A computerized nationwide network for nosocomial infection surveillance in Belgium

To assess the feasibility of computerized nationwide surveillance of nosocomial infections in Belgium, and to obtain preliminary national and hospital-specific incidence data.

Prospective multicenter cohort study of surgical wound infections (SWI).

All 218 acute care hospitals in Belgium in the period October 14 to December 14, 1991.

Eighty-five of 218 acute care hospitals (39%) succeeded in collecting the required information and in completing this pilot study, although 50% of the participating hospitals had no previous experience in nosocomial infection surveillance. Seventy percent of the small-size hospitals (< 200 beds) did not participate, mainly because of shortages of manpower. A lack of collaboration from clinicians was a problem in most participating hospitals. SWI postdischarge surveillance was most successful when based on information collected by the surgeons at the surgical outpatient clinic; by this method, postdischarge information was obtained on 43.9% of all surgical procedures. A total of 201 infections were observed among 10,537 operations, with a crude incidence rate of 1.91 per 100 operations or 1.51 per 1,000 person-days of observation. Infection rates by operation type and risk indicators are congruent with those of the literature. Survival analysis showed that the overall cumulative infection risk at 21 days postprocedure attained 81.6% of the 30-days risk.

This nationwide network for nosocomial infection surveillance has introduced the practice of computerized surveillance of performance in a large number of hospitals. Still, several aspects of the surveillance demand to be improved: the collaboration of the clinicians, the quality of the data, and the postdischarge surveillance methodology.