13 September 2012
Importance of standardisation of HAI definitions in interpretation of international and/or multinational prevalence studies
- Mater Misericordiae University Hospital, Dublin, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
Citation style for this article: Cotter M, Donlon S, Fitzpatrick F. Importance of standardisation of HAI definitions in interpretation of international and/or multinational prevalence studies
. Euro Surveill. 2012;17(37):pii=20269. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20269
Date of submission:
04 September 2012
To the editor: A recent publication by Eilers et al. reported the Dutch experience of the prevalence and determinants associated with healthcare-associated infections (HAI) in long-term care facilities . Ireland also participated in the European Centre for Disease Control coordinated healthcare-associated infections in long-term care facilities (HALT) point prevalence study in 2010. Eilers et al. reported that the prevalence of HAI in Irish long-term care facilities was 11.3%; however, this figure represents the proportion of residents that had either signs or symptoms of infection and/or were on antibiotics. The prevalence of infection in our study was 3.7% (using adapted McGeer definitions) or 2.4% (when strictly applying the McGeer definitions) [1–3].
Eilers et al. defined infection as having a ’suspicion of infection‘, i.e. having at least one symptom or sign on the HALT score list. In our study 266 (6.4%) residents had signs or symptoms of infection and it is this figure that is perhaps more comparable than the 11.3% quoted.
The HALT study has provided, for the first time, many European countries (including Ireland) with baseline data on HAI prevalence and antimicrobial use in long-term care facilities. As long-term care facilities represent a heterogeneous group of healthcare facilities, with care ranging from social to medical, inter-facility comparisons without adjustment for case mix can be difficult. In Ireland, we have used the HALT results to draft national guidelines for antimicrobial prescribing in long-term care  and to inform preventative programmes at a local level. However, surveillance definitions for HAI in this setting are not yet standardised leading to difficulties when comparing international and/or multinational studies. The proposed HALT-2 study in 2013 may be an opportunity to address this deficit.
- Eilers R, Veldman-Ariesen MJ, Haenen A, van Benthem BH. Prevalence and determinants associated with healthcare-associated infections in long-term care facilities (HALT) in the Netherlands, May to June 2010. Euro Surveill. 2012;17(34):pii=20252. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20252
- Cotter M, Donlon S, Roche F, Byrne H, Fitzpatrick F. Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study. J Hosp Infect. 2012;80(3): 212-6.
- McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, et al. Definitions of infection for surveillance in long-term care facilities Am J Infect Control. 1991;19(1):1-7
- HSE-Health Protection Surveillance Centre. Diagnosis & Management of Urinary Tract Infection in Long Term Care Residents > 65 years. Dublin:HPSC; 2011. Available from: http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,12929,en.pdf