National healthcare-associated infections surveillance programs: A scoping review

National surveillance of healthcare-associated infections (HAIs) is necessary to identify areas of concern, monitor trends, and provide benchmark rates enabling comparison between hospitals. Benchmark rates require representative and large sample sizes often based on pooling of surveillance data. We performed a scoping review to understand the organization of national HAI surveillance programs globally.

The search strategy included a literature review, Google search and personal communications with HAI surveillance program managers. Thirty-five countries were targeted from four regions (North America, Europe, United Kingdom and Oceania). The following information was retrieved: name of surveillance program, survey types (prevalence or incidence), frequency of reports, mode of participation (mandatory or voluntary), and infections under surveillance.

Two hundred and twenty articles of 6,688 identified were selected. The four countries with most publications were the US (48.2%), Germany (14.1%), Spain (6.8%) and Italy (5.9%). These articles identified HAI surveillance programs in 28 of 35 countries (80.0%), operating on a voluntary basis and monitoring HAI incidence rates. Most HAIs monitored surgical site infections in hip (n=20, 71.4%) and knee (n=19, 67.9%) and Clostridoides difficile infections (n=17, 60.7%).

Most countries analyzed have HAI surveillance programs, with characteristics varying by country. Patient-level data reporting with numerators and denominators is available for almost every surveillance program, allowing for reporting of incidence rates and more refined benchmarks, specific to a given healthcare category thus offering data that can be used to measure, monitor, and improve the incidence of HAIs.