Nosocomial infections control in France: the 2005 2008 national program

Background: The organization for control of nosocomial infection (NI) at the national level has progressively been reinforced in France since 1992. In 2004, the first national control program (2005-2008) was issued. The program included 5 major objectives: to reinforce the infection control organization and resources, to improve the adoption of preventive practices by health care professionals, to optimize the organization and data output from the NI surveillance networks and alert system, to improve communication with patients on the infectious risk, and to promote research in the field. A set of 12 quantified objectives were defined; 5 indicators related to organization, resources and results for healthcare facilities (HCF), stratified on HCF category and ranked by performance class (A-E) were also elaborated and progressively released.

Objective: To evaluate the Frenc program

Methods: Evaluation of the program is based on aggregated data from the mandatory annual report issued by each HCF, from which are derived the national indicators, and on the results of national surveillance networks over time.

Results: Between 2005 and 2008, most of the target objectives have been achieved : an infection control team has been appointed in 94% HCFs; the consumption of alcohol-based products for hand hygiene doubled in over 50% ; 90% have developed an evaluation program ; 96% have an organization for sentinel events alert; 89% have an anti-infective drug committee, 97% produced guidelines for surgical prophylaxis, and 88% follow-up their antibiotic consumption;  96% provide patients an information leaflet on NI. Almost all HCF publish the panel of the 5 national indicators.
The results of the 5 indicators, published each year since 2006, also show improvement : 89% of HCF have reached the best performance class for the global indicator of NI control (based on organization, resources and activities); 70% have advanced by at least one class in 3 years for the alcohol-based product consumption indicator; 70% have reached the highest class for the antibiotic stewardship indicator ; 95,5% of HCF performing surgery have organized targeted surveillance of surgical site infection (SSI); the latest released indicator (Jan. 2009) is the number of MRSA per 1,000 patient-days.
Other results confirm the global improvement in NI control: in the 3rd national prevalence survey (2006) including more than 2,300 HCFs and almost 400,000 patients, the prevalence of infected patients (4.97%) had decreased by 12% compared to 2001, and that of MRSA infection decreased by 40%; a 38% decrease in the overall incidence of SSI rates also occurred between 1999 and 2006.

Conclusions: These results suggest a positive impact of the French infection control program, particularly for MRSA and SSI rates. To pursue the goal of improving global control of HCAI, the subsequent (2009-2013) program provides a new set of objectives and will provide revised indicators for HCFs.