[Critical study of surveillance of nosocomial infections]

The institution of a continuous surveillance program is a compulsory prerequisite to the effective control of nosocomial infections. This is actually the main task of the Committee for Nosocomial Infection Control as ruled by the decree of 8 May 1988. The methodology of this surveillance relies on the continuous collection of data. It must apply to hospitals of any size and lead to practical actions, at the general or local level according to circumstances. Data concern patients and staff as well. They must be collected from different sources among which the bacteriology and hygiene laboratories play an important role. However infection records from wards constitute the cornerstones for the surveillance program: the personnel involved in the filling of the forms must be clearly identified. The scope of the surveillance and analytical methods are also discussed: a comprehensive control of the whole hospital associated with incidence measurement appears to be the best approach. Prevalence surveys are also performed. They allow a better control of continuous surveillance processes. However these processes will only be profitable if the data to be recorded have been previously specified. It is of importance to get the most comprehensive data about infectious hazards. One might rely not on global infection rates per hospital, as they have no significance, but on specific infection rates in correlation with body sites or risk factors.