Prevalence of Healthcare-Associated Infections, France, 2006

Background: Point prevalence surveys (PPS) are efficient tools to assess the burden of healthcare-associated infections (HAI), especially in healthcare facilities (HCF) where ongoing surveillance is impossible. Two national PPS were conducted in France in 1996 and 2001, including 830 and 1,533 HCF, respectively. A third survey was conducted in June 2006.

Objective: To assess the burden of HAI among hospitalized patients, to describe their characteristics and, by comparison to the 2001 PPS results, to assess the impact of the national infection control program.

Methods: The survey was proposed to all public and private HCF and used definitions adapted from CDC. For all patients hospitalized in participating HCF, data were collected on a given day in June by trained investigators using a standardized questionnaire and dedicated software. Data were sent by encrypted e-mail to regional infection control coordinating centers (CClin) and aggregated at national level by the French Institute for Public Health Surveillance (InVS). The prevalence of patients with a HAI (PPHAI) was compared between 2001 and 2006 using a multiple Poisson regression model, adjusting for characteristics of HCF, wards and patients.

Results: 2,337 HCF (accounting for 95% of all French hospital beds) participated in the survey and included 358,353 patients; 17,817 (4.97%) were infected and 19,294 HAI were documented; 1 406 (0.39%) patients were infected by methicillin-resistant Staphylococcus aureus (MRSA). Urinary tract, lower respiratory tract and surgical site infections accounted for 30, 15 and 14% of HAI, respectively. Among 15,800 isolated micro-organisms, the 3 most frequent were Escherichia coli (25%, of which 10% were cefotaxime- or ceftriaxone-resistant), S. aureus (19%, of which 52% were methicillin-resistant) and Pseudomonas aeruginosa (10%, of which 25% were ceftazidime-resistant). The PPHAI varied with type of HCF (from 1.84% in psychiatric hospitals to 9.34% in cancer centers) or wards (from 0.89% in obstetrics to 22.40% in intensive care units) and was greater among the elderly, males, patients with severe underlying disease, immunocompromised, undergoing surgery or exposed to invasive devices such as vascular catheter, urinary catheter or intubation/tracheotomy (Graph). Compared to 2001, the prevalence in 2006 was significantly lower for HAI (adjusted prevalence ratio [PRa] = 0.89, 95%CI: 0.87-0.91) and for MRSA infection (PRa = 0.56, 95%CI: 0.51-0.62).

 

Conclusions: This survey is the largest HAI PPS conducted to date worldwide. The observed decrease in the PPHAI, particularly for MRSA, suggests a positive impact of the French national infection control program. The survey also increased the awareness and knowledge of healthcare professionals and was an important tool for defining the new 2009-2013 national infection control program.