National surveillance of Health care-associated infection in Taiwan: an easy way to get an overview

Background: Health care-associated infections (HAIs) are the most common complications influencing hospitalized patients. To control HAI, the importance of surveillance infection rates has been emphasized. At national level, not only unusual events in high risk areas should be identified and controlled but the status of HAI should also be overviewed to infer the allocation of health resource.

Objective: To perform an annual survey to ascertain incidence of HAI rates in Taiwan.

Methods: All medical centers and regional hospitals in Taiwan are invited to participate in this survey. This study used a paper-based surveillance form to collect aggregate data from local infection control practices. These aggregate data included hospital-wide crude infection rates and ICU infection rate (reported monthly and is stratified by types of location, sites of infection, and device-associated) in 2008.

Results: There were 100 hospitals enrolled in the survey, of which 97 had responded and filled the data completely. In this group, there were 20 medical centers and 77 regional hospitals. A total of 65 (67%) hospitals were with more than 500 bed numbers. Among 18,060,979 patient-days in 97 hospitals, 58,987 developed HAIs and the pooled infection rate was 3.3‰ (3.3 episodes per 1000 patient-days). Among 451 intensive care units, the pooled rate was 10.8‰, which was around 3 times higher than hospital wide infection rate (Figure 1). The medical ICU (14.1 cases per 1000 patient-days) and surgical ICU (11.8 cases per 1000 patient-days) posed the greatest risk in medical centers and regional hospitals, respectively. Regarding the distribution of infection sites, urinary tract infection (UTI) accounted for 39% of all HAIs, followed by blood stream infection (29%) and then pneumonia (18%). As the urinary catheter utilization ratio (68%) was also highest among all three devices under surveillance, catheter-associated urinary tract infection posed the greatest risk among device-associated infection (6.0 and 4.5 cases per 1000 urinary catheter-days in medical centers and regional hospitals, respectively) and accounted for about 77% of all UTIs.

Figure 1: HAI rates in medical centers and regional hospitals

 

Conclusions: In addition to the annually paper-based surveillance, a voluntary participating, web-based surveillance system collecting the detailed information including laboratory data of infected cases is ongoing in our country. With the continuous collection of national surveillance data on HAI incidence could infer its impact on health of our citizens and select important issue on national level, providing information about where and which type of infections that should be targeted with further infection control intervention, as well as serving to evaluate the outcome of our forthcoming national hand hygiene campaign.