Nasjonalt Folkehelseinstitutt (Norwegian Institute of Public Health), Oslo, Norway
In 1996, the Norwegian Ministry of Health issued regulations on the prevention of nosocomial infections (NIs). The regulations were revised in 2005 . As part of the infection control programme, hospitals and long-term care facilities (LTCFs) are obliged to have a surveillance system for NIs in place and to report the results to the Norwegian Institute of Public Health (NIPH). NIPH coordinates the surveillance activities and publishes annual statistics.
NIPH received the first annual reports from two thirds of the hospitals in 1999. That year, surveillance reports from LTCFs were sent from only one of the 19 counties in Norway . Separate surveillance protocols for either hospitals or LTCFs were developed in 2002, and at present all hospitals and around one third of the LTCFs participate every year.
The hospitals and LTCFs are invited to participate in two nationwide point-prevalence surveys each year. The system is compatible with the recommendations of the “Hospitals in Europe Link for Infection Control through Surveillance” (HELICS) cooperation project of the European Union.
NIPH collects information on the occurrence of the most common nosocomial infections :
- Urinary tract infections
- Lower respiratory tract infections
- Superficial and deep surgical site infections
- Soft tissue skin infections (only in LTCFs)
- Septicaemias (only in hospitals)
The case definitions are simplified versions of the definitions recommended by the Centers for Disease Control and Prevention (CDC). Patients who underwent surgery 30 days prior to the infection (or one year in the case of implant surgery) are also reported.
A paper version of the surveillance protocol was posted to all institutions in 2002 and 2004. Since autumn 2005, NIPH sends out an invitation by e-mail before every survey, In addition the protocol is available on the NIPH homepage (http://www.fhi.no).
On the day of the prevalence survey each ward or unit registers infections according to the protocol. The infection control personnel coordinate the data collection and report to NIPH either directly into the web-based surveillance tool or by mail or e-mail. Almost all hospitals report electronically. An increasing part of the LTCFs participate, this year it was two thirds. The reports that are received are summary data and contain no patient identification. Since 2007 all institutions can see their own prevalence data presented online and compare their results with the regional and national results. In addition, two seasonal and one annual summary report are published on the NIPH web site.
The development of the prevalence of NIs at hospitals in Norway from 2002 to 2007 is shown in Figure 1. The NI prevalence has been stable in the last years, including the distribution of the different types of infection.
The development of the prevalence of NIs in LTCFs in Norway from 2002 to 2007 is shown in Figure 2. The surveys show that also in LTCFs, the prevalence over the years has been relatively stable.
The prevalence surveys cannot replace the surveillance of the incidence of NIs. They give only snap-shot impressions of the infection status of the patients hospitalised on a certain day, and the results must be interpreted with caution, especially in small units. The results must be evaluated in connection with other available information and can then be useful to indicate the extent and distribution of NIs by type of department, size of health care institution and geographic location, show the development over time and indicate problems that may require more extensive investigation.
The web-based surveillance tool simplifies and secures the data registration at the hospitals and LTCFs as well as at the NIPH. In addition, it gives the institutions faster and easier access to the results.