Web-RAISIN: a Framework for Web-based Surveillance of Healthcare-Associated Infections in France

Background: Up until 2008 the national nosocomial infection alert, investigation, and surveillance network (Raisin), a partnership between the regional infection control (IC) coordinating centers (CClin) and the French national public health surveillance institute (InVS), conducted the surveillance of healthcare-associated infections using specific applications. These applications were developed through various software (e.g., Epi Info, Access) and made available to each healthcare facility (HCF). Such systems were difficult to maintain, were not user-friendly, and did not allow a timely feedback of data.

Objective: In order to facilitate participation of HCFs and to increase timeliness in the feedback of surveillance results, the Raisin decided to provide HCFs with a web-based surveillance application that would be more user-friendly, easier to maintain and to administrate, and would allow better feedback through standardized reports. Surgical site infection surveillance was defined as the main priority for developing this web-based application.

Methods: A pilot application has been tested for the last 2 years by HCFs from the West CClin area. The system was developed by the West CCLIN in 2007 using free software under GPL (php, MySQL), widely used standard and programming language for database administrated through the Internet. Specifications of the system were defined by IC professionals, information system experts and public health specialists, working in HCFs of western France with the following requirements : the system should be simple to implement and maintain ; easy to use with an interface designed for IC professionals ; able to run in any environment ; easily upgradeable.

Results: The developed system allows on-line entry of HCFs surveillance data ; data quality analysis before validation ; data validation ; import from and export to various file formats ; the dynamic generation of standardized reports (poster and brief reports) available in real time at HCF level as well as at regional or national level ; the monitoring of the level of participation of HCFs. The system has been available (on the West CClin website http://www.cclinouest.com/, tab «Surveillances») and tested since 01/01/2008 in the West CClin area. In 2008, 107 HCFs and 252 surgical units  (119 and 307 in 2009) entered surveillance data on 30,375 (36,991 in 2009) surgical procedures ; 15 HCFs and 30 units (11 and 28 in 2009) imported their data directly from another software or extracted them from their hospital information system. Regular meetings were organized with IC professionals in order to assess their acceptability and improve the system.

Conclusions: This new web-based application has been well received by IC professionals involved in SSI surveillance in Western France and will be extended nationally in 2010. It will also provide a framework for web-based surveillance of other healthcare-associated infections in France.