.
- Implementation of the European Centre for Disease Prevention and Control (ECDC) HAI surveillance protocol (HALT-2) was initiated in primary care hospitals.
- The study aimed to assess the burden of HAIs and antimicrobial prescribing patterns for targeted improvement strategies.
Purpose of the Study:
- Introduce the HALT-2 surveillance protocol in primary care settings.
- Measure the prevalence and burden of healthcare-associated infections (HAIs).
- Analyze antimicrobial use patterns to inform infection prevention and control measures.
Main Methods:
- Two point prevalence surveys (PPS) were conducted in autumn 2015 and spring 2017.
- Infection control personnel (ICP) were trained on HAI definitions and the study protocol.
- Data were collected via questionnaires, analyzed by the regional infection control unit, and feedback was provided to hospitals.
Main Results:
- A total of 2218 patients (22 hospitals) in 2015 and 2343 patients (25 hospitals) in 2017 were surveyed.
- The overall prevalence of HAI was 11% in both survey periods, with significant inter-hospital variation.
- Common HAI sites included respiratory and urinary tracts; 37% of HAIs originated from referring hospitals. One-fourth of patients received systemic antimicrobials.
Conclusions:
- The HALT-2 protocol is effective for establishing HAI surveillance and prevention in primary care hospitals, particularly those with high patient transfer rates.
- The study identified a substantial burden of HAIs and significant antimicrobial use in primary care settings.
- For efficient annual repetition, the use of shorter, electronic questionnaires is recommended to improve data collection processes.
Background:
In Finland, the surveillance of healthcare-associated infections (HAI) became obligatory by the renewed Communicable Diseases Act on the 1st March 2017.
Aim:
To introduce HAI surveillance protocol (HALT-2 by ECDC) in primary care hospitals in the largest hospital district in Finland, and to measure the burden of HAIs and antimicrobial use patterns for improvement.
Methods:
Two identical point prevalence surveys (PPS) were organized in autumn 2015 and in spring 2017. The infection control persons (ICP) in the hospitals were inducted to the HAI definitions and the study protocol to collect the data with questionnaires on the study days. The data were checked and analyzed by the areal infection control unit. The hospitals were provided feedback of the results and HAI prevention methods.
Findings:
In 2015, 2218 patients from 22 hospitals and in 2017, 2343 patients from 25 hospitals were studied. The prevalence of HAI was 11% in both surveys (ranges per hospital 4-24% and 4-31%, respectively). Of all HAIs, 37% originated from referring hospitals. Respiratory tract, urinary tract and skin were the most frequent sites of infection. One fourth of all patients received at least one systemic antimicrobial. The process showed that recognition of HAIs may be difficult for non-experienced ICPs.
Conclusions:
The HALT-2 protocol proved useful in introducing HAI surveillance and prevention in primary care hospitals with active patient transfer from other hospitals and relatively high prevalence of HAI and antimicrobial use. For annually repeated surveys, slightly shorter electronic questionnaires are essential.
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